• Preventing Myopia During the COVID-19 Pandemic

    Infection-control measures imposed during the COVID-19 pandemic, one of the worst disease outbreaks in history, have accelerated the adoption of digital technology worldwide.

    Learn about early intervention at the AAO 2020 Symposium on Myopia

    According to UNESCO, approximately 1.37 billion students (80% of the world’s student population) from more than 130 countries globally are affected, with digital or e-learning approaches replacing face-to-face, classroom-based learning. 

    Even before the pandemic, childhood myopia and subsequent visual loss from severe myopia-related complications in adulthood had become increasingly recognized as a public health problem with a significant economic burden. 

    As a prolonged battle against COVID-19 becomes increasingly likely, there is a real concern that the COVID-19 pandemic may insidiously exacerbate the myopia epidemic. Global estimates showed the prevalence of myopia will increase from about 20% now to 50% by 2050. 

    The link between COVID-19 and myopia

    How is the COVID-19 pandemic linked to myopia? First, school closures and the shift towards online learning increases digital screen time and the overall time spent on near work. Social distancing measures and fear of community spread have decreased outdoor time for school-aged children. 

    Second, the local education system can affect the health of students by instituting policies that can control myopia. Some health studies have shown that encouraging students to participate in outdoor activities away from their devices can lessen the incidence of myopia. 

    Third, working from home has become increasingly common, and parents may inadvertently not be the best role models at home when they spend an inordinate amount of time in front of a digital screen instead of teaching children to rest their eyes.

    Myopia and digital screen time, near work and outdoor time

    Digital screen use is inextricably linked to near work, a risk factor for myopia. The Generation R study is a large cohort study of 5,074 children in Rotterdam that found an association between increased computer use and myopia at 9 years of age. The combined effect of near work, including computer use, reading time and reading distance, increased the odds of myopia at 9 years old. In another study of 418 students, device-recorded smartphone data usage, an objective surrogate for time spent using the smartphone, was independently associated with myopia.

    Outdoor time is a well-established environmental factor for myopia, with pooled results from clinical trials demonstrating reduced myopic shift of 0.30 D in both those with and without myopia, compared with controls after three years. Increasing outdoor time away from screens has shown to have a positive public health impact in preventing myopia in several countries, including Taiwan and Singapore.

    How can we mitigate the impact of digital technology during the COVID-19 pandemic and avoid a myopia boom? Here are some suggestions:

    • Raise awareness on the detrimental effects of indoor near work and encourage outdoor time. Parents need to understand the importance of maintaining good habits during the pandemic lockdown and beyond, including encouraging students to take frequent breaks from near work and limiting their recreational screen time.
    • Government agencies, eyecare professionals and schools should collaborate to design a healthy and holistic home-based learning curriculum. Such a curriculum would encourage learning not just from online educational resources, but also include taking frequent breaks and participating in indoor physical or household activities such as cooking, baking, cleaning, etc. 
    • Continue to engage in outdoor activities where it is safe and legal to do so. Taking breaks outdoors for two to three hours per day should be encouraged, especially given the flexibility of home-based learning. 
    • Cultivate a healthy relationship with digital devices. Parents can set time limits on screen time using applications on their children’s devices and guide their children in using electronic materials. Digital applications that monitor device usage and remind users to disconnect after prolonged consumption of digital content are great for digital detox.

      This helps them to effectively process the content, thereby decreasing the overall time spent online. Parents themselves can make a conscious effort to avoid recreational screen time and substituting it with offline playtime and nondigital activities such as family activities, art and music.
    • Regular eye examinations and myopia treatment should continue. With the widespread adoption of telemedicine, regular consultations with eyecare professionals must continue for monitoring of myopia progression. It is particularly important that children on myopia treatment, such as atropine and orthokeratology, not to have a lapse in their treatment because there is a risk of rebound myopia when treatment ends prematurely.
    Wong Chee Wai About the author: Dr. Wong Chee Wai is a vitreoretinal surgeon at the Singapore National Eye Centre. He completed a Medical and Surgical Retina fellowship at the Singapore National Eye Centre and a PhD thesis on ocular drug delivery at Utrecht University. He is also an Assistant Professor with Duke-NUS Medical School and deputy director of undergraduate education in charge of the Duke-NUS Ophthalmology medical student rotation. He serves as a committee member for the Singapore Society of Ophthalmology, and as the chair of its Young Ophthalmologists Chapter.

    AAO 2020 Symposium on Myopia: Global Initiative on Early Intervention

    On Nov. 13 at 4:30 p.m. PT, the Task Force on Myopia will present a symposium for AAO 2020 Virtual, “Global Initiative in Early Intervention to Prevent Myopia Progression.” It is designed to help members understand the scope of myopia on a worldwide basis, consequences of high myopia, available interventions to decrease progression of the condition and public health approaches implemented around the world.

    The Academy’s Board of Trustees created the Task Force on Myopia in 2019 to recognize the high priority that myopia poses as a major cause of visual impairment globally. Co-chairs Richard Abbott, MD, and Academy international trustee Donald Tan, MD, FRCS, FRCOphth headed the committee, and YO Marcus Ang, MBBS, was one of the members of the global task force.

    On Sept. 12 the board approved a white paper and implementation plan that provides a synthesis of the relevant scientific literature and an action plan to address prevention of myopia progression in the areas of education, public health, research and advocacy. Stay tuned for more details on the symposium for AAO 2020.