Progression of Myopia in School-Aged Children After COVID-19 Home Confinement

IMPORTANCE Time spent in outdoor activities has decreased owing to home confinement for the coronavirus disease 2019 (COVID-19) pandemic. Concerns have been raised about whether home confinement may have worsened the burden ofmyopia owing to substantially decreased time spent outdoors and increased screen time at home. OBJECTIVE To investigate the refractive changes and prevalence ofmyopia in school-aged children during the COVID-19 home confinement. DESIGN, SETTING, AND PARTICIPANTS A prospective cross-sectional study using school-based photoscreenings in 123 535 children aged 6 to 13 years from 10 elementary schools in Feicheng, China, was conducted. The study was performed during 6 consecutive years (2015-2020). Data were analyzed in July 2020. EXPOSURES Noncycloplegic photorefraction was examined using a photoscreener device. MAIN OUTCOMES AND MEASURES The spherical equivalent refractionwas recorded for each child and the prevalence ofmyopia for each age group during each year was calculated. The mean spherical equivalent refraction and prevalence ofmyopia were compared between 2020 (after home confinement) and the previous 5 years for each age group. RESULTS Of the 123 535 children included in the study, 64 335 (52.1%) were boys. A total of 194 904 test results (389 808 eyes) were included in the analysis. A substantialmyopic shift (approximately -0.3 diopters [D]) was found in the 2020 school-based photoscreenings compared with previous years (2015-2019) for younger children aged 6 (-0.32 D), 7 (-0.28 D), and 8 (-0.29 D) years. The prevalence ofmyopia in the 2020 photoscreenings was higher than the highest prevalence ofmyopia within 2015-2019 for children aged 6 (21.5% vs 5.7%), 7 (26.2% vs 16.2%), and 8 (37.2% vs 27.7%) years. The differences in spherical equivalent refraction and the prevalence ofmyopia between 2020 and previous years were minimal in children aged 9 to 13 years. CONCLUSIONS AND RELEVANCE Home confinement during the COVID-19 pandemic appeared to be associated with a significantmyopic shift for children aged 6 to 8 years according to 2020 school-based photoscreenings. However, numerous limitations warrant caution in the interpretation of these associations, including use of noncycloplegic refractions and lack of orthokeratology history or ocular biometry data. Younger children's refractive status may be more sensitive to environmental changes than older ages, given the younger children are in a critical period for the development ofmyopia.

Automated summary

During the COVID-19 home confinement, a significant myopic shift was observed in children aged 6 to 8, while differences in spherical equivalent refraction and the prevalence of myopia were minimal in children aged 9 to 13. These findings suggest that younger children may be more sensitive to environmental changes affecting their refractive status.