AbstractAdolescents’ extensive use of digital devices raises significant concerns about their visual health. This study aimed to adapt and validate the computer vision syndrome questionnaire (CVS-Q©) for adolescents aged 12–17 years. A mixed-method sequential design was used. First, a qualitative study was involved two nominal groups to assess the instrument’s acceptability.

摘要青少年广泛使用数字设备引起了人们对其视觉健康的极大关注。这项研究旨在为12-17岁的青少年改编和验证计算机视觉综合症问卷（CVS-Q©）。采用混合方法序贯设计。首先，定性研究涉及两个名义组，以评估仪器的可接受性。

A subsequent cross-sectional quantitative study with 277 randomly selected adolescents assessed reliability and validity. Participants completed the adapted CVS-Q©, an ad hoc questionnaire, and the ocular surface disease index (OSDI) questionnaire. Repeatability was tested in 54 adolescents after 7–14 days.

随后对277名随机选择的青少年进行了横断面定量研究，评估了信度和效度。参与者完成了改编后的CVS-Q©，即席问卷和眼表疾病指数（OSDI）问卷。在7-14天后，对54名青少年进行了重复性测试。

The Rasch-Andrich rating scale model was used. Instructions and symptoms were modified to obtain the 14-item CVS-Q teen©. It showed unidimensionality, no local dependence between items, and respected monotonicity. Adequate internal consistency (person reliability = 0.69, item reliability = 0.98) and intraobserver reliability (intraclass correlation coefficient = 0.77, Cohen's Kappa = 0.49) were observed.

。修改了说明和症状以获得14项CVS-Q teen©。它表现出一维性，项目之间没有局部依赖性，并且尊重单调性。观察到足够的内部一致性（个人可靠性=0.69，项目可靠性=0.98）和观察者内可靠性（组内相关系数=0.77，科恩Kappa=0.49）。

A significant correlation (0.782, p < 0.001) between CVS-Q teen© and OSDI supported construct validity. A score of ≥ 6 points indicated computer vision syndrome (CVS) (sensitivity = 85.2%, specificity = 76.5%, and area under the curve = 0.879). In conclusion, CVS-Q teen© is a valid and reliable instrument for assessing CVS in adolescents using digital devices, applicable in research and clinical practice for early identification and recommendations for visual health..

CVS-Q teen©与OSDI支持的结构效度之间存在显着相关性（0.782，p<0.001）。得分≥6分表示计算机视觉综合征（CVS）（敏感性85.2%，特异性76.5%，曲线下面积0.879）。总之，CVS-Q teen©是使用数字设备评估青少年CVS的有效且可靠的工具，适用于研究和临床实践，以早期识别和建议视觉健康。。

IntroductionThe new information and communication technologies (NICTs) have spread worldwide in recent years, particularly among children and adolescents. 93.1% of people aged 10–15 years use a computer, 94.9% use the Internet and 69.5% have a smartphone1.One of the health problems that results from prolonged use of digital devices is computer vision syndrome (CVS), which is defined as a group of problems related to eyes and vision2.

简介近年来，新的信息和通信技术（NICT）在世界范围内传播，特别是在儿童和青少年中。93.1%的10-15岁人群使用电脑，94.9%使用互联网，69.5%使用智能手机1。长期使用数字设备导致的健康问题之一是计算机视觉综合症（CVS），它被定义为一组与眼睛和视力有关的问题2。

These symptoms arise when demands exceed visual capabilities. Digital device use involves intense visual strain with continuous accommodation and convergence adjustments, leading to more symptoms in individuals with oculomotor anomalies or uncorrected refractive errors3. It also reduces blink frequency and amplitude which can cause ocular surface problems4.

当需求超过视觉能力时，就会出现这些症状。。它还降低了眨眼频率和振幅，这可能会导致眼表问题4。

It has been observed that using electronic devices leads to an increase in incomplete blinks5. Also, CVS increases in those who have been using digital devices for more years6 and more hours of daily use7.Most studies on CVS focus on working populations8,9,10 and some on university students11,12,13.

据观察，使用电子设备会导致不完全眨眼的增加5。。

CVS prevalence ranges from 50.0 to 70.0% in workers8,9, and can reach up to 90.0% among university students11. A literature review identified 10 studies on CVS in adolescents, all published in the last 6 years, mainly in Asia14,15,16,17,18,19,20,21,22,23. Reported prevalence ranges from 12.014 to 93.0%23.

CVS患病率在工人中为50.0%至70.0%，在大学生中可达90.0%11。文献综述确定了10项关于青少年CVS的研究，这些研究都是在过去6年中发表的，主要在亚洲14,15,16,17,18,19,20,21,22,23。报告的患病率从12.014%到93.0%不等23。

These studies used ad hoc questionnaires15,16,17,22, non-specific CVS tools19, or instruments designed and validated for adults or in other languages without prior adaptation and validation for adolescent14,18,20,21,23. Other studies have linked increased myopia and dry eye in children with time spent on computer games, mobile phones, and reduced outdoor activities24,25.

。其他研究将儿童近视和干眼症的增加与花在电脑游戏，手机上的时间以及户外活动的减少联系起来24,25。

Longer digital devic.

更长的数字设备。

1.

1.

Item and person fit to the predictions of the Rasch model. This was assessed using the mean squares (MNSQ) infit and outfit statistics; a range between 0.60 and 1.40 suggests a good fit37. Outfit MNSQ values > 2.00 should be dropped as they indicate inaccurate measurement37.

项目和人员符合Rasch模型的预测。这是使用均值平方（MNSQ）infit和装备统计数据进行评估的；介于0.60和1.40之间的范围表示拟合良好37。装备MNSQ值>2.00应该被删除，因为它们表明测量不准确37。

2.

2.

Item polarity. Assessed by inter-item correlations. These should be positive and away from 0 (or, alternatively, the observed correlation should be similar to the expected one), which will confirm that it is not necessary to eliminate any item.

项目极性。通过项目间相关性评估。这些应该是正的并且远离0（或者，观察到的相关性应该与预期的相关性相似），这将证实没有必要消除任何项目。

3.

3.

Empirical measure of item category. Monotonicity is assessed if all response categories are represented for each item and classified according to their level of severity.

项目类别的经验测量。如果每个项目都代表了所有响应类别，并根据其严重程度进行了分类，则会评估单调性。

4.

4.

Performance of the rating scale. It is assessed whether between the different thresholds of the response probability curves there is a minimum separation of 1.40 logits37. In the case of the CVS-Q© there are two severity thresholds, a threshold between categories 0 and 1 and a threshold between categories 1 and 2..

评定量表的表现。评估响应概率曲线的不同阈值之间是否存在1.40 logits37的最小间隔。在CVS-Q©的情况下，有两个严重性阈值，一个介于0和1类之间的阈值，一个介于1和2类之间的阈值。。

5.

5.

Dimensionality of the questionnaire and local dependence of the items. Dimensionality is assessed using principal component analysis of Rasch residuals. For unidimensionality to exist, the variance unexplained by the first contrast must be < 10.0% and the eigenvalue of the first contrast must be < 1.90.

问卷的维度和项目的局部依赖性。使用Rasch残差的主成分分析来评估维度。为了存在一维性，第一对比度无法解释的方差必须小于10.0%，第一对比度的特征值必须小于1.90。

The Yen-Q3 statistic was calculated to assess the local independence of the items. Any residual correlation with a value higher than 0.20 of the mean correlation could indicate local dependence38..

。任何值高于平均相关性0.20的残差相关性都可能表明局部依赖性38。。

6.

6.

Measurement error. The information function of the questionnaire (and its reciprocal, the standard error measurement, SEM) is generated. This function describes the variation of the accuracy of the questionnaire along the latent trait and allows us to know the areas of highest accuracy of the instrument..

测量误差。生成问卷的信息函数（及其倒数，标准误差测量，SEM）。该函数描述了问卷准确性沿潜在特征的变化，并使我们能够知道仪器的最高准确性区域。。

7.

7.

Internal consistency and person-item separation index. An internal consistency for persons ≥ 0.7039 is considered good and for items it should be > 0.9040. The person separation index should be > 2.00 logits for persons and > 3.00 logits for items.

内部一致性和个人-项目分离指数。对于人≥0.7039的内部一致性被认为是好的，对于项目，它应该是>0.9040。人员分离指数应为人员的2.00 logits和项目的3.00 logits。

8.

8.

Targeting. The appropriateness of the severity level of the items to the sample is assessed. A good alignment between items and persons occurs when the mean scores of the persons are close to 0 logits. A difference of more than 1 logit may indicate poor targeting41.

目标。评估项目严重程度与样本的适当性。当人员的平均得分接近0 logits时，项目和人员之间就会发生良好的对齐。大于1 logit的差异可能表明靶向性差41。

9.

9.

Analysis of differential item functioning (DIF) and its impact on questionnaire scores. This assesses whether the way in which items define a measurement scale is the same for different groups37. It was analysed according to sex, academic year, school and textbook. An item was considered to have DIF if the between-group contrast (DIF size) was > 0.64 and the t-Rasch-Welch test value was significant at the 0.05 level after Bonferroni correction37.

分析差异项目功能（DIF）及其对问卷分数的影响。这评估了不同群体的项目定义测量量表的方式是否相同37。根据性别，学年，学校和教科书进行分析。。

The proportion of estimates that differed by > 0.50 logits was calculated as an indicator of the impact of DIF on the scores..

计算差异大于0.50 logits的估计比例，作为DIF对分数影响的指标。。

In addition, to further investigate construct validity, a convergent validity study was conducted using the ocular surface disease index (OSDI) questionnaire, as it has some items similar to those of the CVS related to dry eye42. After testing for normality, we analysed the difference in the scores obtained between the two questionnaires (Student's t-test) and the difference in the prevalence of CVS (Chi-square) in adolescents with and without dry eye symptoms.Step 5: test–retest reliabilityBetween 7 and 14 days after the first measurement, a random subsample of 54 adolescents completed the adapted CVS-Q© V3 again.

此外，为了进一步研究结构效度，使用眼表疾病指数（OSDI）问卷进行了收敛效度研究，因为它有一些与干眼症相关的CVS相似的项目42。在测试正常性后，我们分析了两份问卷（学生t检验）之间获得的分数差异以及有和没有干眼症状的青少年CVS患病率（卡方）的差异。步骤5：测试-重新测试可靠性在第一次测量后7至14天内，54名青少年的随机子样本再次完成了改编的CVS-Q©V3。

The intraclass correlation coefficient (ICC) based on a mixed-effects model with a measure of absolute agreement was calculated for questionnaire scores, and Cohen's Kappa Index (k), with a corresponding 95% confidence interval (95%CI), was calculated for differences in CVS diagnosis. The acceptable level of ICC is ≥ 0.7039 and for k a ≤ 0 was considered as indicating no agreement, 0.01–0.20 as none to slight, 0.21–0.40 as fair, 0.41- 0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement43.

计算基于具有绝对一致性度量的混合效应模型的组内相关系数（ICC）用于问卷评分，并计算具有相应95%置信区间（95%CI）的科恩Kappa指数（k）用于CVS诊断的差异。ICC的可接受水平为≥0.7039，对于k a≤ 0被认为表示不同意，0.01-0.20表示无至轻微，0.21-0.40表示公平，0.41-0.60表示中等，0.61-0.80表示实质，0.81-1.00表示几乎完美的协议43。

In addition, mean scores were compared between the two administrations (Student’s t-test for paired data).Step 6: criterion validityThe same criterion used by the authors of the original questionnaire 'occurrence of at least one symptom two or three times a week' was used to define the presence of CVS29.

此外，比较了两次管理之间的平均得分（配对数据的学生t检验）。步骤6：标准有效性原始问卷作者使用的相同标准“每周至少出现两次或三次至少一种症状”用于定义CVS29的存在。

Sensitivity and specificity were calculated, allowing the receiver operating characteristic (ROC) curve to determine the diagnostic performance of the questionnaire and the cut-off point or score from which to consider the adolescent symptomatic.The statistical programmes SPSS version 28, Winsteps version 5.2.5.1 and Jamovi 2.2.5 were used t.

计算敏感性和特异性，使受试者工作特征（ROC）曲线能够确定问卷的诊断性能以及考虑青少年症状的临界点或分数。使用统计程序SPSS版本28，Winsteps版本5.2.5.1和Jamovi 2.2.5。

Data availability

数据可用性

The datasets that support the findings of the current study are available from the corresponding author MSB on reasonable request.

支持当前研究结果的数据集可根据合理要求从通讯作者MSB获得。

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Download referencesFundingThis work was supported by the call “Health Research Projects”, Health Research Fund of the Institute of Health Carlos III, Ministry of Science and Innovation and European Union, through European Regional Development Fund (ERDF) “A way to make Europe” [PI20/01629].Author informationAuthor notesTheseauthors are joint lead authors: Natalia Canto-Sancho and Mar Seguí-Crespo.Authors and AffiliationsPublic Health Research Group, University of Alicante, San Vicente del Raspeig, SpainMar Seguí-Crespo, Natalia Cantó-Sancho, Mar Sánchez-Brau & Elena Ronda-PérezDepartment of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, SpainMar Seguí-CrespoBiomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, SpainElena Ronda-PérezAuthorsMar Seguí-CrespoView author publicationsYou can also search for this author in.

下载参考文献资助这项工作得到了“健康研究项目”的呼吁，卫生研究所卡洛斯三世健康研究基金，科学与创新部和欧盟的支持，通过欧洲区域发展基金（ERDF）“创造欧洲的方式”[PI20/01629]。作者信息作者注意到作者是联合首席作者：纳塔莉亚·坎托·桑乔和马尔·塞古伊·克雷斯波。作者和附属机构阿利坎特大学公共健康研究小组，圣维森特德拉斯佩格，斯潘马尔·塞古伊-克雷斯波，纳塔利亚·坎托桑乔，马桑切斯·布劳和埃琳娜·隆达·佩雷斯阿利坎特大学光学，药理学和解剖学系，圣维森特德拉斯佩格，斯潘马尔·塞古伊-克雷斯波流行病学和公共卫生生物医学研究网络中心（CIBERESP），马德里，斯帕内莱纳·隆达·佩雷斯·奥瑟斯马尔·塞古伊-克雷斯波维尤作者出版物您也可以在是的。

PubMed Google ScholarNatalia Cantó-SanchoView author publicationsYou can also search for this author in

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PubMed谷歌ScholarMar Sánchez BrauView作者出版物您也可以在

PubMed Google ScholarElena Ronda-PérezView author publicationsYou can also search for this author in

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PubMed Google ScholarContributionsMSC and ERP were responsible for the conception and design of the study, and for acquiring funding. MSB was responsible for the data collection. NCS and MSB performed the formal analysis. All authors contributed to the interpretation of the data and the drafting and revising of the manuscript, as well as reading and approving the submitted version.Corresponding authorCorrespondence to.

PubMed Google ScholarContributionsMSC和ERP负责研究的概念和设计，并获得资金。MSB负责数据收集。NCS和MSB进行了形式分析。所有作者都为数据的解释，稿件的起草和修订以及阅读和批准提交的版本做出了贡献。。

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Reprints and permissionsAbout this articleCite this articleSeguí-Crespo, M., Cantó-Sancho, N., Sánchez-Brau, M. et al. CVS-Q teen: an adapted, reliable and validated tool to assess computer vision syndrome in adolescents.

转载和许可本文引用本文Seguí-Crespo，M.，Cantó-Sancho，N.，Sánchez-Brau，M。等人。CVS-Q teen：一种适应，可靠且经过验证的工具，用于评估青少年的计算机视觉综合征。

Sci Rep 14, 21576 (2024). https://doi.org/10.1038/s41598-024-70821-9Download citationReceived: 27 March 2024Accepted: 21 August 2024Published: 16 September 2024DOI: https://doi.org/10.1038/s41598-024-70821-9Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

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KeywordsAdolescentComputer vision syndromeQuestionnaireDigital devicesPsychometricsValidation study

关键词DolescentComputer vision syndromeQuestionnaireDigital Devices心理测量学验证研究

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