The Role of Neck Muscle Strength and Posture in Digital Device-related Visual Disturbances: A Scoping Review

Abstract

Background: The proliferation of digital device use has coincided with increasing prevalence of both musculoskeletal complaints and visual disturbances. While computer vision syndrome (CVS) and neck pain are often studied independently, emerging evidence suggests complex interrelationships between cervical function and visual disturbances. The cervico-ocular reflex and cervical proprioceptive input may represent critical links between neck dysfunction and visual symptoms, yet this relationship remains inadequately characterized in the context of digital device use. Objective: To systematically map and synthesize available evidence examining the role of neck muscle strength and cervical posture in digital device-related visual disturbances, identify key mechanisms linking these phenomena, and highlight gaps in current knowledge to inform future research and clinical practice. Methods: A scoping review was conducted following the Arksey and O'Malley (2005) methodological framework and reported according to PRISMA guidelines. Electronic databases were systematically searched from inception to October 2025 using terms related to neck posture, muscle strength, digital devices, and visual disturbances. Studies were included if they involved human participants using digital devices and examined relationships between cervical function (posture, muscle strength, proprioception) and visual symptoms or function. Two independent reviewers conducted screening and data extraction. Given the heterogeneity of study designs and outcome measures, a narrative synthesis approach was employed. Results: Five studies met inclusion criteria, comprising four cross-sectional studies, and one prospective cross-sectional study, with a total of 425 participants across diverse geographical locations (Netherlands, Canada, Australia, Spain, Turkey). Key findings revealed: (1) individuals with neck pain demonstrated significantly increased cervico-ocular reflex (COR) gain compared to healthy controls (0.53-0.61 vs 0.37-0.45; p<0.011), suggesting compensatory upregulation in response to altered cervical proprioceptive input; (2) computer workers with persistent neck pain exhibited significantly higher rates of convergence insufficiency (61% vs 27%; p=0.007) and reduced accommodation amplitude compared to pain-free controls; (3) impaired cervical proprioception, measured by joint position error, correlated strongly with altered COR function (r=0.68, p<0.01); (4) reduced cervical flexor muscle endurance showed strong inverse correlation with neck pain severity (r=-0.71, p<0.001) in smartphone users; and (5) computer vision syndrome symptom burden correlated significantly with neck pain severity across multiple studies (r=0.52-0.64, p<0.001). These relationships persisted across different age groups and device types, suggesting generalizability of findings. Conclusions: Consistent associations exist between cervical dysfunction and visual disturbances in digital device users, with plausible neurophysiological mechanisms. However, cross-sectional designs preclude causal inference, and no interventional studies were identified. Future research requires prospective studies and randomized trials examining whether cervical interventions improve visual outcomes. Clinical awareness of cervical-visual interconnections may inform interdisciplinary assessment, though intervention recommendations await stronger evidence.