Researchers have reported an increase in myopia progression among Chicago-area children early in the COVID-19 pandemic. This finding suggests that the closure of schools and cancellation of activities may have played a significant role. In a retrospective observational study involving over 2,000 children, the change in mean spherical equivalent from 2020 to 2021 was 2.2 times greater than from 2019 to 2020. Rebecca Mets-Halgrimson, MD, and colleagues reported these findings in the British Journal of Ophthalmology.

Unraveling the Link between COVID-19 and Myopia Progression in Kids

Overall Cohort Findings

In the overall cohort of over 2,000 children, a remarkable difference was observed. The change in mean spherical equivalent from 2020 to 2021 was 2.2 times greater than from 2019 to 2020, with values of 0.42 D and 0.19 D respectively. This significant increase indicates a clear shift in myopia progression during the pandemic. It shows that the pandemic had a profound impact on the visual health of these children.Moreover, in a subset analysis of patients with cycloplegic refraction in all 3 years, there was a significant difference in myopic shift between years (F-ratio 14.4, P<0.00001). There was a significant change from 2020 to 2021 (P=0.00008), but not from 2019 to 2020. This further emphasizes the specific period during which the pandemic had a more pronounced effect on myopia progression.

Impact on Different Age Groups

Looking at the prevalence of myopia grouped by age, 8-year-old and 17-year-old patients had the greatest increase compared with baseline. This indicates that certain age groups were more vulnerable to the changes in myopia progression during the pandemic. It suggests that the factors associated with the pandemic had a more significant impact on these specific age groups.When grouped by refractive error, children with low myopia (-0.5 D to -3.00 D) showed the greatest change in mean spherical equivalents in 2020 to 2021. This highlights the specific range of myopia where the pandemic had the most notable effect. It provides valuable insights into which children were most affected and the extent of the change in their visual health.

Expert Opinions

Jeffrey J. Walline, OD, PhD, of the Ohio State University in Columbus, emphasized that shifts in refractive error typically decrease as children age. However, the study findings suggest that children became nearsighted earlier and nearsighted children increased their myopia progression following the pandemic. These factors would lead to children requiring spectacle wear at earlier ages and more frequent changes in prescription for myopic children.David Mackey, AO, of the University of Western Australia and the Lions Eye Institute in Perth, pointed out that most glasses are given in 0.25-D increments. A 0.42-D increase is nearly two steps compared to a 0.19-D increase, which is under one step. Many people might not bother changing glasses for a one-step increase but would be likely to for a two-step increase. So, this increase in the rate of myopia progression would be noticeable for many on an individual level.Ahmed Kassem, MD, of the Sanford South University Eye Center and Optical in Fargo, North Dakota, noted that the COVID-19 lockdown represented the perfect storm for these two factors to simultaneously occur, with restrictions imposed on outdoor activities and switching to virtual classrooms. However, the study doesn't investigate near work or time outdoors, so it provides no insight into the potential mechanism related to an increase in myopia progression.It's difficult to understand the "true meaning" of the study due to its design, as it includes some myopic and some non-myopic children, and each year contains a different sample with some children consistently represented throughout.Still, it's important for clinicians to understand the impact of screen time and near work on myopia progression, particularly in younger age groups. This could lead to the consideration of myopia control approaches such as low-dose atropine, orthokeratology, and defocus-modifying spectacles sooner in this age group.For this study, Mets-Halgrimson and colleagues included 2,064 patients ages 2-17 years with cycloplegic refractions in the months of January, February, or March in the years 2019, 2020, or 2021 at a tertiary children's hospital. The first 3 months of each year were chosen to reflect similar periods before the pandemic (2019 and 2020) and during it (2021). The mean age of the study population increased from 9.6 in 2019 to 9.9 in 2020 and 10.5 in 2021, while the mean spherical equivalents changed from 0.12 D in 2019 to -0.07 D in 2020 and -0.49 D in 2021. In a subset of 109 patients who returned for evaluations in all 3 years, the mean spherical equivalents decreased from 0.66 D in 2019 to 0.51 D in 2020 and 0.22 D in 2021. These detailed data provide a comprehensive understanding of the impact of the pandemic on myopia progression in Chicago-area children.