Effect of COVID-19 lockdown on refractive errors in Italian children aged 5–12 years: A multi-center retrospective study

Abstract

Purpose to explore the potential consequences of the COVID-19 lockdown on the prevalence of myopia among Italian children aged 5–12 years. Materials and Methods retrospective multicenter study conducted in Italy. Population: children aged 5–12. Selection: random selection of children who received an eye exam between 2016 to 2021. Inclusion criteria: healthy children presenting for a routine eye exam. Exclusion criteria: presence of ocular comorbidities other than refractive error, such as blepharoptosis, media opacities, corneal or retinal dystrophies, strabismus, amblyopia, or concurrent therapy with atropine 0.01%. Outcome measure: age and spherical equivalent (SE) measured in diopters (D) in the right eye (RE) in cycloplegia. Statistical analysis: ANOVA test. Results total of 803 children. In the years prior to COVID-19, the mean SE ± SD of healthy age-school children was: 0.54 ± 1.49 D in 2016; 0.43 ± 1.84 D in 2017; 0.34 ± 1.41 D in 2018; 0.35 ± 1.75 D in 2019 (ANOVA, p = .659). In 2021, the mean SE changed to −0.08 ± 1.44 D (ANOVA, p = .005). Mean age was comparable in all groups (ANOVA, p = .307). The prevalence of myopes (SE ≤−0.5D) and hyperopes (SE ≥ 2D) was respectively 24.10% and 9.64% among children aged 60–96 months, and 63.86% and 6.02% among children aged 97–144 months. These values represent a statistically-significant increase in the number of myopes (Chi-square, p = .016) and decrease in the number of hyperopes (Chi-square, p = .001), as compared to previous years (.06 and.48 respectively). Conclusion this retrospective study shows a statistically-significant decrease in the mean SE in children aged 5–12 in the year following the COVID-19 lockdown. The percentage of myopes has increased significantly, while the percentage of hyperopes has decreased. The lifestyle changes caused by the lockdown led children to spend more time on near-work activities and digital devices, and less time outdoors. These are known risk factors for the development and progression of myopia. Studies in different countries are encouraged.

Refractive Error Changes Due to COVID-19 Pandemic Confinement in Children from Puerto Rico: A Retrospective Study

“…6,26 However, it was found that the post-confinement mean spherical equivalent was similar for both ethnicities, Spanish (0.00 D) and Italians (−0.08 D). 6,26 In our study, the lowest change in spherical equivalent was found in children aged 7 to 8 years, and the highest change in spherical equivalent was found in children aged 14 to 15 years. The age group with the highest myopic shift among those previously diagnosed with myopia was 14-to 15-year-olds.…”

“…7,[22][23][24] Only a few studies have reported the overall refractive changes, regardless of their classification pre-and post-lockdown in children. 6,25,26 It is important to consider that the refractive error parameters and methodological process vary between studies, thus making it difficult to compare results with our own. In our sample, the mean spherical equivalent pre-confinement was lower than that of Italians but comparable with a study performed on Spanish children.…”

“…These findings differed from those of previous studies performed in Italian, French, and Chinese adolescents, where the highest progression of myopia was seen for the ages of 9 to 12 years. 9,26,27 A recent study on refractive error in children of Puerto Rico revealed an increase in myopia after 14 years of age. 28 When comparing the spherical equivalent (0.03 D) in the 14-year-old group from the previous study, our results demonstrated a more myopic (−0.30 ± 1.81 D) group pre-confinement.…”

Let Us Avoid a ‘Myopic View’ in Times of COVID-19

“…A retrospective study conducted in Italy of 803 children aged 5–12 found a statistically significant decrease in the mean spherical equivalent following the COVID-19 lockdown, from 0.35 ± 1.75 D in 2019 to −0.08 ± 1.44 D in 2021 [ 22 ].…”

Baseline metrics that may predict future myopia in young children

“…Myopia is a major public health concern precipitated by its increasing prevalence worldwide 1–7 and the associated risk of potentially blinding conditions 8–12 . Projections indicate that by the year 2050, over half of the world's population will have myopia, with 10% of those having high myopia 13 .…”