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Ophthalmology

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

Educational Objective
To investigate the refractive changes and prevalence of myopia in school-aged children during the coronavirus disease 2019 (COVID-19) home confinement.

1 Credit CME

JAMA Ophthalmology

Published Online: January 14, 2021

Original Investigation

Article Information and Disclosures

Jiaxing Wang, MD, PhD¹;

Ying Li, MD, PhD¹;

David C. Musch, PhD, MPH²;

Xiaoli Qi, MD³;

Gang Ding, MD³;

Linlin Song, MD³;

Ying Zhang, MD³;

Yuxian Ning, MD³;

Xiaoyu Zeng, MD³;

Ning Hua, MD³;

Shuo Li, MD, PhD⁴;

Xuehan Qian, MD, PhD³

Author Affiliations

¹Department of Ophthalmology, Emory University, Atlanta, Georgia
²Department of Ophthalmology and Visual Sciences, Department of Epidemiology, University of Michigan, Ann Arbor
³Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
⁴Department of Respiratory and Critical Medicine, Tianjin Medical University General Hospital, Tianjin, China

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Key Points

Question Is home confinement due to coronavirus disease 2019 associated with the burden of myopia?

Findings In this cross-sectional study that included 194 904 photoscreening tests conducted in 123 535 children, a substantial myopic shift (−0.3 diopters) was noted after home confinement due to coronavirus disease 2019 for children aged 6 to 8 years. The prevalence of myopia increased 1.4 to 3 times in 2020 compared with the previous 5 years.

Meaning Home confinement due to coronavirus disease 2019 appeared to be associated with a substantial myopic shift in children; younger (aged 6-8 years) children’s refractive status may be more sensitive to environmental changes than older children, given that they are in an important period for the development of myopia.

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 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.

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Article Information

Accepted for Publication: November 12, 2020.

Published Online: January 14, 2021. doi:10.1001/jamaophthalmol.2020.6239

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Wang J et al. JAMA Ophthalmology.

Corresponding Author: Xuehan Qian, MD, PhD, Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin 300384, China (qianxuehan@yahoo.com).

Author Contributions: Drs Wang and Qian had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Wang and Y. Li contributed equally to this work.

Concept and design: Wang, Qian.

Acquisition, analysis, or interpretation of data: Wang, Y. Li, Musch, Wei, Qi, Ding, X. Li, J. Li, Song, Ning, Zhang, Zeng, Hua, S. Li, Qian.

Drafting of the manuscript: Wang, Y. Li.

Critical revision of the manuscript for important intellectual content: Musch, Wei, Qi, Ding, X. Li, J. Li, Song, Ning, Zhang, Zeng, Hua, S. Li, Qian.

Statistical analysis: Wang, Y. Li.

Obtained funding: Qian.

Administrative, technical, or material support: Wei, Qi, Ding, X. Li, J. Li, Song, Ning, Zhang, Zeng, Hua, S. Li, Qian.

Supervision: Qian.

Conflict of Interest Disclosures: None reported.

Funding/Support: 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).

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Chris Andrews, PhD (Department of Ophthalmology and Visual Sciences, and Department of Epidemiology, University of Michigan), provided advice on statistical analysis. Lingling Wang, MD (Shandong First Medical University, Feicheng Hospital), contributed to the photoscreening work in Feicheng, China. No compensation was provided for these contributions.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.