Rapid Progression of Myopia During the Pandemic

Written by: Nicole Fan

From: São Paulo

Edited by: Luana Mayer

As part of the containment strategy of governments worldwide to control the spread of the Coronavirus, schools had to be closed temporarily, driving them to adopt the system of online learning, where digital technology played a substantial role to continue ensuring a safe education for students. The COVID-19 pandemic has, consequently, radically changed the way children learn, as well as how teachers teach. While online learning has opened numerous doors and opportunities we had never even realized before, it has unfortunately caused detrimental impacts on our health and well-being, in this case, particularly on our eyes. 

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The sudden and radical shift from regular school to absolute distance learning was challenging and nerve-racking at times since we would have never expected such uncertain and unusual circumstances. It has stimulated children to end up spending the majority of their time in front of their online devices such as their laptops, cell phones, or tablets, whether it be working late for school assignments or playing video games for fun. As a result, there has been a severe increase in digital screen time while at the same time, limited access to outdoor activities due to protective health measures and lockdown. This combination - more screen time and less outdoor activities - could potentially harm eye vision and put children at higher risk of developing nearsightedness (myopia). Thus, ophthalmologists have started to raise concerns regarding the onset and rapid progression of the myopia epidemic amidst the COVID-19 outbreak.

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Have you ever felt a lingering headache, fatigue in the eye, or needed to squint your eyes to see clearly? These are one of the most characteristic symptoms of nearsightedness, or also referred to as myopia. It is a prevalent vision condition where you can see objects that are close clearly, but those far away are often blurry. Myopia emerges when your eyeball is longer than usual or when the focusing power of the eye is too strong, inducing light rays to focus in front of the retina instead of on it, forming a blurry distant vision. It tends to run in families, genetically, and progresses throughout time gradually or rapidly. Moreover, patients generally opt to either use glasses or contact lenses to correct their vision. However, another alternative is performing LASIK surgery, utilizing a cutting laser to change the shape of the cornea and therefore improve vision. 

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The rapid rise and progression of myopia have been a persistent concern over the past decades, particularly in East Asia, where notably more than 90% of teenagers and young adults are short-sighted. Research has shown that this booming trend in the myopia epidemic is forecast to advance and even worsen throughout time and that by mid-century, approximately half of the global population will be myopic. 

According to a review paper published in the American Journal of Ophthalmology, written by Chee Wai Wong and co-authors, it is fundamental to discern educational screen time with recreational screen time. While digital use is an undeniable aspect nowadays to substitute in-presence school, online recreational activities have been prevalent among children's free time as they have become familiarized with various media and platforms. Besides, Wong claims that "there is a risk that they might increasingly replace outdoor activities or even indoor non-digital recreational time with screen''.

The World Health Organisation (WHO) has several recommendations to mitigate the worldwide progression of myopia. One of them is that they suggest children under 5 years of age to spend no more than 1 hour per day of screen time. Furthermore, the Children's Eye Foundation encourages children to minimize their exposure to digital devices as much as possible with frequent breaks and to prioritize daily outdoor play. 

Dr. Wong also strictly believes in the urgent need for raising awareness on this cause, and he hopes to build closer collaboration between parents, government bodies, and schools to alleviate the long-term collateral damage of COVID-19 policies. He emphasizes the fact that myopia is not only a matter of using glasses to correct vision but that as myopic children mature, they face increased risks of eye complications such as glaucoma and macular degeneration, becoming  something worth preventing forthwith. "It is quite important that ophthalmologists try to increase the awareness that the prolonged use of digital devices, which was a necessary and beneficial step to cushion the disruption to school education, can have a detrimental impact on the prevalence of myopia'' he stated. 

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To sum up ideas, the global myopia incidence has been continuously progressing, and according to studies, it has no possibility of stabilizing any time soon, considering the prolonged use of digital devices due to the COVID-19 outbreak. Therefore, it is crucial to raise awareness of the detrimental effects of high exposure to indoor online work and to promote outdoor time under safe and legal conditions. Parents also play an essential role in properly managing their children's screen time and pointing the importance of maintaining healthy habits, especially at difficult times like the one we are currently living in.