Trends of myopia development among primary and junior school students in the post-COVID-19 epidemic period

Trends in myopia development among Chinese children and adolescents in Xuzhou during one academic year

Purpose

This study investigates the prevalence and progression of myopia among primary and secondary school students in Xuzhou City, China, during one academic year.

Methods

The study employed a prospective research design and utilized a whole-group sampling method to conduct non-cycloplegic spot photo screenings on 37,938 students from 44 primary and secondary schools in Xuzhou City, China. A one-year study was conducted to gather spherical equivalent refraction (SER), and subsequent analysis was carried out to explore the disparities in myopia prevalence among primary and secondary school students within the same academic year, as well as the progression of myopia.

Results

During the 2022 academic year, the overall prevalence of myopia in the first and second semesters was 62.6 and 64.2% respectively, indicating an increasing trend. Particularly in primary school (Grades 1-6), the prevalence of myopia increased with higher grade levels, and significant variations in myopia prevalence were observed mainly in grades 1-3 and 7 (p < 0.05). The incidence rate of myopia in middle school remained stable, while in primary school, there was a positive correlation between myopia incidence and the grade level, with the highest rate of 20.1% in grade 6. Among the myopic population, the median value of spherical equivalent refraction slightly decreased between the two semesters. The proportion of high myopia increased among students in grades 5-8.

Conclusion

Our study revealed that within one academic year, the prevalence of myopia and the severity of myopia have significantly increased in Xuzhou City, China, accompanied by an increase in the proportion of high myopia. For different grade levels, we should adopt personalized prevention and control measures, with a particular focus on lower grade levels and students who have just entered a new grade.

Prevalence and related factors of children myopia in Pudong New Area, Shanghai: a cross-sectional study

OBJECTIVES

This study aimed to assess the prevalence and related factors of myopia among school-aged children after COVID-19 pandemic.

DESIGN

Cross-sectional study.

SETTING

Pudong New Area, Shanghai.

PARTICIPANTS

1722 children aged 7-9 randomly selected from 8 primary schools were screened from 1 February 2023 to 30 April 2023.

MAIN OUTCOME MEASURES

Children's height, weight and eye parameters were examined. Myopia was defined as a cycloplegic spherical equivalent ≤-0.50 dioptres in either eye. A vision-related behaviour questionnaire was applied to investigate the associations between myopia and its risk factors.

RESULTS

Of the 1722 individuals enrolled, 25.6% (456) had myopia. After adjusting other characteristics, the following factors were associated with an increased rate of myopia: age (9 years vs 7 years, adjusted OR (AOR) 1.84, 95% CI 1.18 to 2.85, p=0.007), parental myopia status (both myopia vs none, AOR 5.66, 95% CI 3.71 to 8.63, p<0.001; one myopia vs none, AOR 2.92, 95% CI 1.93 to 4.42, p<0.001), reading books too close (yes vs no, AOR 1.58, 95% CI 1.20 to 2.08, p=0.001), writing with a tilted head (yes vs no, AOR 1.37, 95% CI 1.05 to 1.77, p=0.019), sleep patterns (early to bed late to rise vs early to bed early to rise, AOR 1.52, 95% CI 1.02 to 2.26, p=0.039). By contrast, a higher monthly household income and the habit of reading while lying down were associated with lower risk of myopia.

CONCLUSIONS

The prevalence of myopia is of concern among young school-aged children after COVID-19. Correcting eye use behaviour and improving sleep habits may reduce myopia. Also, gender differences should be considered in prevention strategies for children's myopia.

Prevalence Trend of Myopia during the Post-COVID-19 Epidemic Period among Preschoolers: A Prospective School-based Study

SIGNIFICANCE

Changes in behavior and lifestyle during the post-coronavirus disease 2019 (COVID-19) epidemic may have some impact on myopia rates in preschoolers, and exploring the changes in myopia rates in preschool children may inform the formulation of myopia prevention and control policies.

PURPOSE

This study aimed to investigate the prevalence of myopia in preschool children during the post-COVID-19 epidemic period in Xuzhou, China.

METHODS

A series of cross-sectional school-based studies was conducted. A total of 117,632 preschool children aged 3 to 6 years were subjected to annual vision screening from 2019 to 2021. Spot photo screening was used to record the spherical equivalent refraction for each child and to analyze the prevalence of myopia by age, sex, and region during the post-COVID-19 epidemic period.

RESULTS

A total of 113,979 preschool children were included in the analysis, of whom 60,784 (53.3%) were male and 53,195 (46.7%) were female. For all children, the mean ± standard deviation spherical equivalent refraction in 2019, 2020, and 2021 was +0.32 ± 0.50, +0.34 ± 0.55, and +0.34 ± 0.54 D, respectively (all P < .05), indicative of a very slight hyperopic shift. In all age groups, the change in mean spherical equivalent refraction and its distribution were relatively stable. From 2019 to 2021, the overall prevalence of myopia in preschool children was 3.1, 3.3, and 3.5%, respectively. The rise in myopia rates was minimal. The largest increase in the annual prevalence of myopia was seen among children aged 6 years, at 0.5%, followed by those aged 5 years (0.4%) and aged 3 years (0.4%). The prevalence was higher in boys than girls and in urban versus rural areas.

CONCLUSIONS

During the post-COVID-19 epidemic period, the refractive status of Xuzhou preschool children remained stable.

Comparison of myopia progression among Chinese schoolchildren before and during COVID-19 pandemic: a meta-analysis

AIM

To compare myopia progression in Chinese schoolchildren before and after the COVID-19 pandemic home confinement.

METHODS

This study was done through the data searched from PubMed, Embase, Cochrane Library, and Web of Science from January 2022 to March 2023 related to the COVID-19 pandemic home confinement and myopia progression among Chinese schoolchildren. Myopia progression was evaluated by the mean change of spherical equivalent refraction (SER) and axial length (AL) before and during the COVID-19 pandemic. Sex and regional differences in myopia progression among schoolchildren before and during the COVID-19 pandemic were also analyzed.

RESULTS

A total of eight eligible studies were included in this study. There was a significant difference in SER before and during home confinement during the COVID-19 pandemic (OR = 0.34; 95%CI = [0.23, 0.44]; Z = 6.39; P < 0.00001), but no significant difference in AL (OR = 0.16; 95%CI = [- 0.09, 0.41]; Z = 1.22, P = 0.22). There was a significant difference in SER between male and female groups during the COVID-19 home confinement (OR = 0.10; 95%CI = [0.00, 0.19]; Z = 1.98, P = 0.05). As for regional analysis, there was a significant difference in SER between urban and rural areas during the COVID-19 quarantine period (OR = -0.56; 95%CI = [- 0.88, - 0.25]; Z = 3.50, P = 0.0005).

CONCLUSIONS

Compared with the time before the COVID-19 home confinement, a higher rate of myopic progression among Chinese schoolchildren during the period of the COVID-19 pandemic was demonstrated.

Challenges of refractive cataract surgery in the era of myopia epidemic: a mini-review

Myopia is the leading cause of visual impairment in the world. With ever-increasing prevalence in these years, it creates an alarming global epidemic. In addition to the difficulty in seeing distant objects, myopia also increases the risk of cataract and advances its onset, greatly affecting the productivity of myopes of working age. Cataract management in myopic eyes, especially highly myopic eyes is originally more complicated than that in normal eyes, whereas the growing population of cataract with myopia, increasing popularity of corneal and lens based refractive surgery, and rising demand for spectacle independence after cataract surgery all further pose unprecedented challenges to ophthalmologists. Previous history of corneal refractive surgery and existence of implantable collamer lens will both affect the accuracy of biometry including measurement of corneal curvature and axial length before cataract surgery, which may result in larger intraocular lens (IOL) power prediction errors and a compromise in the surgical outcome especially in a refractive cataract surgery. A prudent choice of formula for cataract patients with different characteristics is essential in improving this condition. Besides, the characteristics of myopic eyes might affect the long-term stability of IOL, which is important for the maintenance of visual outcomes especially after the implantation of premium IOLs, thus a proper selection of IOL accordingly is crucial. In this mini-review, we provide an overview of the impact of myopia epidemic on treatment for cataract and to discuss new challenges that surgeons may encounter in the foreseeable future when planning refractive cataract surgery for myopic patients.