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Were environmental changes during the outbreak of COVID-19 associated with increased development of myopia in young schoolchildren in China?
In this observational study longitudinally monitoring 2114 students from grade 2 to grade 3, myopia incidence doubled from November and December 2019 to November and December 2020 compared with the same period from 2018 to 2019. The proportion of children without myopia and with spherical equivalent refraction greater than −0.50 D and less than or equal to +0.50 D in grade 3 had increased by 18% by November and December 2020 compared with the same period in 2019.
These data suggest that development of myopia in young Chinese schoolchildren may have increased during the COVID-19 outbreak; the long-term impact of environmental changes during the COVID-19 outbreak period on the development of myopia in children needs further investigation.
During the outbreak of COVID-19, outdoor activities were limited and digital learning increased. Concerns have arisen regarding the impact of these environmental changes on the development of myopia.
To investigate changes in the development of myopia in young Chinese schoolchildren during the outbreak of COVID-19.
Design, Setting, and Participants
In this observational study, 2 groups of students from 12 primary schools in Guangzhou, China, were prospectively enrolled and monitored from grade 2 to grade 3. Comparisons between the exposure and nonexposure groups were made to evaluate any association between environmental changes during the COVID-19 outbreak period and development of myopia. The exposure group received complete eye examinations in November and December 2019 and November and December 2020. The nonexposure group received examinations in November and December 2018 and November and December 2019.
Main Outcomes and Measures
Changes in cycloplegic spherical equivalent refraction (SER), axial length (AL) elongation, and myopia incidence from grade 2 to grade 3.
Among the 2679 eligible students in grade 2 (mean [SD] age, 7.76 [0.32] years; 1422 [53.1%] male), 2114 (1060 in the nonexposure group and 1054 in the exposure group) were reexamined in grade 3. Compared with the period from November and December 2018 to November and December 2019, the shift of SER, AL elongation, and myopia incidence from grade 2 to grade 3 from November and December 2019 to November and December 2020 was 0.36 D greater (95% CI, 0.32-0.41; P < .001), 0.08 mm faster (95% CI, 0.06-0.10; P < .001), and 7.9% higher (95% CI, 5.1%-10.6%; P < .001), respectively. In grade 3 students, the prevalence of myopia increased from 13.3% (141 of 1060 students) in November and December 2019 to 20.8% (219 of 1054 students) in November and December 2020 (difference [95% CI], 7.5% [4.3-10.7]; P < .001); the proportion of children without myopia and with SER greater than −0.50 D and less than or equal to +0.50 D increased from 31.1% (286 of 919 students) to 49.0% (409 of 835 students) (difference [95% CI], 17.9% [13.3-22.4]; P < .001).
Conclusions and Relevance
In this study, development of myopia increased during the COVID-19 outbreak period in young schoolchildren in China. Consequently, myopia prevalence and the proportion of children without myopia who were at risk of developing myopia increased. Future studies are needed to investigate long-term changes in myopia development after the COVID-19 pandemic.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: July 17, 2021.
Published Online: September 16, 2021. doi:10.1001/jamaophthalmol.2021.3563
Correction: This article was corrected on October 21, 2021, to fix the axis labels in Figure 2B.
Corresponding Author: Xiao Yang, MD, PhD, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 S Xianlie Rd, Guangzhou 510060, China (firstname.lastname@example.org); Ciyong Lu, MD, PhD, Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (email@example.com).
Author Contributions: Drs Yang and Lu had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Hu and Zhao share co–first authorship.
Concept and design: Hu, Zhang, Y. Guo, Lu, Yang, He.
Acquisition, analysis, or interpretation of data: Hu, Zhao, Ding, Zhang, Z. Li, Feng, Tang, Q. Li, L. Guo, Lu, Yang, He.
Drafting of the manuscript: Hu, Z. Li, Tang, Lu.
Critical revision of the manuscript for important intellectual content: Zhao, Ding, Zhang, Y. Guo, Feng, Q. Li, L. Guo, Lu, Yang, He.
Statistical analysis: Hu, Ding, Zhang, Z. Li, Tang, Lu.
Obtained funding: Hu, Zhang, Lu, Yang.
Administrative, technical, or material support: Zhao, Z. Li, Y. Guo, Feng, Lu.
Supervision: Y. Guo, Lu, Yang, He.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work was supported by the Science and Technology Program of Guangzhou (grant 201803010062), the National Natural Science Foundation of China (grants 82070994 and 81900899), and the Natural Science Foundation of Guangdong (grant 2017A030313755).
Role of the Funder/Sponsor: The funders 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.
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