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Myopia in Schoolchildren After COVID-19 Home Confinement
TAKE-HOME MESSAGE
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Compared with previous years, the authors found an increase in myopic shift among Chinese children aged 6 to 8 years during a time frame that included the stay-at-home period due to the COVID-19 pandemic. The increase in myopia was greater in younger children — approximately 3 times greater than in previous years for 6-year-olds, 2 times greater for 7-year-olds, and 1.4 times greater for 8-year-olds. Continued follow-up will assess if these changes are permanent.
- Myopia in Chinese schoolchildren progressed during the COVID-19 stay-at-home period. Parents are encouraged to limit screen time and encourage outdoor activity.
abstract
This abstract is available on the publisher's site.
Access this abstract nowImportance
Time spent in outdoor activities has decreased owing to home confinement for the coronavirus disease 2019 (COVID-19) pandemic. Concerns have been raised about whether home confinement may have worsened the burden of myopia owing to substantially decreased time spent outdoors and increased screen time at home.
Objective
To investigate the refractive changes and prevalence of myopia in school-aged children during the COVID-19 home confinement.
Design, Setting, and Participants
A prospective cross-sectional study using school-based photoscreenings in 123 535 children aged 6 to 13 years from 10 elementary schools in Feicheng, China, was conducted. The study was performed during 6 consecutive years (2015-2020). Data were analyzed in July 2020.
Exposures
Noncycloplegic photorefraction was examined using a photoscreener device.
Main Outcomes and Measures
The spherical equivalent refraction was recorded for each child and the prevalence of myopia for each age group during each year was calculated. The mean spherical equivalent refraction and prevalence of myopia were compared between 2020 (after home confinement) and the previous 5 years for each age group.
Results
Of the 123 535 children included in the study, 64 335 (52.1%) were boys. A total of 194 904 test results (389 808 eyes) were included in the analysis. A substantial myopic shift (approximately -0.3 diopters [D]) was found in the 2020 school-based photoscreenings compared with previous years (2015-2019) for younger children aged 6 (-0.32 D), 7 (-0.28 D), and 8 (-0.29 D) years. The prevalence of myopia in the 2020 photoscreenings was higher than the highest prevalence of myopia within 2015-2019 for children aged 6 (21.5% vs 5.7%), 7 (26.2% vs 16.2%), and 8 (37.2% vs 27.7%) years. The differences in spherical equivalent refraction and the prevalence of myopia between 2020 and previous years were minimal in children aged 9 to 13 years.
Conclusions and Relevance
Home confinement during the COVID-19 pandemic appeared to be associated with a significant myopic shift for children aged 6 to 8 years according to 2020 school-based photoscreenings. However, numerous limitations warrant caution in the interpretation of these associations, including use of noncycloplegic refractions and lack of orthokeratology history or ocular biometry data. Younger children's refractive status may be more sensitive to environmental changes than older ages, given the younger children are in a critical period for the development of myopia.
Additional Info
Disclosure statements are available on the authors' profiles:
Progression of Myopia in School-Aged Children After COVID-19 Home Confinement
JAMA Ophthalmol 2021 Jan 14;[EPub Ahead of Print], J Wang, Y Li, DC Musch, N Wei, X Qi, G Ding, X Li, J Li, L Song, Y Zhang, Y Ning, X Zeng, N Hua, S Li, X QianFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Eye Care
This paper deals with a critical topic: the escalating myopia prevalence among school children in China and associated environmental factors. It is not a new topic. Previous papers have addressed myopia and environmental factors. However, the issue is timely. This school-based cross-sectional study presents convincing statistical data. The authors query whether pandemic control efforts, which involved confinement, homeschooling, and reliance on digital screen time, may negatively affect children's refractive status, exacerbating and accelerating myopia progression.
The authors examined the distribution of spherical equivalent refraction (SER) and myopia prevalence among a cohort of schoolchildren in China aged 6 to 13 years and compared findings with data from the previous 5 years. Whereas mean SER was relatively stable from 2015 to 2019, in 2020, the mean SER decreased significantly and myopia prevalence increased (21.5% at 6 years, 26.2% at 7 years, and 37.2% at 8 years) compared with earlier years for 6- to 8-year-olds. The authors propose this SER decrease, which was measured immediately after home confinement ended in June 2020, reflects the outcome of home confinement. As 9- to 13-year-old participants did not experience an equivalent shift in refraction, younger children may be more sensitive to environmental change than older children. The study's strengths include the large population, standardization of examination protocols, and prevalence data recorded for 6 consecutive years. However, numerous limitations warrant caution in interpreting these associations, including noncycloplegic refractions and lack of ocular biometric data.
Furthermore, screen time, level of engagement with schoolwork, and time spent outdoors were not recorded. Children younger than 6 years were not included, limiting our understanding of when the proposed sensitive period starts. However, if these findings are confirmed and replicated elsewhere, this study has important clinical practice implications; children aged 6 to 8 years may be experiencing a critical period for myopia development. Environmental and lifestyle interventional behaviors may have the potential to be more effective during this increased plasticity period, and myopia control clinical interventions may be more manageable. Most importantly, from a public health perspective, educating the general public and involving parents in myopia prevention efforts (encouraging family outdoor activities, reducing extra homework, and frequent breaks) is vital for children younger than 8 years.