Pandemic lockdown may have worsened myopia burden in young children

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Findings from a recent study indicated that home confinement during the COVID-19 pandemic appeared to be associated with an increase in myopia prevalence in younger school-aged children.

Myopia is a common health concern throughout the world. However, the COVID-19 pandemic may have increased its incidence — not as a direct result of COVID-19 infection, but because of the increased amount of time children spent indoors for most of 2020 and beyond.

Elise Kramer

School closures and a shift to more online courses meant that millions of children spent large portions of their days working at computers instead of being outside. While staying home and learning online was instrumental in protecting children and their families from COVID-19, it may have had an unintended side effect: a negative impact on the eye health of young students.

New data published in JAMA Ophthalmology suggested that the lockdown during the pandemic may have worsened the burden of myopia in children 6 years to 13 years old in China, with a particularly substantial increase in myopia in children 6 to 8 years old.

The researchers looked at more than 120,000 children from 10 elementary schools in Feicheng. They screened children for the presence of myopia each year from 2015 to 2020, and the results were recorded in July 2020. At that point, “a substantial myopic shift” was found in the 2020 screenings compared with the screenings performed during the previous years. Children ages 6 years to 8 years had the highest prevalence of myopia, with only minimal shifts in the 9- to 13-year-olds.

Because of COVID-19, school-aged children were confined to their homes from January to May 2020, taking online courses instead of attending school in person. That meant the amount of time these children spent outdoors was decreased (to none at all in many cases), while their indoor activities and screen time increased. Spending less time outdoors is known to be a major risk factor for myopia in children.

One reason that younger children may have been affected more widely is that their eyes (and their myopia) are in an earlier stage of development. We know that myopia is easier to manage when treatment is started early, probably because the plasticity of the condition is higher in younger children. Beyond age 8 years or so, the plasticity of myopia decreases, and the condition becomes more difficult to control. This theory is supported by the fact that orthokeratology, a specific type of myopia treatment, may be more effective when started at an earlier age.

What does this information mean for parents of young children? For one thing, regular exams are crucial, especially during a child’s early school years, and especially if they spend a good deal of time indoors or looking at screens.

Young children often do not know when something is wrong with their vision, so optometrists should educate parents to not wait until children tell them that they are having trouble seeing. A professional eye exam can reveal vision problems in the early stages when children’s eyes are more malleable and more likely to respond well to treatment.

Clinicians also should encourage parents to ensure that their children get plenty of time outdoors and away from screens. In addition to the significant uptick in myopia potentially caused by pandemic-related home confinement, the prevalence of this condition has been increasing in the last few decades as technology advances, and kids spend more of their time in front of screens. Be sure parents encourage frequent breaks from screens to focus on something farther away for a while to help the eyes relax and reduce eye strain.

If a child was confined at home for a long time during the COVID-19 pandemic, a prompt eye exam is warranted. Today’s myopia management treatments are effective at slowing the progression of the disease when initiated early.

For more information:

Elise Kramer, OD, FAAO, FSLS, practices in Miami, Fla., specializing in ocular surface disease and regular and specialty contact lens fitting. She can be reached at elise@miamicontactlens.com.