Myopia progression in children during home confinement in the COVID-19 pandemic: A systematic review and meta-analysis

Abstract

Purpose: Myopia is a growing pandemic, especially in children, who risk low vision later in life. Home confinement during the COVID-19 pandemic may have increased myopia progression through increased screentime, decreased time outdoors and increased near work activities. The aim of this study is to compare progression of myopia in children during home confinement period in the COVID-19 pandemic with pre-COVID-19 progression.

Methods: On January 2023 PubMed, EMBASE and Cochrane were searched for relevant studies. Studies meeting the following criteria were eligible for inclusion: children (under 18 years), home confinement due to COVID-19, spherical equivalent refractive (SER) and axial length (AL) measurements and a follow-up period to measure progression. Quality appraisal was performed by two reviewers independently using the Joanna Briggs Institute tool for cohort studies. Outcomes for myopia were assessed through meta-analysis, analyzing SER (random effects) and AL (fixed effects).

Results: Hundred and two articles were identified in the search, of which five studies were included in the analysis. Risk of bias is moderate with a few critical flaws in the studies. Myopia progressed more rapidly during the COVID-19 pandemic compared to the pre-COVID-19 period, both in terms of SER (-0.83D [95 %CI, -1.22, -0.43] and AL (0.36 mm [95 %CI, 0.13, 0.39]).

Conclusion: Progression of myopia during the COVID-19 pandemic accelerated more rapidly compared to the pre-COVID-19 period. Impact of home confinement on myopia may be considered when future lockdown measures are being contemplated.

Keywords: Axial length; Covid-19; Home confinement; Myopia; Spherical equivalent.

Fig. 1

PRISMA Flowchart. Identification of studies via databases are included in the PRISMA Flowchart. Duplicates are removed and excluded reports are sorted by given reason.

Fig. 2

Effect size of spherical equivalent refraction (SER) in diopter. For each study, SER data from exposed and control group are retrieved in effect size data including standard deviation. All included studies together give the pooled effect. The bold line at ‘0′ represents no difference in effect size of SER between the two groups. The left side of the chart implies an increase in SER towards myopia.

Fig. 3

Effect size of axial length (AL) in mm. For each study, AL data from exposed and control group are retrieved in effect size data including standard deviation. All included studies together give the pooled effect. The bold line at ‘0′ represents no difference in effect size of AL between the two groups. The right side of the chart implies a growth of AL.

Fig. 4

Axial length (AL) growth percentile. For this figure the growth percentile chart from He et al. 2023 is used with in (A) the male growth curve and (B) the female growth curve. The y-axis represents the distribution of the AL in mm. The x-axis represents the distribution of age in years. Underneath the figure the distribution of axial length growth percentile is illustrated. Each included study is plotted in the chart with error bars based on the overall mean baseline values of the whole study population. The horizontal error bar includes the standard deviation of age, the vertical error bar includes the standard deviation of AL.