Myopia progression in school children with prolonged screen time during the coronavirus disease confinement

Abstract Background: Myopia, the most common refractive error, is a global public health problem with substantial visual impairment if left untreated. Several studies have investigated the association between increased near-work and restricted outdoor activities in children with myopia; however, such studies in children without myopia are scarce. We aimed to monitor the effect of the coronavirus disease-۲۰۱۹ (COVID-۱۹) home confinement and mandatory virtual learning on myopic progression among myopic and non-myopic school-aged children. Methods: We conducted a retrospective chart review of children aged ۶ – ۱۲ years attending regular visits to the pediatric ophthalmology clinic in a tertiary eye hospital in Eastern Province, Saudi Arabia. Cycloplegic refraction was determined from three visits at least six months apart: two visits before the start of the COVID-۱۹ pandemic and one during the COVID-۱۹ home confinement. Parents were asked about the time spent in near-work and outdoor activities, the devices used during virtual learning, and the demographic characteristics of the children. Statistical analyses were conducted to compare myopia progression before and during the COVID-۱۹ home confinement. Results: A total of ۱۶۰ eyes of ۸۰ children were analyzed. The boy (n = ۴۶) to girl (n = ۳۴) ratio was ۱.۴:۱. The hyperopia (n = ۱۳۱ eyes) to myopia (n = ۲۹ eyes) ratio was ۴.۵:۱. Most eyes exhibited a hyperopic shift before the confinement; however, all eyes displayed a myopic shift during the confinement. When comparing both eyes of the same individual, the more myopic or less hyperopic eye in the same child had a significantly greater myopic shift than the fellow eye (both P < ۰.۰۵). Children who used tablets showed a significant myopic shift (P < ۰.۰۵). Likewise, children in both age categories (less than or equal to ۸ and > ۸ years), boys, those living in an apartment, and those having parents with bachelor’s degrees experienced a significant myopic shift during COVID-۱۹ home confinement compared to before (all P < ۰.۰۵). The mean myopic shift was greater in children aged > ۸ years than in those aged less than or equal to ۸ years. Children with and without a family history of myopia had a myopic shift in the mean spherical equivalent during COVID-۱۹ home confinement; however, that of children with no family history was statistically significant (P < ۰.۰۵). Conclusions: Progression of myopia accelerated in children during the COVID-۱۹ pandemic. Excessive time spent on digital screen devices at near distances is considered a substantial environmental contributor to myopic shift in children. Further multicenter studies with extended follow-up periods are needed to assess the factors contributing to myopic progression in our population.