2020 as the Year of Quarantine Myopia

Abstract

Although reports on coronavirus disease 2019 affecting health already exceed 32 000 articles, studies on direct effects on the eye appear to be limited. 1 Conjunctivitis, retinitis, episcleritis, and optic neuritis have all been described as ocular manifestations, but frequency and morbidity are fortunately not striking. This has relieved us as ophthalmologists and given the impression that we have been spared a heavy patient load attributable to COVID-19 complications. We have focused on reorganizing our clinics and made sure that anti-vascular endothelial growth factor treatments and other urgent patient care were not obstructed.In this issue of JAMA Ophthalmology, Wang et al 2 are telling us another story. They suggest we should be worried about the ophthalmic outcome of COVID-19, not from the virus itself but from the potential outcome of an antivirus measure on eye health, specifically an outcome in children that may have major consequences for visual acuity later in life. China, followed by other Asian countries, was the first to experience the severe virus outbreak, the first to start closing schools and imposing home confinement, and the first (to our knowledge) to report the potential consequences of these actions on myopia. For the eye, this appears to be development of myopia at a young age; particularly, an early onset potentially increases the burden.What Wang et al 2 are reporting reflects an impressive scientific achievement. In China, a complete lockdown with home confinement took place from January to May, and schools reopened in June. During this 1 month, the examiners performed noncycloplegic photorefraction in schoolchildren aged 6 to 13 years; during the 3 months that followed, they analyzed all data and prepared for publication. The study was part of a yearly survey that started in 2015 and was in its totality truly big data (N = 123 535). A slight but potentially relevant omission is the number of children who participated each year, particularly this year. It is therefore unclear whether the number of participants in 2020 is the same as in other years, which would provide greater confidence of a fair comparison. Also, cycloplegic refractions are the gold standard in defining myopia in this age group.To assess temporal trends across age groups, the authors 2 calculated the mean spherical equivalent for each age at each year and estimated the prevalence of myopia. Overall, it is important to note the high proportion of myopia in these Asian children who are still in elementary school. At age 13 years, more than 80% already had myopia, while the prevalence at this age in European children is 25%. At all ages, mean refractive error involved greatest myopia in 2020, in girls even more so than boys. Most com-

Impact of COVID-19 Home Confinement in Children’s Refractive Errors

“…There, Wang et al have found that home confinement during the COVID-19 pandemic was associated with a substantial myopic shift for younger school-aged children (6–8 years) [ 37 ]. Klaver et al reviewed the publication of Wang and alerted about the need for intelligent lockdowns for the future, highlighting the importance of considering careful planning of indoor activities and not restricting outdoor activities in children [ 38 ]. The same alert has been performed by other eye care professionals [ 39 , 40 ].…”

The effect of home education on myopia progression in children during the COVID-19 pandemic

“…It has previously been suggested that the intensive use of digital and virtual learning using a screen, resulting from the closure of schools and the intensification of home quarantine during the COVID-19 pandemic, would increase the myopia rate [ 7 ]. This kind of myopia, which is also described ‘Quarantine myopia’, has increased during the COVID-19 pandemic [ 8 ]. According to the United Nations Educational, Scientific and Cultural Organisation, 1.1 billion children in over 140 countries have been exposed to digital devices due to pandemic restrictions and distance education during May 2020 [ 8 , 9 ].…”

“…This kind of myopia, which is also described ‘Quarantine myopia’, has increased during the COVID-19 pandemic [ 8 ]. According to the United Nations Educational, Scientific and Cultural Organisation, 1.1 billion children in over 140 countries have been exposed to digital devices due to pandemic restrictions and distance education during May 2020 [ 8 , 9 ]. The schools were closed on March 2020 in Turkey and are still closed at the time this article was written (mid-January 2021) and home education continues.…”

The effect of 0.01% atropine on ocular axial elongation for myopia children: a meta-analysis

“…With the development of the information age, the incidence of myopia is increasing rapidly year by year, especially among yongner children [23]. The continuous progression of myopia will have a series negative effects [24].…”