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Myopia Incidence Potential Public Health Concern in Schoolchildren Amid COVID-19 Pandemic, Experts Say

According to the findings of a population-based study conducted by the Chinese University of Hong Kong, unprecedented quarantine and social distancing measures imposed during the coronavirus disease 2019 (COVID-19) pandemic led in a “myopia explosion” in school-aged children in Hong Kong (CUHK).

Myopia Incidence Potential Public Health Concern in Schoolchildren Amid  COVID-19 Pandemic, Experts Say
Photo: Myopia Incidence In Schoolchildren | InStyleHealth

During the COVID-19 pandemic, schoolchildren saw a 2.5-fold rise in myopia incidence, as well as rapid myopia progression.

The Hong Kong Children Eye Investigation provided two cohorts for this observational study (HKCES). The COVID-19 cohort (n=709; mean age, 7.25 years) was recruited during a period of school closures and social activity limitations, with an 8-month follow-up. The COVID-19 pre–cohort (n=1,084; mean age, 7.29 years) was recruited before the epidemic and followed for three years.

The COVID-19 group had a 2.5-fold greater yearly incidence rate of myopia than the pre–COVID-19 cohort, at 29.68 percent vs. 11.63 percent.

Furthermore, during the epidemic, myopia progression was nearly two times higher. The COVID-19 group had an estimated yearly change in spherical equivalent refraction (SER) of -0.80 D, compared to -0.41 D in the pre–COVID-19 cohort, and an estimated annual change in axial length (AL) of 0.45 mm vs 0.28 mm. During the pandemic, both AL elongation and SER alterations predicted quicker myopia progression.

“It should be noted that -6.0 D is considered high myopia, which can lead to glaucoma, macular degeneration, and retinal detachment,” said researcher Professor Calvin Pang of the Department of Ophthalmology and Visual Sciences at the Chinese University of Hong Kong.

The experts noted, “Another concerning finding was the considerable changes in children's lifestyle during the COVID-19 epidemic, with a 68 percent decrease in outdoor time and a 2.8-fold rise in screen time.”

“During the epidemic, schoolchildren spent an average of 7 hours indoors but just 24 minutes outdoors per day, compared to 2.5 hours indoors and 75 minutes outdoors per day before the pandemic,” they wrote.

The research speculated that childhood myopia as a result of the COVID-19 pandemic could be a major public health problem, given Hong Kong’s high prevalence of myopia, which affects more than 40% of children under the age of eight.

“The concern about a myopia epidemic in children during the COVID-19 pandemic hits particularly close to home, as Hong Kong is one of the world’s most densely populated cities, with the overwhelming majority of the population living in urban areas, where outdoor spaces are scarce,” said Professor Clement Tham of the CUHK Department of Ophthalmology and Visual Sciences.

“Under these conditions, pupils spend substantially less time outside and significantly more time near employment. These two behaviors are linked to the development and progression of myopia,” according to Tham.

“Increasing outdoor time to 2 hours per day or 14 hours per week is recommended for youngsters to prevent myopia progression. Educators and parents should assist youngsters adopt healthy digital device habits, such as taking a 30-second break after 30 minutes of staring at a screen, according to Dr. Jason Yam of the CUHK Department of Ophthalmology and Visual Sciences. “Finally, in high-risk children, effective myopia control through pharmaceutical or optical therapies should be implemented.”


Source: Br J Ophthalmol 2021;doi:10.1136/bjophthalmol-2021-319307

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