Stay-at-home myopia among school children during the COVID-۱۹ pandemic

Abstract Background: Uncorrected myopia represents a major cause of visual disability in children, especially in low-income and middle-income countries. However, there is still debate about the effect of e-learning and “stay-at-home” guidelines on the refractive status of school children, especially in the absence of long-term follow-up data. This study aimed to assess the impact of stay-at-home enforcement during the COVID-۱۹ pandemic on myopia progression in students in the Suez Canal Area, Egypt. Methods: This longitudinal observational study included ۱۶۵۰ students. All students aged ۸–۱۵ years with visual complaints, who had attended routine annual vision checks since ۲۰۱۸, were enrolled and assessed annually for myopia progression until ۲۰۲۱. Cycloplegic and noncycloplegic refraction, axial length (AL), corneal curvature, and uncorrected and best-corrected distance visual acuity were measured. The participants were administered a questionnaire that focused mainly on collecting information on their visual habits. Results: Our study included ۳۳۰۰ eyes of ۱۶۵۰ school students with myopia during the ۴-year study period from ۲۰۱۸ to ۲۰۲۱. The mean cycloplegic spherical equivalents (CSE) were - ۱.۰۲, - ۱.۵۲, - ۲.۰۰, and - ۳.۵۰ diopters (D) in ۲۰۱۸, ۲۰۱۹, ۲۰۲۰, and ۲۰۲۱, respectively. This myopic shift in CSE over time was significant (P < ۰.۰۰۱). The average keratometric reading (Avg K) increased significantly during the follow-up period (P < ۰.۰۰۱). The Avg K measurements were ۴۲.۳۲, ۴۲.۶۲, ۴۳.۰۲, and ۴۴.۱۹ D in ۲۰۱۸, ۲۰۱۹, ۲۰۲۰, and ۲۰۲۱, respectively. The changes in Avg K were significant (P < ۰.۰۰۱). The mean AL measurements were ۲۲.۵۳, ۲۲.۵۹, ۲۲.۶۹, and ۲۲.۷۱ mm in ۲۰۱۸, ۲۰۱۹, ۲۰۲۰, and ۲۰۲۱, respectively. Although statistically significant (P < ۰.۰۰۱), changes in AL were clinically insignificant throughout the study period. The mean durations spent on electronic devices at home were ۲.۱۲, ۲.۴۶, ۳.۱۰, and ۶.۰۰ hours in ۲۰۱۸, ۲۰۱۹, ۲۰۲۰, and ۲۰۲۱, respectively. The changes over time were significant (P < ۰.۰۰۱). Conclusions: During the COVID-۱۹ pandemic, studying at home accelerated the degree of refraction toward myopia in school children in Egypt. Further studies are needed to assess the academic performance of students with progressive myopia. Keywords: myopia stay at home orders health lockdown COVID-۱۹ pandemic corneal topography eye axial length visual acuity ocular refraction