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Myopia and Quarantine

A pandemic inside a pandemic. Leigh Spielberg MD reports from the EURETINA 2021 Virtual Congress.

Leigh Spielberg

Posted: Monday, November 1, 2021

A pandemic inside a pandemic. Leigh Spielberg MD reports from the EURETINA 2021 Virtual Congress.

The pandemic’s damaging effects on eye health are now coming to light. Some of the most pressing problems were highlighted during a special session, “Better Patient Counselling: Using Epidemiological Evidence in Day-to-Day Clinical Practice.”

Caroline Klaver MD, PhD opened the session with her presentation, “Myopia and Quarantine.” It has been known for quite some time that near work, which includes screen time, can contribute to the progression of myopia. In contrast, outdoor time has been shown to be beneficial. These findings have been distilled into the anti-myopia lifestyle advice for children, resulting in the 20-20-2 rule. For near work, this means after 20 minutes of near work, children (as well as the adults) should gaze into the distance for 20 seconds. In addition, children should spend 2 hours per day outside.

Quarantine and isolation requirements in the COVID-19 era have made following these guidelines very difficult. “During COVID-19, we’re not only experiencing a viral pandemic, but also a myopia pandemic,” she emphasised.

All children are at risk, including teenagers, although the younger the child, the greater the risk of myopia progression, she stressed.

“According to a recent study of more than 100,000 children in China, the risks are greatest for school children aged six to eight years. The prevalence of myopia in six-year-olds more than doubled from 2019 to 2020. This correlates with an enormous increase in screen time pre- and post-COVID-19 and a corresponding decrease in time spent outdoors.”

In another study, the percent of Chinese children spending more than two hours per day using digital devices increased from approximately 20% to nearly 80%.

“A significant percentage of children were found to be spending seven hours per day online,” Dr Klaver said.

But what does “screen time” mean, exactly? And is there a difference amongst screen types and between handheld devices and other near activities, such as reading? The primary risk factor seems to be the distance between the eyes and the object viewed.

“Desktop computers seem to cause a milder increase in myopia than smartphones, which are held closer to the eyes. And books seem to be worse than desktop computers.”

What seems to matter most is the distance to the object read and the continuous duration of use. Farther is better, and frequent breaks are also beneficial.

So, what should we tell our paediatric patients? Practically speaking, the WHO guidelines for screen time still apply: no screen time for children less than two years of age. Children two to five should spend less than an hour with a device, while those from six to 10 should stay under two hours and 11-to-15-year-olds should spend less than three hours per day, with breaks every 20 minutes.

“Quarantine is risky for myopia, and awareness of increased myopia risk with severe homebound quarantine is warranted,” Dr Klaver concluded.

She urges eye care professionals to “vocalise these risks to those responsible for managing pandemic behavioural policy.”

Caroline Klaver MD, PhD, is a Professor of Ophthalmology and Epidemiology at Erasmus MC & Radboud, Rotterdam, the Netherlands. caroline.klaver@radboudumc.nl


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