Survey on the Progression of Myopia in Children and Adolescents in Chongqing During COVID-19 Pandemic

Wujiao Wang, Lu Zhu, Shijie Zheng, Yan Ji, Yongguo Xiang, Bingjing Lv, Liang Xiong, Zhuoyu Li, Shenglan Yi, Hongyun Huang, Li Zhang, Fangli Liu, Wenjuan Wan, Ke Hu, Wujiao Wang, Lu Zhu, Shijie Zheng, Yan Ji, Yongguo Xiang, Bingjing Lv, Liang Xiong, Zhuoyu Li, Shenglan Yi, Hongyun Huang, Li Zhang, Fangli Liu, Wenjuan Wan, Ke Hu

Abstract

Background: The Covid-19 pandemic restricts children and adolescents from doing normal daily activities such as playing outdoors and going to school. The incidence and prevalence of myopia have increased during the COVID-19 pandemic. The aim of this study was to investigate and evaluate the impact of the home confinement during the COVID-19 pandemic on the progression of myopia among children and adolescents in Chongqing, China. Methods: The survey was conducted by using stratified samplings. Samples were randomly selected from the 2019 National Student Physique and Health Survey database, and their visual function and refractive data were compared with those in 2020. Vision-related behavior questionnaire including digital screen exposure was applied to investigate the correlation between eye parameter and eye health-related behavior. Results: A total of 1,733 and 1,728 students were enrolled in 2020 and 2019, respectively. The percentage of myopia students was 55.02% in 2020, which was higher than that in 2019 (44.62%). The mean uncorrected visual acuity (UCVA, LogMAR, 0.35 ± 0.42) in 2020 was higher than that in 2019 (0.27 ± 0.36, P < 0.001). The mean spherical equivalent (SE) refraction (-1.94 ± 2.13 D) in 2020 was lower than that in 2019 (-1.64 ± 5.49 D, P < 0.001). For students who used digital devices for online courses, the mean SE in the television group (-1.10 ± 1.49 D) was better than that in the computer group (-2.03 ± 2.37 D, P = 0.0017) and in the cell phone group (-2.02 ± 2.09 D, P = 0.0028). The average duration of online classes (r = -0.27, P < 0.0001), the number of online classes per day (r = -0.33, P < 0.0001), as well as digital screen exposure time (r = -0.20, P < 0.0001) were negatively correlated with SE, and the average time of outdoor activity (r = 0.20, P < 0.0001) was positively correlated with SE. Conclusions: Increased digital screen exposure contributes to myopic progression in children and adolescents of Chongqing during the COVID-19 pandemic. Suitable digital devices should be provided for online classes and outdoor activity should be advocated to prevent myopic pandemic.

Keywords: COVID-19; myopia; prevention; progression; quarantine.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Wang, Zhu, Zheng, Ji, Xiang, Lv, Xiong, Li, Yi, Huang, Zhang, Liu, Wan and Hu.

Figures

Figure 1
Figure 1
Comparison of myopia rate among teenagers in different age groups before and after the epidemic.
Figure 2
Figure 2
The mean uncorrected visual acuity and spherical equivalent refraction in the urban and the rural of 2020.
Figure 3
Figure 3
The mean uncorrected visual acuity and spherical equivalent refraction with different digital devices used for education in 2020.

References

    1. Okeyo ILA, Dowse R. An illustrated booklet for reinforcing community health worker knowledge of tuberculosis and facilitating patient counselling. Afr J Prim Health care Fam Med. (2018) 10:1687. 10.4102/phcfm.v10i1.1687
    1. Zhang W, Yang X, Zhao J, Yang F, Jia Y, Cui C, et al. . Depression and psychological-behavioral responses among the general public in China during the early stages of the COVID-19 pandemic: survey study. J Med Internet Res. (2020) 22:e22227. 10.2196/22227
    1. Qian YS, Chu RY, He JC, Sun XH, Zhou XT, Zhao NQ, et al. . Incidence of myopia in high school students with and without red-green color vision deficiency. Invest Ophthalmol Vis Sci. (2009) 50:1598–605. 10.1167/iovs.07-1362
    1. Saw SM, Zhang MZ, Hong RZ, Fu ZF, Pang MH, Tan DT. Near-work activity, night-lights, and myopia in the Singapore-China study. Arch Ophthalmol. (2002) 120:620–7. 10.1001/archopht.120.5.620
    1. Lim HT, Yoon JS, Hwang SS, Lee SY. Prevalence and associated sociodemographic factors of myopia in Korean children: the 2005 third Korea National Health and Nutrition Examination Survey (KNHANES III). Jpn J Ophthalmol. (2012) 56:76–81. 10.1007/s10384-011-0090-7
    1. Matsumura H, Hirai H. Prevalence of myopia and refractive changes in students from 3 to 17 years of age. Surv Ophthalmol. (1999) 44(Suppl 1):S109–15. 10.1016/S0039-6257(99)00094-6
    1. Lin LL, Shih YF, Hsiao CK, Chen CJ. Prevalence of myopia in Taiwanese school children: 1983 to 2000. Ann Acad Med. (2004) 33:27–33. 10.1097/00000441-200401000-00012
    1. Lin S, Ma Y, He X, Zhu J, Zou H, Lin S, Ma Y, et al. . Using decision curve analysis to evaluate common strategies for myopia screening in school-aged children. Ophthalmic Epidemiol. (2019) 26:286–94. 10.1080/09286586.2019.1616774
    1. VanderVeen DK, Kraker RT, Pineles SL, Hutchinson AK, Wilson LB, Galvin JA, et al. . Use of orthokeratology for the prevention of myopic progression in children: a report by the american academy of ophthalmology. Ophthalmology. (2019) 126:623–36. 10.1016/j.ophtha.2018.11.026
    1. Pellegrini M, Bernabei F, Scorcia V, Giannaccare G. May home confinement during the COVID-19 outbreak worsen the global burden of myopia? Graefes Arch Clin Exp Ophthalmol. (2020) 258:1339. 10.1007/s00417-020-04728-2
    1. Hu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of Age at myopia onset with risk of high myopia in adulthood in a 12-year follow-up of a Chinese cohort. JAMA Ophthalmol. (2020) 138:1–6. 10.1001/jamaophthalmol.2020.3451
    1. Sumitha M, Sanjay S, Kemmanu V, Bhanumathi MR, Shetty R. Will COVID-19 pandemic-associated lockdown increase myopia in Indian children? Indian J Ophthalmol. (2020) 68:1496. 10.4103/ijo.IJO_1443_20
    1. Saxena R, Vashist P, Tandon R, Pandey RM, Bhardawaj A, Menon V, et al. . Prevalence of myopia and its risk factors in urban school children in Delhi: the North India Myopia Study (NIM study). PLoS One. (2015) 10:e0117349. 10.1371/journal.pone.0117349
    1. Guo Y, Liu LJ, Xu L, Lv YY, Tang P, Feng Y, et al. . Outdoor activity and myopia among primary students in rural and urban regions of Beijing. Ophthalmology. (2013) 120:277–83. 10.1016/j.ophtha.2012.07.086
    1. Goldschmidt E, Jacobsen N. Genetic and environmental effects on myopia development and progression. Eye. (2014) 28:126–33. 10.1038/eye.2013.254
    1. Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental history of myopia, sports and outdoor activities, and future myopia. Invest Ophthalmol Vis Sci. (2007) 48:3524–32. 10.1167/iovs.06-1118
    1. Liao C, Ding X, Han X, Jiang Y, Zhang J, Scheetz J, et al. . Role of parental refractive status in myopia progression: 12-year annual observation from the Guangzhou Twin Eye Study. Invest Ophthalmol Vis Sci. (2019) 60:3499–506. 10.1167/iovs.19-27164
    1. Rose KA, Morgan IG, Jenny Ip, Kifley A, Huynh S, Smith W, et al. . Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. (2008) 115:1279–85. 10.1016/j.ophtha.2007.12.019
    1. Guggenheim JA, Northstone K, McMahon G, Ness AR, Deere K, Mattocks C, et al. . Time outdoors and physical activity as predictors of incident myopia in childhood: a prospective cohort study. Invest Ophthalmol Vis Sci. (2012) 53:2856–65. 10.1167/iovs.11-9091
    1. Wu PC, Chen CT, Lin KK, Sun CC, Kuo CN, Huang HM, et al. . Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmology. (2018) 125:1239–50. 10.1016/j.ophtha.2017.12.011
    1. Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, et al. . Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. (2017) 95:551–66. 10.1111/aos.13403
    1. Cho K-S, Lee J-M. Influence of smartphone addiction proneness of young children on problematic behaviors and emotional intelligence: Mediating self-assessment effects of parents using smartphones. Comput Hum Behav. (2017) 66:303–11. 10.1016/j.chb.2016.09.063
    1. Bernard JY, Padmapriya N, Chen B, Cai S, Tan KH, Yap F, et al. . Predictors of screen viewing time in young Singaporean children: the GUSTO cohort. Int J Behav Nutr Phys Act. (2017) 14:112. 10.1186/s12966-017-0562-3
    1. Guan H, Yu NN, Wang H, Boswell M, Shi Y, Rozelle S, et al. . Impact of various types of near work and time spent outdoors at different times of day on visual acuity and refractive error among Chinese school-going children. PLoS One. (2019) 14:e215827. 10.1371/journal.pone.0215827
    1. Qian DJ, Zhong H, Li J, Niu Z, Yuan Y, Pan CW. Myopia among school students in rural China (Yunnan). Ophthalmic Physiol Opt. (2016) 36:381–7. 10.1111/opo.12287
    1. Yotsukura E, Torii H, Inokuchi M, Tokumura M, Uchino M, Nakamura K, et al. . Current prevalence of myopia and association of myopia with environmental factors among schoolchildren in Japan. JAMA Ophthalmol. (2019) 137:1233–9. 10.1001/jamaophthalmol.2019.3103
    1. Lanca C, Saw SM. The association between digital screen time and myopia: a systematic review. Ophthalmic Physiol Opt. (2020) 40:216–29. 10.1111/opo.12657
    1. Jones-Jordan LA, Mitchell GL, Cotter SA, Kleinstein RN, Manny RE, Mutti DO, et al. . Visual activity before and after the Onset of Juvenile Myopia. Invest Ophthalmol Vis Sci. (2011) 52:1841–50. 10.1167/iovs.09-4997
    1. Saw S-M, Chua W-H, Hong C-Y, Wu H-M, Chan WY, Chia KS, et al. . Nearwork in early-onset myopia. Invest Ophthalmol Vis Sci. (2002) 43:332–9. 10.1021/ol1006604
    1. Morgan I, Rose K. How genetic is school myopia? Prog Retinal Eye Res. (2005) 24:1–38. 10.1016/j.preteyeres.2004.06.004
    1. Morgan IG, French AN, Ashby RS, Guo X, Ding X, He M, et al. . The epidemics of myopia: aetiology and prevention. Prog Retinal Eye Res. (2018) 62:134–49. 10.1016/j.preteyeres.2017.09.004
    1. Rose KA, French AN, Morgan IG. Environmental factors and myopia: paradoxes and prospects for prevention. Asia-Pacific J Ophthalmol. (2016) 5:403–10. 10.1097/APO.0000000000000233
    1. Debulpaep S, Dreesman A, Dirix V, Toppet V, Wanlin M, Geysens L, et al. . Tuberculosis transmission in a primary school and a private language school. An Estimation of Infectivity. Front Pediatr. (2020) 8:10. 10.3389/fped.2020.00010
    1. Goh PP, Abqariyah Y, Pokharel GP, Ellwein LB. Refractive error and visual impairment in school-age children in Gombak District, Malaysia. Ophthalmology. (2005) 112:678–85. 10.1016/j.ophtha.2004.10.048
    1. He M, Huang W, Zheng Y, Huang L, Ellwein LB. Refractive error and visual impairment in school children in rural southern China. Ophthalmology. (2007) 114:374–82. 10.1016/j.ophtha.2006.08.020
    1. Salomão SR, Cinoto RW, Berezovsky A, Mendieta L, Nakanami CR, Lipener C, et al. . Prevalence and causes of visual impairment in low-middle income school children in São Paulo, Brazil. Invest Ophthalmol Vis Sci. (2008) 49:4308–13. 10.1167/iovs.08-2073
    1. Sharma IP, Lepcha NT, Lhamo T, Ellwein LB, Pokharel GP, Das T, et al. . Visual impairment and refractive error in school children in Bhutan: the findings from the Bhutan School Sight Survey (BSSS 2019). PLoS One. (2020) 15:e0239117. 10.1371/journal.pone.0239117
    1. Zhu Q, Liu Y, Tighe S, Zhu Y, Su X, Lu F, et al. . Retardation of myopia progression by multifocal soft contact lenses. Int J Med Sci. (2019) 16:198–202. 10.7150/ijms.30118

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