The effect of home confinements on myopic risk profile in European adolescents: The Generation R Study

ABSTRACT

Purpose: To battle the spreading of the COVID-19 virus, all over the world measures like home confinement and nation-wide lockdowns have been implemented at regular intervals. These measures have shown an increase in myopic incidence particularly in China, which applied a very strict lockdown and home confinement. The Netherlands used a so called “intelligent lockdown” which allowed children to go outside. We evaluated the association between COVID restrictions and myopia risk factors in an European cohort of adolescents. Methods: A total of 1101 participants (mean age 16.3 ± 3.65 yrs) of the population-based prospective birth-cohort study Generation R filled in a questionnaire about their behavior before, during, and after lockdown in the Netherlands. These participants had undergone cycloplegic refractive error measurement at 13 years of age. We evaluated time spent outdoors, time spent online (handheld or other devices), time spent on near work (education and non-educational) from March-October 2020 in myopic (spherical equivalent <-0.5D) and non-myopic children. We used a repeated measures ANOVA to compare differences between these time periods, and logistic regression corrected for age, gender, and ethnicity to evaluate differences between myopic and non myopic children. Results: During and after lockdown the children spent signicantly more time online (+113 and +59min/day) on both hand held (+64 and +10 min/day) and other devices (+49 and +7 min/day), and on educational nearwork (+73 and +63min/day). Non-educational near work increased only significantly during lockdown (+176 min/day). Time spent outside did not change significantly and was ±2 hours/day. Children of non-European descent spent more time online (235min/day vs 260 min/day, P= 0.004) and on non-educational near work (452 min/day vs 559 min/day, p=0.0002). We found no significant difference in behavior between myopic and non-myopic children. Conclusions: The Dutch lockdown for COVID increased digitized near work in adolescents, but did not affect outdoor exposure. Children without myopia did not do better than those already myopic. Based on these results, we expect that the COVID pandemic will also lead to an increase in myopia prevalence and progression in European children, but to a lesser extent than in Asia.