Influence of coronavirus disease 2019 on myopic progression in children treated with low-concentration atropine

Abstract

Purpose The outbreak of coronavirus disease 2019 (COVID-19) has caused many children to stay indoors. Increased near work and insufficient outdoor activities are considered important risk factors for myopic progression. This study aimed to compare the changes in myopic progression before and after COVID-19 in children treated with low-concentration atropine. Methods The records of 103 eyes of 103 children who were treated with low-concentration atropine eye drops were retrospectively reviewed. We classified children according to the concentration of atropine eye drops and children’s age. The beginning of the pre-COVID-19 period was set from January 2019 to May 2019, and the endpoint was set in March 2020. The beginning of the post-COVID-19 period was set in March 2020, and the endpoint was set from January 2021 to March 2021. We evaluated the questionnaires administered to children’s parents. Results A significant myopic progression was observed in the post-COVID-19 period compared to the pre-COVID-19 period in the 0.05% and 0.025% atropine groups (P < 0.001 and P = 0.020, respectively). For children aged 5 to 7 and 8 to 10 years, the axial elongations were significantly faster in the post-COVID-19 period than in the pre-COVID-19 period (P = 0.022 and P = 0.005, respectively). However, the rates of axial elongation and myopic progression were not significantly different between pre- and post-COVID-19 in children aged 11 to 15 years (P = 0.065 and P = 0.792, respectively). The average time spent using computers and smartphones and reading time were significantly increased, and the times of physical and outdoor activity were significantly decreased in the post-COVID-19 period compared to the pre-COVID-19 period. Conclusions The rates of myopic progression have increased substantially after the spread of COVID-19 with an increase in the home confinement of children. Therefore, it is necessary to control the environmental risk factors for myopia, even in children undergoing treatment for the inhibition of myopic progression.

The Association Between Environmental and Social Factors and Myopia: A Review of Evidence From COVID-19 Pandemic

“…A total of seven studies were conducted in cohorts of the same group of children at different ages (Longitudinal cohort), the other four studies were conducted in cohorts of the different groups of children at the same age (Crosssectional cohorts). All studies without myopia preventive intervention found at least one of the following outcomes: increased myopia prevalence (ranging from 7.5-20.5% with a trend of more rising of prevalence in younger age groups (29)), increased myopia incidence (from 7.5% to 15.3%), greater myopia progression (negative SER change ranging from 0.05-0.98 D (29,(31)(32)(33)(34)(35)(36)38) or negative rate of SER changes ranging from 0.05-0.1 D/month (30,37)) during the COVID-19 lockdown. With preventive interventions, a study in Taiwan reported stable myopia prevalence throughout the COVID-19 lockdown (39).…”

“…A total of five studies monitored the changes in axial length (AL) during the COVID-19 lockdown. (31,32,34,36,37) Two of these studies reported an increase in AL during the lockdown (ranging from 0.08-0.31 mm) (31,32). Another two studies found faster AL elongation during the lockdown (0.47 mm/year compared to 0.29 mm/year (36), the rate of AL increase ranging from 0.03-0.05 mm/month (37)).…”

“…(31,32,34,36,37) Two of these studies reported an increase in AL during the lockdown (ranging from 0.08-0.31 mm) (31,32). Another two studies found faster AL elongation during the lockdown (0.47 mm/year compared to 0.29 mm/year (36), the rate of AL increase ranging from 0.03-0.05 mm/month (37)). Whereas the only study from China (34) reported no difference of AL before and after that lockdown period (0.01 mm, p = 0.37).…”

“…Behavioral changes during the lockdown were evaluated by a questionnaire in seven studies. (32)(33)(34)(35)(37)(38)(39) Increase in time spending on total near work, including reading, homework, online learning and digital screen time (2.4-4.63 h/day) (32,34,35,37) and a reduction in total outdoor activities (0.1-0.86 h/day) (32,34,35,37) were reported. Among these studies, four studies reported the direct association of specific behavioral changes and worsening of myopia.…”

“…Behavioral changes during the lockdown were evaluated by a questionnaire in seven studies. ( 32 – 35 , 37 – 39 ) Increase in time spending on total near work, including reading, homework, online learning and digital screen time (2.4–4.63 h/day) ( 32 , 34 , 35 , 37 ) and a reduction in total outdoor activities (0.1–0.86 h/day) ( 32 , 34 , 35 , 37 ) were reported.…”