Progression of Myopia in School-Aged Children After COVID-19 Home Confinement

• Type of Material: Article
• Authors: Jiaxing Wang, Emory University; Ying Li, Emory University; David C Musch, University of Michigan; Nan Wei, Tianjin Medical University; Xiaoli Qi, Tianjin Medical University; Gang Ding, Tianjin Medical University; Xue Li, Tianjin Medical University; Jing Li, Tianjin Medical University; Linlin Song, Tianjin Medical University; Ying Zhang, Emory University; Yuxian Ning, Tianjin Medical University; Xiaoyu Zeng, Tianjin Medical University; Ning Hua, Tianjin Medical University; Shuo Li, Tianjin Medical University; Xuehan Qian, Tianjin Medical University
• Language: English
• Date: 2021-01-14
• Publisher: AMER MEDICAL ASSOC
• Publication Version: Final Published Version
• Copyright Statement: 2021 Wang J et al. JAMA Ophthalmology.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamaophthalmol.2020.6239
• Title of Journal or Parent Work: JAMA OPHTHALMOLOGY
• Volume: 139
• Issue: 3
• Start Page: 293
• End Page: 300
• Grant/Funding Information: This work was supported by grant 17ZXHLSY00020 from the Tianjin Municipal Science and Technology Commission and grant YDYYRCXM-B2018-02LC from Tianjin Medical University Eye Hospital High-Level Innovative Talent Program for Distinguished Scholar (Dr Qian).
• Keywords: ELONGATION; AMBLYOPIA; RISK-FACTORS; ASSOCIATION; Science & Technology; DOMINANCE; ANISOMETROPIA; PREVALENCE; Ophthalmology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Importance: 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 123535 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 123535 children included in the study, 64335 (52.1%) were boys. A total of 194904 test results (389808 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.