Myopia Progression during the COVID-19 Era: A Systematic Review and Meta-analysis.

BACKGROUND: To evaluate myopia progression during the novel coronavirus disease 2019 (COVID-19) pandemic and its risk factors. METHODS: We searched PubMed, Scopus, and Web of Science to find literature until August 2022 related to COVID-19 pandemic and myopia progression. Outcomes of myopia progression included axial length (AL) and spherical equivalent (SE). Factors of screen time and outdoor activity time were analyzed. RESULTS: Thirty-three studies were included in this meta-analysis. Compared to the same period before the COVID-19 pandemic, myopia prevalence increased (OR = 1.11; 95% CI, 1.05-1.18). The outcomes of SE decreased -0.61 diopter (95% CI, -0.98 to -0.23), and AL increased 0.42 mm (95% CI, 0.13-0.7). Mean screen time was increased 6.25 hours/day (95% CI, 4.84-7.66), and outdoor activity time was decreased -1.52 hours/day (95% CI, -3.20 to -0.15). CONCLUSION: Establishing care policies is necessary to restrict behavioral changes and their consequences during the pandemic.

Myopia control with dual-focus soft contact lenses during the first year of measures to contain the COVID-19 pandemic.

PURPOSE: This study compared refractive and axial length (AL) changes in children wearing dual-focus soft contact lenses for myopia control (MiSight®) with myopic children wearing spectacles one year from the start of lockdown during the COVID-19 pandemic. METHODS: This retrospective, descriptive, parallel-group, observational study reviewed the charts of 11 children who began treatment for myopia control with dual-focus soft contact lenses for myopia control (MiSight®) in March 2020 and 11 matched spectacle-wearing controls. The mean increase in spherical equivalent refraction (SER) and AL from the beginning of the lockdown and up to 1 year later were compared. The parents of the children were asked about the average time spent on near work, contact lens wearing time both during and after the strict confinement and whether they had discontinued contact lens wear during lockdown. RESULTS: During this first year of preventive COVID-19 measures (March 2020-March 2021), for the contact lens group the average SER and AL increased -0.14 ± 0.09D and 0.13 ± 0.05 mm, respectively. For the spectacle wearers, the corresponding increases were -0.54 ± 0.16D and 0.25 ± 0.08 mm, respectively. A significant difference was found between the groups for both SER (p < 0.001) and AL (p < 0.05). The average time spent outdoors was restricted for both groups during lockdown and increased after. However, statistically significant changes in the time spent outdoors during and after lockdown were only found for the spectacle group (p < 0.05; t-test), whereas this change was not significant for the contact lens group (p = 0.08). CONCLUSIONS: Over the observed time period, dual-focus soft contact lenses for myopia control were effective despite the decreased time spent outdoors during the COVID-19 pandemic.

Multiple Factors Causing Myopia and the Possible Treatments: A Mini Review.

The myopia epidemic has become a global public health problem. Although myopia is progressing worldwide, the recent coronavirus infections 2019 (COVID-19) outbreak has spurred myopia progression. The current evidence-based treatments for humans are atropine eye drops, optical treatment with defocus, use of orthokeratology, extending proximity working distance, pausing from near work every half hour and increased time outside the home. Studies on myopia using animal models have been conducted for more than 40 years. In recent years, new mechanisms of myopia suppression have been revealed from animal experiments such as inflammation control, intraocular pressure control, light control, and the activity of early growth response protein 1 control. This mini-review provides a summary of the scientific evidence currently available on the control of myopia, and the possible treatments mitigating myopia.

Evaluation of an Optical Defocus Treatment for Myopia Progression Among Schoolchildren During the COVID-19 Pandemic.

Importance: Myopia progression has been found to be worsening during the COVID-19 pandemic. It is important to control the rapid myopia progression in this period. Objective: To analyze the association of COVID-19-related lockdown measures with myopia progression in schoolchildren and to compare the performance of defocus incorporated multiple segments (DIMS) lens with that of single vision lens (SVL) treatment in reducing myopia progression. Design, Setting, and Participants: This cohort study involved an exploratory, prespecified, comparison of 2 independent longitudinal studies performed at the same institute beginning in 2019. Data from Hong Kong schoolchildren (aged 7-13 years) were gathered and analyzed. Data analysis was performed from June to July 2021. Exposure: Schoolchildren in study 1 wore a DIMS lens for 18 months, and those in study 2 wore a SVL for 24 months. Main Outcomes and Measures: Cycloplegic spherical equivalent refraction and axial length were measured. Studies 1 and 2 started before the start of lockdown measures and continued throughout the lockdown. In both studies, periods of fewer and more COVID-19-related lockdown measures were identified. Because COVID-19 lockdown caused deviations from the visit schedule, myopia progression was normalized to 12-month change, which were compared between DIMS and SVL groups, also during the periods with less and more lockdown time. Results: There were 115 participants (58 girls [50.4%]; mean [SD] age, 10.3 [1.5] years) in the DIMS group; their mean (SD) baseline refraction was -4.02 (1.46) D. There were 56 participants (29 girls [51.8%]; mean [SD] age, 10.8 [1.5] years) in the SVL group; their mean (SD) baseline refraction was -2.99 (1.06) D. After controlling for the covariates, DIMS treatment was significantly associated with 34% less axial elongation (0.19 mm [95% CI, 0.16 to 0.22 mm] vs 0.30 mm [95% CI, 0.25 to 0.35 mm]; P < .001) and 46% less myopic progression after 12 months (-0.31 D [95% CI, -0.39 to -0.23 D] vs -0.57 D [95% CI, -0.69 to -0.45 D]; P = .001) compared with SVL treatment. In both the DIMS and SVL groups, more lockdown time was associated with significantly more spherical equivalent refraction (-0.54 D [95% CI, -0.64 to 0.44 D] vs -0.34 D [95% CI, -0.44 to -0.25 D]; P = .01) and axial length (0.29 mm [95% CI, 0.25 to 0.32 mm] vs 0.20 mm [95% CI, 0.16 to 0.24 mm]; P = .001) compared with less lockdown time. No significant interaction between treatment type and lockdown time was observed. Conclusions and Relevance: In this exploratory analysis, myopia progressed more rapidly in schoolchildren during the period when there were more COVID-19-related lockdown measures. However, optical treatment with DIMS was significantly associated with slower myopia progression compared with SVL treatment during the lockdown period.

Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers: A Serial Survey in Taiwan before and during the Coronavirus Disease 2019 Pandemic.

PURPOSE: To report the prevalence of preschool myopia after implementing a policy intervention promoting outdoor activities and the secular trend of myopia before and during the coronavirus disease 2019 (COVID-19) pandemic in a Taiwan preschool population. DESIGN: Repeated countywide population-based, cross-sectional surveys based on the Yilan Myopia Prevention and Vision Improvement Program (YMVIP). PARTICIPANTS: Among 23 930 kindergarteners 5 to 6 years of age from 7 school-year cohorts in Yilan County from 2014 through 2020, a total of 21 761 children (90.9%) were included for analysis. METHODS: Since launching the YMVIP in August 2014, myopia prevention strategies, such as increasing outdoor activities (2 hours/weekday), have been promoted in all kindergartens, and countywide school-based eye examinations, including cycloplegic autorefraction, and caregiver-administered questionnaires have been carried out annually for all participants. MAIN OUTCOME MEASURES: The prevalence of myopia (spherical equivalent, ≤ -0.5 D in either eye) in each of the 7 school-year cohorts of preschoolers 5 to 6 years of age. RESULTS: The prevalence of myopia continuously decreased for 2 years after implementing the YMVIP: 2014 cohort, 15.5% (95% confidence interval [CI], 14.2%-16.8%); 2015 cohort, 13.5% (95% CI, 12.3%-14.7%); and 2016 cohort, 8.4% (95% CI, 7.4%-9.4%). Subsequent cohorts were exposed maximally to these school-based myopia prevention strategies, and the prevalence of myopia remained relatively stable, between 8.5% and 10.3%, even during the COVID-19 pandemic. Multivariate logistic regression analysis showed a dose-dependent association between the duration of exposure to preventive strategies and the prevalence of myopia (up to 1-year YMVIP exposure, odds ratio, 0.86 [95% CI, 0.74-0.99]; up to 2-year YMVIP exposure, odds ratio, 0.56 [95% CI, 0.50-0.63]) after controlling other myopigenic factors. CONCLUSIONS: This population-based evidence showed high prevalence of preschool myopia and an L-shaped decline after introducing strategies to promote outdoor activities in kindergartens. With undisrupted school-based preventive strategies, the prevalence of myopia can be kept stable, even during the COVID-19 pandemic.

Decreased effectiveness of 0.01% atropine treatment for myopia control during prolonged COVID-19 lockdowns.

The COVID-19 pandemic of 2020 and its' accompanied lockdowns impacted the entire globe in ways the world is only beginning to comprehend. In Israel, children age 9-15 had not been in a frontal classroom and been socially restricted from March 2020 till March 2021. Fourteen of these children that had been under myopia control treatment which had been effective prior to the pandemic were included in this retrospective study to learn if their myopia continued to stay under control, or if the unique environmental modifications affected their progression. The results showed that average increase in spherical equivalent refraction and axial length, measured with optical biometer OA-2000 (Tomey GmbH, Nagoya, Japan), during the year of lockdowns was -0.73 ± 0.46D/0.46 ± 0.31 mm respectively, while the average increase in the year prior was -0.33 ± 0.27D/0.24 ± 0.21 mm. Though several articles have indicated the pandemic environment has influenced myopia progression in children, this communication indicates a possible significant impact of the environment on myopia increase even in individuals under effective atropine treatment. These children's' progression suggests practitioners consider and address multiple aspects simultaneously when attempting myopia control.

Slowing Down Myopia Progression with Contact Lenses - Everyday Cases from the Clinic.

BACKGROUND: An estimated 49.8% of the world population will be myopic by 2050. Multifocal contact lenses (MFCLs) and orthokeratology (OK) reduce peripheral retinal hyperopic defocus, which animal studies have shown to positively impact eye growth. MFCLs are expected to slow myopic progression by 20 - 50% and OK by 30 - 60%, making them valuable therapeutic tools. In view of the guidelines for myopia management published by the International Myopia Institute in 2019, the aim of this retrospective data analysis of a tertiary care center was to review past experience with OK and MFCLs for myopia control and gain information to update current practice. PATIENTS AND METHODS: The contact lens (CL) database of the Eye Clinic of the University Hospital of Basel was searched with the label "myopia progression" between January 2012 - 2020. Patients were included if they gave informed consent, were younger than 19 years old at baseline, and had no ocular comorbidities that could potentially compromise vision. Primary outcomes were progression of spherical equivalent refraction for MFCL patients and progression of axial length (AL) for the OK group, comparing with historical data from OK trials. Secondary outcomes were the presence of risk factors for myopia, age, refractive error at baseline, follow-up duration, and adverse effects during therapy. RESULTS: Twenty-one patients could be included, with a mean age of 12.80 ± 3.32 years (y) at baseline. The majority of patients were older than 12 years and already myopic (- 3.89 ± 2.30 diopters) when control treatment was started. Overall, follow-up ranged from 0.08 to 6.33 years (2.03 ± 1.66 y). In the patients treated with MFCLs, myopia control improved significantly when patients changed from spectacles to MFCLs. In the OK group, 14% dropped out during the first year and 2 patients had multiple AL measurements during therapy, which showed a slower growth of AL when compared to other OK trials and controls with spectacles. There were two cases of non-severe keratitis. Environmental risk factors had not been documented and only 48% of clinical records had a documented family risk assessment. CONCLUSION: Patients showed a slower myopia progression under MFCLs or OK, which supports their role as a treatment option in myopia management. In this regard, AL measurement is an important additional parameter to be included in the assessment of myopia progression in clinical practice. Identification of children at risk of developing high/pathologic myopia (family history, environmental risk factors) needs to improve so that the first stages of myopic shift can be recognized and targeted. Changes in lifestyle should be actively encouraged, especially when the impact of decreases in outdoor time secondary to COVID-19 is yet to become clear.

Contact lens education for the practitioners of the future.

The World Health Organization has identified a shortage of trained human resources as one of the greatest challenges to increasing the availability of eye care services and reducing preventable visual impairment around the world. Increased prevalence of myopia and new strategies for myopia management have raised the prospect of various interventions, including contact lenses for therapeutic use as well as for refractive correction. More personnel skilled in contact lens fitting will be needed to address potential worldwide demand for these interventions. This review investigates the current status and future requirements of global contact lens education in light of these developments. The COVD-19 pandemic led educational institutions worldwide to move towards online delivery. An online survey among 546 educators, conducted in May 2020, investigated changes to contact lens education delivery before and after the onset of the pandemic. A total of 214 responses were received from 32 countries. Prior to COVID-19 restrictions, 23% of educators had conducted more than 50% of their total teaching online; however, 69% expected to conduct more than half of their teaching online by the end of 2020 and 12% anticipated 90% or more of their teaching would be online. Some 76% of educators expected to provide more online lectures after the pandemic and 63% anticipated new methods to deliver practical education. Around half were planning to introduce new teaching online platforms (54%) and more online assessment methods (53%). The global need for increasing numbers of skilled personnel points to a crucial role for educators in teaching the contact lens practitioners of the future. Contact lens education delivery was already evolving prior to COVID-19, and changes that are currently occurring may lead to permanent differences in the way contact lenses are taught in future. The International Association of Contact Lens Educators (IACLE) provides educators with a standardised global curriculum, online resources and teaching technology that could also serve as a model for wider ophthalmic education in future.