The visual consequences of virtual school: acute eye symptoms in healthy children

Temporal Variations in Convergence Insufficiency Symptomatic Status among University Students before and after COVID-19: A Longitudinal Analysis from 2018 to 2023

The present study aimed to assess the symptomatic status of Convergence Insufficiency (CI) in university students from 2018 to 2023 considering the educational environment pre- and post-COVID-19 pandemic confinements. A Convergence Insufficiency Symptom Survey (CISS) was conducted annually from 2018 to 2023, excluding 2020, in an initial group of 217 third-year Optics and Optometry degree university student participants. In the final group (178 participants), the statistical differences in CISS scores between years were analysed, both overall and by questionnaire subgroup, along with associations between CISS diagnostic categories before and after 2020. Significant differences were found between years in the subscale and total score analyses (Kruskal-Wallis, both p ≤ 0.049). Pairwise comparisons showed significant differences for the performance subgroup in 2021 vs. 2019 and 2018 (Mann-Whitney, both p ≤ 0.004), while in terms of the total score, there was a statistical difference in 2021 vs. 2018 (Mann-Whitney, p < 0.001). The distribution analysis indicated a significant difference between groups (Chi, p = 0.004), with participants from 2021 or later more likely to exhibit higher CISS scores (OR = 3.47, 95%CI 1.04-8.58). The present study shows significant temporal increments in symptomatic status related to CI among university students from 2018 to 2023, indicating a potential impact of the COVID-19 pandemic educational landscape on these outcomes.

Refractive Error Changes Due to COVID-19 Pandemic Confinement in Children from Puerto Rico: A Retrospective Study

SIGNIFICANCE

The progression of myopia increased in children after the pandemic confinement. A myopic shift in the refractive error of the Hispanic population was found regardless of the refractive status of the school-aged children studied.

PURPOSE

This study aimed to evaluate the refractive error in Puerto Rican children before and after the COVID-19 pandemic. We were interested in whether there was a significant change in refractive error attributed to online learning during the pandemic lockdown.

METHODS

A retrospective record review of children aged 7 to 18 years who underwent a comprehensive visual evaluation between 2018 and 2021 at the Inter American Eye Institute in Puerto Rico was performed. The spherical equivalent pre- and post-lockdown was compared. The study excluded the best-corrected visual acuities worse than 20/40, any corneal or retinal disease, and amblyopia.

RESULTS

In total, 801 records were included in this study. The mean age was 12.7 ± 3.2 years, with 50.3% male and 49.7% female children. The mean spherical equivalent for the right and left eyes was similar ( r = 0.93, P ≤ .001). A significant difference in the mean spherical equivalent was found pre- and post- lockdown (0.22 ± 0.59 D, t800 = 10.44, P ≤ .001). A myopic shift post-lockdown was significant for all ages except those in the 7- (0.13 ± 0.79 D, t28 = 0.84, P = .40) and 8-year-old range (0.12 ± 0.65 D, t40 = 1.22, P = .23), respectively. No significant change was found between sexes before (0.16 ± 0.12 D; t799 = 1.38, P = .16) and after (0.15 ± 0.13 D; t799 = 1.19, P = .23) confinement.

CONCLUSIONS

The current study revealed a significant myopic shift in Hispanic school-aged children as a result of the pandemic confinement.

Effects of remote learning during the COVID-19 lockdown on children's visual health: a systematic review

OBJECTIVES

Increased exposure to digital devices as part of online classes increases susceptibility to visual impairments, particularly among school students taught using e-learning strategies. This study aimed to identify the impact of remote learning during the COVID-19 lockdown on children's visual health.

DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Scopus, PubMed and ScienceDirect databases from the year 2020 onwards.

ELIGIBILITY CRITERIA

We included cross-sectional, case-control, cohort studies, case series and case reports, published in English, Spanish or French, that approached the effects of remote learning during the COVID-19 lockdown on visual health in neurotypical children.

DATA EXTRACTION AND SYNTHESIS

We included a total of 21 articles with previous quality assessments using the Joanna Briggs checklist. Risk of bias assessment was applied using the National Institutes of Health quality assessment tool for before-and-after studies with no control group; the tool developed by Hoy et al to assess cross-sectional studies; the Murad et al tool to evaluate the methodological quality of case reports and case series; and the Newcastle-Ottawa Scale for cohort studies.

RESULTS

All but one study reported a deleterious impact of the COVID-19 lockdown on visual health in children. Overall, the most frequently identified ocular effects were refractive errors, accommodation disturbances and visual symptoms such as dry eye and asthenopia.

CONCLUSIONS

Increased dependence on digital devices for online classes has either induced or exacerbated visual disturbances, such as rapid progression of myopia, dry eye and visual fatigue symptoms, and vergence and accommodation disturbances, in children who engaged in remote learning during the COVID-19 lockdown.

PROSPERO REGISTRATION NUMBER

CRD42022307107.

Prevalence and Risk Factors of Parents Perceived Digital Eye Strain Syndrome among Saudi Students 1 Year after Online Studies: A Web-Based Survey

PURPOSE

The purpose is to present the prevalence and risk factors of parents' perceptions of digital eye strain (DES) syndrome 1 year after virtual learning among Saudi students.

METHODS

This web-based survey was conducted in December 2021 in Qassim, Saudi Arabia. Sixteen symptoms of DES were inquired. Parents responded to the frequency and severity of DES symptoms in their wards. The DES score assessed by the parents/guardian was associated with different determinants.

RESULTS

The survey included 704 students. The prevalence of DES was 59.4% (95% confidence interval 55.0; 63.8). Severe (scoring 18+) and moderate (score 12-18) grades of DES were found in 24% and 14% of students, respectively. Headache (20.9%), deterioration of vision (14.5%), difficulty focusing (12.5%), watering/tearing of eyes (10.1%), and blurred vision (10.8%) were noted as main DES symptoms. Girls, intermediate school students, students with spectacles, those with more than 4 h daily screen time or who position devices 25 cm or less from their eyes, and those attending virtual class for more than 4 h a day were found to have significantly severe DES grades. Females (P = 0.16), having outdoor activities of 1+ h (P = 0.02), 2+ h of daily screen time (P = 0.24), and attending virtual class for 4+ h (P = 0.001) were significant predictors of moderate and severe DES. Poor eye health and lower scholastic status were associated with severe DES.

CONCLUSION

DES in students after 1 year of virtual studying was high. Risk factors need to be addressed to avoid DES and its impact on students.