Childhood myopia and the coronavirus disease 2019 pandemic: Lessons for future pandemics

This is the authors' abstract. We don't add key points for this paper.

Several systematic reviews and meta-analyses have demonstrated that the coronavirus disease 2019 (COVID-19) pandemic worsened the progression of childhood myopia.[1,2] Strict public health measures including lockdowns and school closures were implemented in many countries during the pandemic to curb its spread. According to the United Nations Educational, Scientific and Cultural Organization, these measures led to 1.6 billion children experiencing life-changing daily routines. With school closures and home-based learning becoming more prevalent during the pandemic, children spent significantly more time viewing computer screens. Simultaneously, lockdowns and social distancing measures limited outdoor activities for children. Increased screen time and reduced outdoor time are both known risk factors for myopia progression.[3,4] Regular eye examinations are crucial for detecting and managing childhood myopia. However, restrictions on nonessential health-care services during lockdowns led to delayed eye examinations for some children, while others missed their appointments out of fear of contracting the virus while visiting clinics and hospitals. This is likely to have resulted in a delay in the diagnosis of myopia and initiation of myopia-control intervention for some children. In addition, for myopes already on treatment, the pandemic caused disruptions to the timely monitoring of their myopia and thwarted potentially necessary adjustments to their treatment regimen, such as changing the concentration of topical atropine therapy or the addition of other myopia-control interventions. So, what lessons can we learn from the COVID-19 pandemic to help prepare for future pandemics? We suggest some form of “intelligent” lockdowns with carefully planned strategies for future pandemics as follows: Reduce near work and accommodation for home-based learning and leisure: Use long viewing distance devices such as projectors and television screens instead of tablets and smartphones as some studies have reported that shorter viewing distances may cause more significant myopia progression than long viewing distance devices due to the increased accommodation effort required[2-5] Ensure adequate breaks in between video conferencing as there is increasing evidence to suggest that the intensity of near work, i.e., sustained reading at closer distance with fewer breaks, may be more important than the total hours of near work contributing to myopia progression[4] Encourage good reading habits such as reading in an adequately lit room and ensuring a good distance between books/computer screens from the eyes[4] Use audio media such as audiobooks and podcasts to replace screen time where feasible Reduce time spent on digital devices such as video gaming by setting limits on screen time or substituting them with activities such as physical exercises, helping with household chores, arts and crafts, baking/cooking, listening to radio, and free play. Spend more time outdoors and place study tables near windows, on balconies and roof terraces, and in gardens and car porches whenever possible Continue monitoring of myopia and education of patients and parents through teleconsultation Institute myopia-control interventions earlier and more aggressively when indicated. The COVID-19 pandemic has taught us that the association between a pandemic and childhood myopia progression is likely to be profound and have major consequences for both visual acuity and the risk of developing associated pathologies such as early cataract, glaucoma, retinal detachment, and myopic maculopathy in later life. It is crucial to adapt myopia management strategies to the unique challenges posed by a pandemic while maintaining a focus on preventive measures and promoting overall eye health. It is, therefore, of paramount importance for all stakeholders – parents, schools, health-care professionals, and governmental agencies – to recognize the significance of this pandemic-induced phenomenon and work together to take measures to control the progression of myopia during future pandemics. Data availability statement Data sharing is not applicable to this article as no datasets were generated or analyzed. Financial support and sponsorship Nil. Conflicts of interest The authors declare that there are no conflicts of interests in this paper.