Lockdowns and logging in to school online have taken their toll on pediatric eyesight. An increasingly alarming number of children need refractive correction, thanks to COVID-19. New research investigates what exactly about the pandemic got us here, and how optometrists on the frontlines can combat this worrying trend.
Every generation brings its share of new tools and toys that change the way humans go about their daily lives. From radio to television to the internet and everything in between (yes, even you, cassette tapes), novel technology has carved channels both subtle and sizable onto the wax of human behavior and health.
The advent of the smartphone and its analogs, like tablets and handheld game systems, has had an indisputably outsized impact on every facet of human existence, including eye health. Access to a constant stream of information has forever altered the way we see the world, but the screens on which we access this information have also changed the way we see, and not for the better.
Eye specialists have long known about the connection between these devices and myopia. As their use has gradually increased, so too have rates of myopia among children. Everyone from doctors on the frontlines to industry has taken notice, and a slow drip of innovation and novel treatments has ensued.
But with COVID-19, this progressive uptick in childhood myopia turned into a deluge, and researchers the world around have been left scrambling about why, and perhaps more importantly, what to do.
Power and numbers
The situation on the ground is dire, and optometrists like Dr. Monica Chaudhry, director of the MC Vision Institute, are watching the pediatric patients pile up. “What we’ve seen in the last three, four years is amazingly different from the experience we had. We’ve seen numbers increasing in children — number one,” she began.
But the story goes well beyond the sheer amount of patients. “Not every patient we used to find [was] progressive. There were quite a few stable patients. But what we have seen recently, especially after the lockdowns, is power in children increasing from minus-four to minus-eight within a year. This had not been our experience — such drastic progressions,” Dr. Chaudhry concluded.
The data accompanying the flood of both newly myopic children during the pandemic and dramatic progressions in the disease are shocking. According to a recent metaanalysis1 of research done on myopia and the pandemic, the prevalence of myopia increased by 10.49% during the pandemic, and 16.5% more children saw myopia progression during COVID than before it.
The factors that increase myopia are nothing new. Increases in screen time and decreases in time spent outside are the active ingredients in the witches’ brew that causes the eyeball to elongate. These factors have long explained the gaps in myopia rates between urban and rural children. They now explain the pandemic myopia explosion, when the virus turned the world into an essentially urban population via lockdowns and their knock-on effects.
Time spent outside significantly decreased during the pandemic,1 according to several studies in the meta-analysis. “Being outdoors releases dopamine, which regulates the growth of the eyeball,” Dr. Chaudhry explained — a sentiment echoed by the meta-analysis.1 “A second reason is that when you are outdoors, you are more relaxed and your eye is more focused for distance,” she continued.
The relaxation of the eye is also the name of the game with screen time. The jury is still out on the effects of blue light being emitted from the screens of phones, tablets, and the like, but the strain put on the eye from excessive near-vision tasks is not.
Myopia progression has been found to increase with mobile phone usage,1 which increased from 52.63% to 68.62% during COVID times. “These small digital devices, the distance at which you hold them is getting closer. And when you are looking nearer, your eye doesn’t relax for distance,” Dr. Chaudhry stated.
A gaggle of guidelines
With kids locked indoors relying on near-vision-heavy devices like smartphones for everything from social interaction to education to entertainment, the COVID-19 pandemic was a perfect storm for myopia. With myopia now entrenched, the question remains of what can be done about it.
Another study2 highlights the critical role that primary eye care providers like optometrists can play. In a perfect world, primary prevention measures like educating professionals who work with children and parents on the importance of putting devices away and getting outside, or at the very least holding them at a distance, are the ideal fix for future pandemics.
But that ship has sailed for the current generation, and secondary and tertiary prevention measures must take center stage in dealing with the current myopia mayhem. Secondary prevention measures involve identifying pre-myopes before symptoms arrive. Guidelines suggested by the study2 involve stepping up screening to include binocular vision, axial length measurements, and cycloplegic refractometry.
Tertiary measures, which aim to slow the progression of the disease, are starting to show much promise. Orthokeratology, a variety of day-use contact lenses, and atropine lead the pack in the early going of the myopia control era. The guidelines2 suggest mass campaigns of education not only on the availability of these novel therapies, but also instructions on how to tailor them to the individual patient.
Time for action
In theory, the tools exist to both nip the blooms of future myopia maelstroms in the bud and treat those who slip through the cracks of prevention programs. But Dr. Chaudhry sees a glaring obstacle. “One of the major add-ons is cost, especially in India,” she opined. “The challenge of bringing awareness, almost all of the money is going there,” she went on. “Even if I build awareness and bring them to the clinic, 80% of my patients cannot afford it.”
The solution for Dr. Chaudhry lies in industry and philanthropy waking up to the reality of myopia and the havoc it can wreak on the future. “By 2050, something like 50% of the population is predicted to be myopic,” she put forward. “The economic burden will be much worse if we don’t get donors and industry into this domain.”
- Cyril Kurupp AR, Raju A, Luthra G, et al. The Impact of the COVID-19 Pandemic on Myopia Progression in Children: A Systematic Review. Cureus. 2022;14(8):e28444.
- Németh J, Aclimandos WA, Tapasztó B, et al. The impact of the pandemic highlights the urgent need for myopia guidelines: The clinicians’ role. Eur J Ophthalmol. 2022;33(2):11206721221143008.