Advancement of Myopia in School-Aged Children During the Era of COVID-19 Remote Learning

Abstract

Introduction: Myopia, or nearsightedness, has been steadily increasing worldwide, particularly among school-aged children. The COVID-19 pandemic, with its shift to distance learning, significantly increased children's screen time while reducing outdoor activities. This raised concerns about accelerated myopia progression, as prolonged screen exposure and reduced natural light became common. Objective: To examine how online learning and other environmental factors influenced the progression of myopia during the COVID-19 pandemic. Materials and methods: A retrospective study conducted from 2020 to 2024 collected data from children aged 6 to 14 during three different periods: before the pandemic, at its onset, and during the pandemic. Information was gathered on demographics, including screen time for educational and recreational activities, outdoor time, and the type of screens used. In addition, measurements of best-corrected distance visual acuity (BCDVA), uncorrected distance visual acuity (UCDVA), and cycloplegic refraction were documented. Results: Out of 100 patients, 48 were boys, with a mean age of 11.26±2.39 years. The majority used mobile phones (61%) and had inadequate outdoor play (87%). Among 200 eyes examined, 146 (73%) exhibited myopia progression. A significant difference in spherical equivalent (SE) was observed between the pre-pandemic and post-pandemic periods −0.28±0.22 D vs −0.40± 0.12 D (p = 0.021). Additionally, uncorrected distance visual acuity (UCDVA) differed between the two periods 0.07±0.11 vs 0.08±0.16 (p = 0.023). Significant hazard ratios for changes in SE were associated with older age (>9 years) (HR [95% CI], 0.72 [0.52–0.85]), increased recreational screen use (HR [95% CI], 1.25 [1.14–1.65]), and inadequate outdoor time (HR [95% CI], 1.46 [1.34–1.66]). Conclusion: Myopia progression accelerated during the COVID-19 pandemic. Factors such as younger age, extended screen time, and inadequate outdoor activity contributed to the ...