Dzenana A Detanac


Global school closures and home quarantine caused by the COVID-19 pandemic increases digital screen time and the overall time spent on near work while decreasing outdoor time especially among school-going children, which can cause serious factors associated with asthenopia, refractive errors, low visual acuity, and accommodative insufficiency. Professionals believe that ophthalmologists now have an opportunity to draw attention to the problem, raise awareness among parents, children, and teachers, and eventually influence policymakers to develop strategies that will help children and students as well as parents and relevant institutions to deal with this issue even beyond the pandemic. Prompt implementation of adequate public and school policies and eye care services globally, effective planning of public health measures for prevention and treatment of myopia must be part of the crucial measures in the future. The consequences of widespread acceptance of digital devices in all spheres of public life by affecting visual function also affect learning, school performance, development of children, and thus their future.


Covid-19, children, digital device overuse, visual impairment

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Wong CW, Tsai A, Jonas JB, Ohno-Matsui K, Chen J, Ang M, et al. Digital screen time during the COVID-19 pandemic: risk for a further myopia boom? Am J Ophthalmol. 2020;223:333–7. doi: 10.1016/j.ajo.2020.07.034

Aslan F, Sahinoglu-Keskek N. The effect of home education on myopia progression in children during the COVID-19 pandemic [published online ahead of print, 2021 Jun 30]. Eye (Lond). 2021;1-6. doi:10.1038/s41433-021-01655-2

Wunsch K, Nigg C, Niessner C, Schmidt SCE, Oriwol D, Hanssen-Doose A, et al.The impact of COVID-19 on the interrelation of physical activity, screen time and health-related quality of life in children and adolescents in Germany: results of the Motorik-Modul Study. Children (Basel). 2021;8(2):98. doi:10.3390/children8020098

Nobari H, Fashi M, Eskandari A, Villafaina S, Murillo-Garcia Ã, Pérez-Gómez J. Effect of COVID-19 on health-related quality of life in adolescents and children: a systematic review. Int J Environ Res Public Health. 2021;18(9):4563. doi:10.3390/ijerph18094563

Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-42. doi: 10.1016/j.ophtha.2016.01.006

Bourne RR, Stevens GA, White RA, Smith LA, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990-2010: a systematic analysis. The Lancet Global Health. 2013;1(6):339-49. doi:10.1016/S2214-109X(13)70113-X

Naidoo KS, Fricke TR, Frick KD, Jong M, Naduvilath TJ, Resnikoff S. Potential lost productivity resulting from the global burden of myopia: systematic review, meta-analysis, and modeling. Ophthalmology. 2019;126(3):338-46. doi: 10.1016/j.ophtha.2018.10.029

Wong TY, Ferreira A, Hughes R, Carter G, Mitchell P. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review. Am J Ophthalmol. 2014;157(1):9-25. doi: 10.1016/j.ajo.2013.08.010

Kozeis N. Impact of computer use on children's vision. Hippokratia. 2009;13(4):230-1

Zhang Z, Xu G, Gao J, Wang L, Zhu Y, Li Z, et al. Effects of e-learning environment use on visual function of elementary and middle school students: a two-year assessment-experience from China. Int J Environ Res Public Health.2020; 17(5):1560.doi:10.3390/ijerph17051560

Moon JH, Lee MY, Moon NJ. Association between video display terminal use and dry eye disease in school children. J Pediatr Ophthalmol Strabismus. 2014;51(2):87-92. doi: 10.3928/01913913-20140128-01

Moon JH, Kim KW, Moon NJ. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case-control study. BMC Ophthalmol. 2016;16(1):188. doi:10.1186/s12886-016-0364-4

Mohan A, Sen P, Shah C, Jain E, Jain S. Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID-19 pandemic: Digital eye strain among kids (DESK study-1). Indian J Ophthalmol. 2021;69(1):140-4. doi:10.4103/ijo.IJO_2535_20

Vilela MA, Pellanda LC, Fassa AG, Castagno VD. Prevalence of asthenopia in children: A systematic review with meta-analysis. J Pediatr Brazil. 2015;91:320–5.

Ramamurthy D, Lin Chua SY, Saw SM. A review of environmental risk factors for myopia during early life, childhood and adolescence. Clin Exp Optom. 2015;98(6):497-506. doi: 10.1111/cxo.12346

Parssinen O, Kauppinen M. Risk factors for high myopia: a 22-year follow-up study from childhood to adulthood. Acta Ophthalmologica. 2018; 97(5): 510-8. doi:10.1111/aos.13964

Wu PC, Chen CT, Lin KK, Sun CC, Kuo CN, Huang HM, et al. Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmology. 2018;125(8):1239-50. doi: 10.1016/j.ophtha.2017.12.011

Read SA, Collins MJ, Vincent SJ. Light exposure and eye growth in childhood. Invest Ophthalmol Vis Sci. 2015;56(11):6779-87. doi: 10.1167/iovs.14-15978

Morgan IG, He M, Rose KA. Epidemic of pathologic myopia: what can laboratory studies and epidemiology tell us? Retina. 2017;37(5):989-97. doi: 10.1097/IAE.0000000000001272

Rose KA, Morgan IG, Ip J, Huynh S, Smith W, Mitchell P. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115:1279-85.

He M, Xiang F, Zeng Y, Mai J, Chen Q, Zhang J, et al. Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial. JAMA. 2015;314(11):1142-8. doi: 10.1001/jama.2015

Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu Jet al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017;95(6):551-66. doi:10.1111/aos.13403

French AN, Morgan IG, Mitchell P, Rose KA. Risk factors for incident myopia in Australian schoolchildren: the Sydney adolescent vascular and eye study. Ophthalmology. 2013;120(10):2100-8. doi: 10.1016/j.ophtha.2013.02.035

Guggenheim JA, Northstone K, McMahon G, Ness AR, Deere K, Mattocks C, et al. Time outdoors and physical activity as predictors of incident myopia in childhood: a prospective cohort study. Invest Ophthalmol Vis Sci. 2012;53(6):2856-65. doi:10.1167/iovs.11-9091

Shah RL, Huang Y, Guggenheim JA, Williams C. Time outdoors at specific ages during early childhood and the risk of incident myopia. Invest Ophthalmol Vis Sci. 2017;58(2):1158-66. doi:10.1167/iovs.16-20894

Huang HM, Chang DST, Wu PC. The association between Near Work activities and myopia in children—a systematic review and meta-analysis. PLoS One. 10(10):e0140419. doi:10.1371/journal.pone.0140419

Ip JM, Saw SM, Rose KA, Morgan IG, Kifley A, Wang JJ, et al. Role of near work in myopia: findings in a sample of Australian school children. Invest Ophthalmol Vis Sci. 2008;49(7):2903-10. doi: 10.1167/iovs.07-0804

Singh NK, James RM, Yadav A, Kumar R, Asthana S, Labani S. Prevalence of myopia and associated risk factors in schoolchildren in North India. Optom Vis Sci. 2019;96(3):200-5. doi: 10.1097/OPX.0000000000001344

Saxena R, Vashist P, Tandon R, Pandey RM, Bhardawaj A, Menon V, et al. Prevalence of myopia and its risk factors in urban school children in Delhi: the North India Myopia Study (NIM Study). PLoS One. 2015;10(2):e0117349. doi: 10.1371/journal.pone.0117349

McCrann S, Loughman J, Butler JS, Paudel N, Flitcroft DI. Smartphone use as a possible risk factor for myopia. Clin Exp Optom. 2021; 104(1): 35-41. doi:10.1111/cxo.13092

Wang J, Li M, Zhu D, Cao Y. Smartphone overuse and visual impairment in children and young adults: systematic review and meta-Analysis. J Med Internet Res. 2020;22(12):e21923. doi:10.2196/21923

Wang J, Li Y, Musch DC, Musch DC, Wei N, Qi X, et al. Progression of myopia in school-aged children after COVID-19 home confinement. JAMA Ophthalmol. 2021;139(3):293–300. doi:10.1001/jamaophthalmol.2020.6239

Piccoti C, Sanchez V, Irigaray LF, Morgan IG, Iribarren R. Myopia progression in children during COVID-19 home confinement in Argentina. Preprint at

Erdinest N, London N, Levinger N, Lavy I, Pras E, Morad Y. Decreased effectiveness of 0.01% atropine treatment for myopia control during prolonged COVID-19 lockdowns. Cont Lens Anterior Eye. 2021; 3:101475. doi: 10.1016/j.clae.2021.101475

Chang P, Zhang B, Lin L, Chen R, Chen S, Zhao Y, et al. Comparison of myopic progression before, during, and after COVID-19 lockdown. [published online ahead of print, 2021 Mar 23]. Ophthalmology. 2021; S0161-6420(21)00234-7. doi:10.1016/j.ophtha.2021.03.029

Alvarez-Peregrina C, Martinez-Perez C, Villa-Collar C, Andreu-Vazquez C, Ruiz-Pomeda A, Sanchez-Tena MA. Impact of COVID-19 home confinement in children's refractive errors. Int J Environ Res Public Health. 2021;18(10):5347. doi:10.3390/ijerph18105347



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