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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Impact of Electronic Gadgets Overuse on Myopia Progression among Young People: A Prospective Study
Correspondence Address :
Dr. Pooja Singh,
c/o Mr. Suresh Kumar Singh, House No. ICDS 97, Infront of Tata Tower, Behind Padmadhar Colony, Dehka, Rewa, Madhya Pradesh, India.
E-mail: drsinghpooja88@rediffmail.com
Introduction: Myopia has a multifactorial aetiology, involving interplay between environmental, genetic and behavioural factors. In today’s times of digitalisation, young people are now more exposed to digital devices, which is another possible risk factor for myopia.
Aim: To determine the effect of mobile and laptop overuse on progression of myopia in young people at three time points of six months interval.
Materials and Methods: This prospective observational study was conducted in the Department of Ophthalmology, Shyam Shah Medical College and associated Gandhi Memorial Hospital, Rewa, Madhya Pradesh, India, from of January 2019 to September 2020. A total of 400 eyes of 200 myopic patients were included. All the eyes were categorised into three groups based upon degree of myopia at the time of presentation. Cycloplegic autorefraction followed by subjective refinement of refraction was done and Spherical Equivalent (SE) was calculated in time 1, time 2 and time 3. Progression of myopia was calculated as increase in myopic refraction of subject’s eye between time 1 and time 3. Questionnaire survey about amount of time spent on mobile and laptop and their working distance was done. Then task-specific-dioptre-hours per day were calculated. Multivariate analysis was done to estimate the adjusted odds ratio for mobile and laptop use associated with myopia progression.
Results: The present study was conducted on 200 patients having varying degree of myopia. Mean age of patients with low, moderate and high myopia was 18.62±3.18, 17.65±3.59 and 17.49±3.91 years, respectively. The male to female ratio was 1.04:1. This study documents task specific mobile and laptop dioptre hours per day was significantly higher in eyes with progression as compared to no progression in low, moderate as well as in high myopes (p-value <0.05).
Conclusion: In the present study, risk of progression of myopia was significantly higher in patients engaged for longer duration on mobile and laptop and at near distance. Thus, this study concludes that overuse of electronic gadgets has a significant adverse impact on myopia progression in young people.
Cycloplegic autorefraction, Spherical equivalent, Task specific dioptre hour
In children and young adults myopia is a common ocular disorder seen and a cause of concern worldwide (1). Myopia is the condition in which parallel light rays from infinity refracted from cornea and lens converge at a focus in front of the retina. The image that projects itself into the retina thus corresponds to the sum of the blur circles, causing poor image quality (2). Myopia is becoming a major epidemiological problem and its prevalence is growing worldwide. By the year 2050, 49.8% of the world’s population is expected to be suffering from myopia and 9.8% from high myopia (3).
The onset of myopia has shifted to younger age, which is a concern, as younger age children exhibit more rapid progression of myopia and are more likely to reach higher degree of myopia (4),(5). High myopia can lead to increased risk of developing vision-threatening conditions including glaucoma, cataract, myopic maculopathy and retinal detachment in future life (6).
Myopia has multifactorial aetiology, involving interplay between environmental, genetic and behavioural factors, with increased time spent in education decreased time outdoors, urbanisation, and long periods of close work like reading, writing and mobile phone use all cited as possible influences (7),(8),(9),(10).
Young people are now exposed to digital devices which are another possible environmental risk factor for myopia (11). Smart phones, laptops and computers are used at a very early age in both school and home (12). Young people are the fastest growing population of mobile phone users (13). Smartphones are now the most widely used device for internet access on a daily basis by the children between age group of 9-16 years in Ireland (14). Computer usage have identified as a risk factor for myopia by several studies (15),(16),(17). In one study, myopia was found to be associated with a closer computer screen working distance (16). Smartphone users typically adopted even more closer working distance than for computer screens (18). Therefore, it is conceivable, that increased and continuous exposure to electronic gadgets might represent a reasonable risk factor for the development or progression of myopia, in young people.
Similar previous studies determined the effect of electronic gadgets over myopia development and compared electronic gadgets uses in myopic and non myopic patients [19-23]. Hence, the present study was conducted to determine the effect of mobile and laptop overuse on progression of myopia in young people at three time points of six months interval.
This prospective observational study was conducted in the Department of Ophthalmology, Shyam Shah Medical College and associated Gandhi Memorial Hospital, Rewa, Madhya Pradesh, India, from January 2019 to September 2020, study was approved by the Institutional Ethical Committee (IEC number 9454/SS/PG/MC/2019). Informed consent was taken from all participants.
Inclusion criteria: All patients having any degree of myopia between the age group of 10-24 years (young people) were included in the study.
Exclusion criteria: Patients having any corneal dystrophy or degeneration, astigmatism more than 2 dioptres, keratoconus, any fundus abnormality other than myopic changes, any media opacity or history of any ocular surgery in the past were excluded from the study.
Sample size calculation: The sample size was calculated by taking prevalence of myopia in India as 13% (24).
N=4pq/d2
Where, N=Sample size
p=13% (Prevalence)
q=100-p=100-13=87%
d=5% (Allowable error)
N=4×13×87/52=181 Round off=200 patients
Study Procedure
A total of 400 eyes of 200 patients (10-24 years age group) diagnosed with myopia of any degree attending the outdoor patient department of Ophthalmology Department of SS Medical College and associated Gandhi Memorial Hospital Rewa (MP) fulfilling the inclusion criteria were enrolled in the study.
The purpose of study was explained to the subjects and their parents in cases of minors and confidentiality was assured. Data collected from all subjects included demographic characteristics like age, gender, residence, occupation and a detailed clinical history including the chief visual complaint, history of present illness, past history of ocular surgeries, any ocular trauma and wearing spectacles for vision correction and its changes.
Questionnaire
A proforma was given to all study subjects about electronic gadgets available at home, the amount of time spent on mobile phone and on the computer and subjects were also asked about their preferred working distance in centimetres for each task.
After that task-specific dioptre-hour per day was calculated by multiplying task specific duration in hours to inverse of working distance in metres (19).
All the study subjects underwent a comprehensive ophthalmic examination which included best corrected visual acuity assessment, anterior segment and posterior segment examination for the diagnosis of myopia.
Cycloplegic refraction with cyclopentolate 1% in both eyes was evaluated at the interval of five minutes for all patients at the time of enrollment, followed by autorefration with Shin Nippon Autorefractometer after 30 minutes. SE was calculated by adding the sum of the sphere power with half of the cylinder power (20). All the eyes were categorised depending upon the degree of myopia as (25):
1. Group A: myopia <-3.00 dioptres (low myopia)
2. Group B: myopia between -3.00 and -6.00 dioptres (moderate myopia)
3. Group C: myopia >-6.00 dioptres (high myopia)
Patients were examined for Spherical Equivalent (SE) of each eye separately at the time of enrolment (time 1) and thereafter at 6 month and 12 month (time 2 and time 3 respectively). Progression of myopia was calculated as increase in myopic refraction of subject’s eye between time 1 and time 3.
Statistical Analysis
The collected data was compiled using Microsoft (MS) excel and analysed using IBM Statistical Package for the Social Sciences (SPSS) software version 20.0. Categorical data like sex, residence, distance and duration of various electronic gadget use was expressed as frequency and percentage whereas, numerical data like age and task specific dioptre hours per day was expressed as mean and standard deviation. Multivariate analysis was done to estimate the adjusted Odds Ratio (OR) for electronic gadgets use associated with myopia progression and t-test was used for association. The p-value less than 0.05 were considered statistically significant.
The present study was conducted on 200 patients having varying degree of myopia. The age of the study subjects varied from a minimum of 10 years to a maximum of 24 years, with mean age of patients with low, moderate and high myopia was 18.62±3.18, 17.65±3.59 and 17.49±3.91 years, respectively. There were 102 males and females were 98 and, the male to female ratio was 1.04:1. Depending on the severity of myopia, 203 (50.75%) eyes were categorised as low myopia, 148 (37%) as moderate and 49 (12.25%) as high myopia.
The study showed that longer use of mobile was significantly associated with higher odds of progression of myopia, only in eyes with moderate myopia (p-value <0.05). For the entire study cohort as well as for those with low and high myopia, no such increase in risk was observed (Table/Fig 1). Analysing myopia progression with respect to distance, authors observed a significantly higher odds of progression in patients using mobiles at distances of 10 cm and 15 cm (p-value <0.05) in all three grades of myopia (Table/Fig 2).
The mean task specific mobile dioptre hours per day in eyes with progression, was 20±10 whereas for eyes with no progression, it was 10±10. The observed difference was statistically highly significant (p-value <0.01). For all the three groups of myopia also, the task specific mobile dioptre hours per day was significantly higher in eyes with progression as compared to no progression (p-value <0.05) (Table/Fig 3).
As regards laptop use, authors found that the odds of myopia progression were 1.23 times higher in patients engaged in longer duration of laptop use especially more than six hours (p-value <0.05). The odds of progression were 1.82 times higher in patients with high myopia engaged in longer duration of laptop use (p-value <0.05), but similar observations were not noted in patients with low or moderate myopia (Table/Fig 4).
On calculating odds of myopia progression for distance of laptop use, they were significantly higher among patients using laptop at 60 cm distance with low and high myopia patients as well as for the entire study population (p-value <0.05). However, in eyes with moderate myopia, use of laptop was significantly associated with higher risk of progression (OR- 2.08; p-value <0.01) only at a distance of 70 cm (Table/Fig 5).
On analysing mean task specific laptop dioptre hours per day in eyes with progression was 2±0 whereas that in eyes with no progression it was 1±0. The observed difference was statistically highly significant (p-value <0.01). Task specific laptop dioptre hours per day was significantly higher in eyes with progression as compared to no progression in low, moderate as well as in high myopes (p-value <0.05) (Table/Fig 6).
The present study aimed to determine the effect of mobile and laptop overuse on progression of myopia in young people. In the present study, mean age of patients with and without myopia progression was 17.9±3.6 and 18.5±3.3 years, respectively. The use of smart phones as well as laptop especially by children and teenagers has increased which has been attributed high risk of myopia development and progression (11). However, in the present study, longer duration of use of mobile was significantly associated with higher odds of progression in eyes with moderate myopia (p-value <0.05). However, no such increase in risk was observed in eyes with low myopia, high myopia as well as all the eyes (p-value >0.05). Similarly, odds of progression was significantly higher in patients with myopia using mobile especially at a distance of 10 cm and 15 cm (p-value <0.01). Overall, mean task specific mobile dioptre hours per day were observed to be significantly higher in eyes with progression (20±10) as compared to eyes with no progression (10±10) (p-value <0.01).
These findings were concordant with the findings of Saxena R et al., in which myopia was significantly associated with playing computer/video/mobile games (p-value <0.001) (21). Similarly, Rusnak S et al., also observed significantly higher (p-value <0.0001) axial length growth in children not engaged in outdoor activity or engaged in near work including use of mobile and laptop (p-value <0.01) (22). McCrann S et al., also observed that significantly longer duration and near distance of mobile phone use in myopic students as compared to non myopes (1,130.71±1,748.14 MB vs 613.63±902.15 MB; p-value=0.001) (23).
In present study, laptop/computer use was observed in small proportions of patients. The present study documented significantly higher odds of progression in patients engaged in longer duration of laptop use especially more than six hours (p-value <0.05).
Though, the progression risk was significantly associated with long duration of laptop use in high myopes (p-value <0.05). With respect to distance of laptop use, odds of progression was significantly higher among patients using laptop at 60 cm distance with myopia (p-value <0.01). Mean task specific laptop dioptre hours per day in eyes with progression was significantly higher (0.2±0) as compared to eyes with no progression (0.1±0) (p-value <0.01). Sheppard AL and Wolffsohn JS concluded that excessive use and access to computer devices and smart phones have been associated with computer vision syndrome which is associated with visual fatigue and digital eye strain (26). These factors might help in progression of myopia. However, Torri H et al., documented that violet light exposure might have beneficial effect on progression of myopia, but such association has not been established (28). Comparison of the findings of present study with similar previous studies is shown in (Table/Fig 7) (21),(22),(23),(26),(27).
Limitation(s)
Electronic gadget use with myopia progression may show significant association, if the follow-up duration of the study was longer than one year. As recruitment of subjects was Outpatient Department based and sample size was smaller, generalisation of results may not represent the population as a whole.
In the present study, myopia progression risk was significantly higher in eyes with longer task specific mobile and laptop dioptre hours per day i.e., risk of progression of myopia was significantly higher in patients engaged for longer duration on mobile and laptop and at near distance. Myopia onset in younger age leads to high myopia in adult life and high myopia is associated with increased risk of severe and irreversible loss of vision. Thus, this study concludes that overuse of electronic gadgets has a significant adverse impact on myopia progression in young people. The current findings suggest that by educating and instructing healthcare providers, children and their parents on reducing screen time and taking frequent breaks while using electronic gadgets will help to prevent further myopia progression.
DOI: 10.7860/JCDR/2023/59952.17511
Date of Submission: Aug 30, 2022
Date of Peer Review: Sep 21, 2022
Date of Acceptance: Jan 23, 2023
Date of Publishing: Feb 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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