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

Abstract

Myopia is the most common refractive error among children. The coronavirus disease 2019 (COVID-19) pandemic has affected children's health in many ways. Policy changes due to the COVID-19 pandemic, such as home quarantine and online schooling, have been proposed as causes for the increased risk of myopia progression. During strict home quarantine, children spend less time outdoors and more time using electronic devices which are important risk factors associated with myopia. Our systematic review aims to assess the relationship between myopia progression and these risk factors in children. We did the literature search from PubMed, Google Scholar, and ScienceDirect. A total of 10 research papers were selected for final review using the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines. The research articles used had a quality of more than 70%. The quality of these articles was determined using the Joanna Briggs Institute (JBI) tool. Our review included eight cross-sectional and two cohort studies. Most of these studies used questionnaires to assess the risk factors of myopia. Standardized ocular examinations were done in most studies to measure visual acuity, spherical equivalent, and axial lengths. Our study found that the progression of myopia was affected by the reduced time spent outdoors and increased screen time during the pandemic. We also found that children's increased use of electronic devices, such as mobile phones and tablets, has significantly affected myopia progression during the pandemic.

Longitudinal Changes in Choroidal Structure Following Repeated Low-Level Red-Light Therapy for Myopia Control: Secondary Analysis of a Randomized Controlled Trial

“…The COVID-19 home quarantine contributed to a rise in near work and a decrease in outdoor activities, 33 both of which are known risk factors for myopic progression. 34,35 The current study's findings are in agreement with previous research demonstrating that myopic progression accelerates after the onset of COVID-19 compared with before the pandemic, [36][37][38][39] even in children who have been treated with low-concentration atropine. 37 Besides, during the COVID-19 pandemic, children who were aware of the progression of their myopia were more inclined to revisit the hospital for follow-up examinations, whereas children who have had successful treatments and their parents may prioritize safety factors and opt not to return for follow-up visits.…”

Myopia Progression during COVID-19 Home Quarantine in Indonesia: A Retrospective Multicenter Cohort Study

“…Growing concern regarding potential myopia progression during COVID-19 emerged as consequence of home quarantine, which affects lifestyle and behavior changes due to school closure and restriction of social activities [7,16] . These changes were new to us, as we had not experienced anything like this in over 100 years.…”

“…Earlier onset of myopia and rapid myopia progression could lead to pathological myopia, developing a range of complications such as retinal detachment, macular hole, cataract, and open angle glaucoma which could lead to irreversible visual loss and even blindness [4] . Studies from several countries found that there was a higher rate of myopia progression during the pandemic [2,[5][6][7] . A meta-analysis found that the change in spherical equivalent was 0.46 D greater during the pandemic compared to pre-The follow-up period in this study was divided into two distinct phases, pre-pandemic (September 2019 to March 2020) and during pandemic (September 2021 to May 2022).…”

How can we better evaluate paediatric progression of myopia and associated risk factors? Lessons from the COVID‐19 pandemic: A systematic review

“…As COVID‐19 is unlikely the last pandemic that the world will face, it is, therefore, important to understand the impact onto childhood myopia caused by the pandemic so that we can better prevent and/or soften the detriments on myopia among children and adolescents. To an extent, recent work by Cyril Kurupp et al and Yang et al have contributed greatly to reiterating significant risk factors of paediatric myopia progression, such as screen time exposure and reduced time spent outdoors (Cyril Kurupp et al, 2022; Yang et al, 2022). However, it is difficult to simply adopt recommendations from prior publications as a consistent limitation in the literature on screen time and paediatric myopia is the heterogeneity of research methodology, including but not limited to the lack of prospective study designs, objective measurement (as opposed to self‐reported data) and stratified analyses (e.g.…”