Coronavirus disease 2019 outbreak and associated public health measures increase the progression of myopia among children and adolescents: Evidence synthesis

Abstract

Purpose: Although studies have suggested that the coronavirus disease 2019 (COVID-19) outbreak increased myopia progression, they had different settings and analysis methods. This study compared myopia progression before and during the COVID-19 outbreak using meta-analysis.

Methods: Relevant literature was searched on EMBASE, PubMed, ClinEpiDB and Web of Science and reviewed until 8 October 2021. The Newcastle-Ottawa Scale was used to evaluate the quality of the original studies. The mean difference of change in spherical equivalent refraction (SER) was used for evaluation before and during the COVID-19 pandemic.

Results: The meta-analysis included eight studies with 773, 797 individuals aged 5-18 years. Pooled analysis indicated that the mean difference of annual myopia progression during the pandemic was 0.41 D higher (95% confidence interval [CI]: 0.35-0.48, p < 0.01) than before the pandemic. Subgroup analysis using cycloplegic (mean difference, 0.30 D; 95% CI, 0.22-0.38; p < 0.01) or noncycloplegic refraction (mean difference, 0.60 D; 95% CI, 0.27-0.93; p < 0.01) indicated that the mean difference of annual myopia progression during COVID-19 significantly increased in both refractive measurements.

Conclusion: Our findings demonstrated that the COVID-19 pandemic accelerated myopic progression compared to the past. Government policies are urgently required to prevent and control myopia progression.

Keywords: COVID-19; meta-analysis; myopia pandemic; optometrist; public health.

FIGURE 1

The selection process diagram to identify eligible studies following Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA)

FIGURE 2

Meta‐analysis of the myopic shift in 773 797 individuals from eight studies. (a) Forest plot of mean difference in annual myopia progression showing the comparison before and during the COVID‐19 pandemic. The square's area was proportionate to study weight. The horizontal line indicates 95% CIs. The overall impact is shown as diamonds, with CIs at the lateral points. (b) Radial plot (c) Funnel plot with pseudo‐95% CIs. CI, confidence interval; MD, difference in mean; SE, standard error

FIGURE 3

Subgroup analysis using (a) non‐cycloplegic and (b) cycloplegic measurement. Forest plot comparing myopia progression before and during the COVID‐19 pandemic. The square area was proportionate to study weight. The horizontal line indicates 95% CIs. The overall impact is shown as diamonds, with CIs at the lateral points. CI, confidence interval