Effect of COVID-19 lockdown on refractive errors in Italian children aged 5-12 years: A multi-center retrospective study

Purpose to explore the potential consequences of the COVID-19 lockdown on the prevalence of myopia among Italian children aged 5-12 years. Materials and Methods retrospective multicenter study conducted in Italy. Population: children aged 5-12. Selection: random selection of children who received an eye exam between 2016 to 2021. Inclusion criteria: healthy children presenting for a routine eye exam. Exclusion criteria: presence of ocular comorbidities other than refractive error, such as blepharoptosis, media opacities, corneal or retinal dystrophies, strabismus, amblyopia, or concurrent therapy with atropine 0.01%. Outcome measure: age and spherical equivalent (SE) measured in diopters (D) in the right eye (RE) in cycloplegia. Statistical analysis: ANOVA test. Results total of 803 children. In the years prior to COVID-19, the mean SE +/- SD of healthy age-school children was: 0.54 +/- 1.49 D in 2016; 0.43 +/- 1.84 D in 2017; 0.34 +/- 1.41 D in 2018; 0.35 +/- 1.75 D in 2019 (ANOVA, p = .659). In 2021, the mean SE changed to -0.08 +/- 1.44 D (ANOVA, p = .005). Mean age was comparable in all groups (ANOVA, p = .307). The prevalence of myopes (SE <=-0.5D) and hyperopes (SE >= 2D) was respectively 24.10% and 9.64% among children aged 60-96 months, and 63.86% and 6.02% among children aged 97-144 months. These values represent a statistically-significant increase in the number of myopes (Chi-square, p = .016) and decrease in the number of hyperopes (Chi-square, p = .001), as compared to previous years (.06 and.48 respectively). Conclusion this retrospective study shows a statistically-significant decrease in the mean SE in children aged 5-12 in the year following the COVID-19 lockdown. The percentage of myopes has increased significantly, while the percentage of hyperopes has decreased. The lifestyle changes caused by the lockdown led children to spend more time on near-work activities and digital devices, and less time outdoors. These are known risk factors for the development and progression of myopia. Studies in different countries are encouraged.

Automated summary

This retrospective study shows a significant increase in myopia prevalence among Italian children aged 5-12 following the COVID-19 lockdown, accompanied by a significant decrease in hyperopia prevalence. The lifestyle changes caused by the lockdown, such as increased near-work activities and digital device use and decreased outdoor time, are known risk factors for the development and progression of myopia. Further studies in different countries are encouraged.