Coronavirus disease 2019 outbreak and associated public health measures increase the progression of myopia among children and adolescents: Evidence synthesis

Abstract

Purpose Although studies have suggested that the coronavirus disease 2019 (COVID‐19) outbreak increased myopia progression, they had different settings and analysis methods. This study compared myopia progression before and during the COVID‐19 outbreak using meta‐analysis. Methods Relevant literature was searched on EMBASE, PubMed, ClinEpiDB and Web of Science and reviewed until 8 October 2021. The Newcastle–Ottawa Scale was used to evaluate the quality of the original studies. The mean difference of change in spherical equivalent refraction (SER) was used for evaluation before and during the COVID‐19 pandemic. Results The meta‐analysis included eight studies with 773, 797 individuals aged 5–18 years. Pooled analysis indicated that the mean difference of annual myopia progression during the pandemic was 0.41 D higher (95% confidence interval [CI]: 0.35–0.48, p < 0.01) than before the pandemic. Subgroup analysis using cycloplegic (mean difference, 0.30 D; 95% CI, 0.22–0.38; p < 0.01) or noncycloplegic refraction (mean difference, 0.60 D; 95% CI, 0.27–0.93; p < 0.01) indicated that the mean difference of annual myopia progression during COVID‐19 significantly increased in both refractive measurements. Conclusion Our findings demonstrated that the COVID‐19 pandemic accelerated myopic progression compared to the past. Government policies are urgently required to prevent and control myopia progression.

Outbreak of COVID-19-Related Myopia Progression in Adults: A Preliminary Study

“…16,17,[24][25][26][27][28] A meta-analysis revealed that the COVID-19 situation, as well as associated public health policies like lockdowns and online education, may have appreciably accelerated myopic progression in children and adolescents when balanced against normal circumstances. 29 Resulting from exposure to the risk factors for myopic advancement, particularly extended near-work activity, a high AC/A ratio, and a significant accommodative lag, this trend may also appear in adult myopia with a faster pace. 30,31 Unfortunately, only four subjects exhibited no myopic shift in both eyes, so the relationship between these characteristics and myopia development was not investigated in this research.…”

The Impact of the COVID-19 Pandemic on Myopia Progression in Children: A Systematic Review

“…The reduced time spent outdoors, increased near work, increased time spent on electronic gadgets, and online learning are some of the contributing factors [ 3 - 4 , 9 ]. Recent studies have found a significant association between myopic progression and policies during the pandemic by governments [ 10 ].…”

Myopia risk behaviour related to the COVID‐19 lockdown in Europe: The generation R study

“…For example, the myopic progression observed here was 0.60D over 3 years, while in a recent meta-analysis of studies from Turkey, Argentina and China, this degree of myopia progression was reached within 1 year. 18 This is the first European COVID-19 study that observed a significant relationship between non-educational nearwork and myopia progression. Globally, daily screen time has increased by approximately two hours between 2002 and 2010, 30 while during the COVID-19 pandemic an immediate increase of approximately one hour was observed.…”

“…For example, Chinese and Argentinian studies found a significant decrease in time spent outdoors during lockdown. 15,16,18 In China, outdoor activities were forbidden and strictly enforced so that children experienced zero minutes per day outdoors. 16 Outdoor exposure is widely accepted as an important protective factor for myopia progression, 29 and the more lenient restrictions may have safeguarded Dutch teenagers from more rapid progression.…”

“…A recent meta-analysis found an annual myopia progression of 0.6 D measured by cycloplegic refraction in several combined studies. 18 Current evidence of the increase in myopia during the COVID-19 pandemic stems from Chinese cohort studies. 15,19 Lockdown measures in Asia involved tight restrictions and total home confinement, whereas more lenient policies facilitated outdoor time in the Netherlands and many other European countries.…”