Examining risk factors related to digital learning and social isolation: Youth visual acuity in COVID-19 pandemic

Cognitive Flexibility's Role in Reducing Academic Stress During the COVID-19 Pandemic

Background

Cognitive flexibility (CF) in the psychological literature has been described as an individual's ability to produce several solutions and retain control in novel situations. Recently, the COVID-19 pandemic appeared to be an ideal scenario that demanded the application of adaptive thinking by students to deal with several challenges of the pandemic.

Aim

This study aimed to assess the role of CF in reducing academic stress among university students due to the sudden and strict implementation of online education during the COVID-19 pandemic.

Methods

This study employed a cross-sectional survey design and data collection was completed during the 2020-2021 academic year. The study sample comprised 328 university students from Saudi Arabia. The online survey method was used, and study tools comprises of reliable and valid psychological measures to assess CF, academic stress, the negative impact of the COVID-19 pandemic, and emotional symptoms. IBMSPSS25 was used for statistical analysis of data. Multiple regression analysis was applied to determine the role of CF in reducing academic stress after controlling for other factors such as gender, age, academic year, negative impact of COVID-19 on daily life, and unpleasant emotional experiences.

Results

CF was significantly decreased the risk of experiencing academic stress (b = ‒0.196, t = ‒3.54; p < 0.001; 95% CI = ‒3.53 to ‒0.11) after controlling for the negative impact of the COVID-19 pandemic on daily life (b = 0.119, t = 2.09; p < 0.05; 95% CI = 0.02-0.63) and emotional repercussions (b = 0.109, t = 1.91; p < 0.05; 95% CI = ‒0.01-0.15).

Conclusion

The current findings suggest that CF could be fostered among university students as a useful mental tool to cope with academic stress during less-structured educational and social circumstances that may impact their daily lives and emotional wellness.

Effects of behaviors and surrounding environment on myopia before and during the COVID-19 pandemic: a longitudinal analysis of children and adolescents in China

Aim

To investigate the relationship between related factors and visual acuity of Chinese school students before and during the COVID-19 pandemic.

Subject and methods

Chinese students from primary and secondary schools were included from the Chinese National Surveys on Students' Constitution and Health CNSSCH (2019). A total of 1496 participants completed follow-ups in June and December 2020, respectively. Generalized estimating equations were used to test the differences in visual environment. Logistic regression models were utilized to examine the roles of behaviors and surrounding environment changes associated with myopia before and during the pandemic.

Results

The prevalence of myopia was 47.7%, 55.6%, and 57.2% in baseline and two follow-ups, respectively. Significant differences existed for gender, learning level, and region (all P < 0.05). The proportion of new myopia and myopia torsion was the highest in the primary schools. Multivariate logistic regression analysis found that screen time ≥ 4h/d (OR = 2.717), poor eye habits (OR = 1.477), insufficient lighting for studying at night (OR = 1.779), desk or roof lamps only (OR = 1.388), and poor sleep quality (OR = 4.512) were the risk factors for myopia (all P < 0.05), and eye exercises (OR = 0.417), milk intake (OR = 0.758), and eggs intake (OR = 0.735) were the protective factors for myopia (all P < 0.05).

Conclusion

Prevalence of myopia increased among Chinese students before and during the COVID-19. It is necessary to pay more attention to the pupils' visual acuity, especially in primary school students, in the future.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01900-w.

Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data

PURPOSE

Myopia prevalence has increased in the UK at age 10-16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4-5 years of age.

METHODS

Retrospective anonymised data from computerised vision screening at age 4-5 years were analysed from serial cross-sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The criterion used was unaided monocular logMAR (automated letter-by-letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of detecting bilateral, moderate myopia rather than amblyopia.

RESULTS

Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2-8.0), 8.5 (8.1-8.9), 7.5 (7.1-7.9), 7.8 (7.4-8.2), 8.7 (8.1-9.2), 8.5 (7.9-9.0) and 9.3 (8.8-9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing frequency of myopia (p = 0.06). A decreasing linear trendline was noted for children 'Under Professional Care'.

CONCLUSIONS

For children 4-5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hypothesis of increasing myopia. The increase in screening failures highlights the importance of eye care in this young population.

Using the C-Read as a Portable Device to Evaluate Reading Ability in Young Chinese Adults: An Observational Study

We evaluated the reading characteristics of normal-sighted young adults using C-Read to provide baseline healthy population values. We also investigated the relationship between the National Eye Institute’s Visual Functioning Questionnaire (VFQ-25) score and reading ability, myopia, and hours of screen use, focusing on the extent to which these factors affect participants’ visual function and, ultimately, their vision-related quality of life (QoL). Overall, 207 young, healthy participants (414 eyes) aged 18–35 years were tested for reading speed using C-Read connected to a smartphone-based application between December 2022 and January 2023. Each participant received a VFQ-25 questionnaire to evaluate vision-related QoL. Data on daily e-screen usage hours were collected. Among the participants, 91 (44.0%) were women; their mean (SD) age was 22.45 (4.01) years. The mean (SD) reading acuity (RA) was 0.242 (0.124), 0.249 (0.120), and 0.193 (0.104) logarithmic minimum angle of resolution (logMAR) for the right, left, and both eyes, respectively. The mean (SD) maximum reading speed (MRS) was 171.65 (46.27), 168.59 (45.68), and 185.16 (44.93) words per minute (wpm) with the right, left, and both eyes, respectively. The mean (SD) critical print size (CPS) was 0.412 (0.647), 0.371 (0.229), and 0.419 (1.05) logMAR per the right, left, and both eyes, respectively. The RA and CPS were significantly different between sexes (p = 0.002 and p = 0.001). MRS was significantly different between the education level (p = 0.005) and myopia level groups (p = 0.010); however, it was not clear whether this difference was confounded by age. The myopic power in diopters significantly affected RA (coefficient, −0.012; 95% CI, −0.018 to −0.006; p = 0.001); screen time significantly affected MRS (coefficient, 0.019; 95% CI, 0.57 to 6.33; p = 0.019). RA (coefficient, −21.41; 95% CI, −33.74 to −9.08; p = 0.001) and duration of screen use (coefficient, -0.86; 95% CI, −1.29 to −0.43; p < 0.001) independently had a significantly negative correlation with VFQ-25 scores. Our findings provide a baseline value for C-Read in normal-sighted young adults. Refractive status significantly affected RA, while screen time significantly affected MRS. Interventions aimed at enhancing RA may have the potential to maximize vision-related QoL and enable older adults with impaired vision to achieve greater outcomes. Future, larger-scale, C-Read experiments will help provide newer, more optimal methods for the early diagnosis of visual impairment.

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 and axial length in school-aged children before, during, and after the COVID-19 lockdown-A population-based study

Background

Myopic shift had been observed during the COVID-19 lockdown in young school children. It remains unknown whether myopic shift is accompanied with increase in axial length. We aimed to evaluate the impact of the COVID-19 lockdown on myopia and axial length of school children in China by comparing them before, during and after the lockdown.

Methods

In this population-based cross-sectional study, school-based myopia screenings were conducted in the Fall of 2019, 2020, and 2021 (representing before, during and after COVID-19 lockdown respectively) in Chengdu, China. Myopia screenings were performed on 83,132 students aged 6 to 12 years. Non-cycloplegic refractive error was examined using NIDEK auto-refractor (ARK-510A; NIDEK Corp., Tokyo, Japan) and axial length was measured using AL-Scan (NIDEK Corp., Tokyo, Japan). Spherical equivalent (SER, calculated as sphere+ 0.5^*cylinder), prevalence of myopia (SER ≤ -0.50 D), and axial length were compared across 3 years stratified by age.

Results

Myopia prevalence rate was 45.0% (95% CI: 44.6-45.5%) in 2019, 48.7% (95% CI: 48.3-49.1%) in 2020, and 47.5% (95% CI: 47.1-47.9%) in 2021 (p < 0.001). The mean non-cycloplegic SER (SD) was -0.70 (1.39) D, -0.78 (1.44) D, and -0.78 (1.47) D respectively (p < 0.001). The mean (SD) axial length was 23.41 (1.01) mm, 23.45 (1.03) mm, and 23.46 (1.03) mm across 3 years respectively (p < 0.001). From the multivariable models, the risk ratio (RR) of myopia was 1.07 (95% CI: 1.06-1.08) times, the SER was 0.05 D (95% CI: 0.04 D to 0.06 D) more myopic and the mean axial length increased by 0.01 mm (95% CI: 0.01 mm to 0.02 mm) in 2020 compared to 2019. In 2021, the risk ratio (RR) of myopia was 1.05 (95% CI: 1.04-1.06), the mean SER was 0.06 D (95% CI: 0.05 D to 0.07 D) more myopic, and the mean axial length increased by 0.03 mm (95% CI: 0.02 mm to 0.04 mm) compared to 2019.

Conclusions

The COVID-19 lockdown had significant impact on myopia development and axial length, and these impacts remained 1 year after the lockdown. Further longitudinal studies following-up with these students are needed to help understand the long-term effects of COVID-19 lockdown on myopia.

Effects of physical activity and use of digital devices on visual acuity in children and adolescents during the COVID-19 pandemic: A cross-sectional study

Purpose

To determine the association between poor visual acuity, the use of digital devices and physical activity (PA) during the COVID-19 pandemic.

Methods

A total of 327,646 Chinese children and adolescents were included in the analysis using a cluster random sampling method; this is a case-control study, of those 144,708 children and adolescents with poor visual acuity were included in the case group, while 182,938 who did not have poor visual acuity were included in the control group. A logistic regression model was used to assess the contribution of PA and the use of digital devices to poor visual acuity.

Results

A total of 144,708 children and adolescents experienced poor visual acuity during the COVID-19 pandemic; 54.8% were male, and 55.2% live in rural areas. Compared to controls, children and adolescents with poor visual acuity exhibited more time for the use of digital devices (4.51 ± 2.44 vs. 3.79 ± 2.34 for cases and controls, respectively; P < 0.001) and PA (3.07 ± 0.92 vs. 2.85 ± 1.00 for cases and controls, respectively; P < 0.001). During the COVID-19 pandemic, risk factors related to poor visual acuity among children and adolescents included the use of digital devices (OR 1.135; 95% CI 1.132-1.139), and PA (OR 1.269; 95%CI 1.259-1.278). The results of interaction analysis show that for children and adolescents aged 12 to 17, the positive association between the use of digital devices and poor visual acuity decreased. The interaction effect between PA and digital devices is 0.987.

Conclusions

Children and adolescents were at risk of poor visual acuity during the COVID-19 pandemic. Extended use of the digital devices increased the risk of poor visual acuity, especially for children aged 6-11 years. But the risk of poor visual acuity among children and adolescents decreases as the time spent on PA increases.

The association between sedentary behavioral characteristics and poor vision among Chinese children and adolescents

Introduction

To understand the features of sedentary behavior of Chinese children and adolescents and its relationship with poor visual acuity, a self-administered "Questionnaire on Sedentary Behavior of Children and Adolescents" was used to survey 4,203 students in grades 4-12 in six administrative regions of China.

Results

(1) The average time spent in sedentary behaviors (SB) of Chinese children and adolescents was about 8.1 h per day, of which the academic sedentary time was the longest, accounting for 79.2% of total sedentary time. The total time spent on SB and the time spent on studying SB were more in the upper grades and less in screen SB and cultural leisure SB, respectively. There were significant sex differences in total SB time (p < 0.05) and weekend sedentary behaviors time (SB-WD) (p < 0.01) among Chinese children and adolescents, with girls being more likely to be higher than boys. There were also significant differences in sedentary time across different regions (p < 0.05), and the longest total sedentary time in East China. (2) Reduction parents' sedentary time and limitation of sedentary behaviors and the use of electronics among children and adolescents can effectively reduce sedentary time among Chinese children and adolescents. (3) Sedentary time was significantly higher in children and adolescents with poor vision than in those with normal vision (p < 0.01), and study SB and screen SB were important independent factors affecting vision. (4) Timing of breaks in SB can play a positive role in promoting vision health.

Conclusion

There were significant grade, sex, and regional differences in the SB of Chinese children and adolescents, and sedentary time was strongly related to the prevalence of poor vision detection rate.

The Impact of the COVID-19 Pandemic on Myopia Progression in Children: A Systematic Review

Myopia is the most common refractive error among children. The coronavirus disease 2019 (COVID-19) pandemic has affected children's health in many ways. Policy changes due to the COVID-19 pandemic, such as home quarantine and online schooling, have been proposed as causes for the increased risk of myopia progression. During strict home quarantine, children spend less time outdoors and more time using electronic devices which are important risk factors associated with myopia. Our systematic review aims to assess the relationship between myopia progression and these risk factors in children.

We did the literature search from PubMed, Google Scholar, and ScienceDirect. A total of 10 research papers were selected for final review using the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines. The research articles used had a quality of more than 70%. The quality of these articles was determined using the Joanna Briggs Institute (JBI) tool. Our review included eight cross-sectional and two cohort studies. Most of these studies used questionnaires to assess the risk factors of myopia. Standardized ocular examinations were done in most studies to measure visual acuity, spherical equivalent, and axial lengths. Our study found that the progression of myopia was affected by the reduced time spent outdoors and increased screen time during the pandemic. We also found that children's increased use of electronic devices, such as mobile phones and tablets, has significantly affected myopia progression during the pandemic.

Psychological and Social Vulnerability in Spaniards' Quality of Life in the Face of COVID-19: Age and Gender Results

Following the serious health situation in Spain and around the world in 2020 and 2021 stemming from COVID-19, this paper examines how the most vulnerable groups (in social and health terms) in Spanish society suffered the worst impacts on their quality of life during the pandemic. The review of the literature and publications released by the health authorities highlight the high number of cases of illness and death due to COVID-19; however, there are no studies about how it has affected aspects of citizens' daily lives, considering some of their sociodemographic characteristics such as age and gender. A key issue when measuring citizens' quality of life is that we typically see a U-shaped curve by age group, where young people register the highest shares along with the elderly; nevertheless, the pandemic has clearly brought about a change in this regard. In this study, we corroborate this finding, along with the psychological issues underlying this fact in young people and the physical ones in the elderly. To do so, we use an ANOVA and regression analysis with data from a sample of 908 Spanish citizens belonging to different age groups. These data were collected through an online survey distributed throughout Spain, mostly by email and social media, between 15 February and 15 April 2021 with a margin of error of 3.25% and a confidence level of 95%. Furthermore, the analysis allowed us to determine how aspects of daily life-family situation, living conditions, social environment, employment and financial situation-have been negatively affected during the pandemic, clearly depending on the age of the people surveyed, pushing them towards social and health vulnerability.

Complex Interplay Between COVID-19 Lockdown and Myopic Progression

Purpose

To compare the myopic progression before and during strict home confinement when coronavirus disease 2019 (COVID-19) outbreak and explore the potential influencing factors.

Methods

A cross-sectional study. One hundred and fifteen myopic children (115 right eyes) who replace their frame-glasses from December 2019 to January 2020 and with complete refractive records in our hospital since myopia were involved in the study. At the beginning of the strict home confinement and after a 3-month strict home confinement during the COVID-19 pandemic, they were invited to our hospital to examine the axial length and refractive errors. And visual functions, convergence insufficiency symptom survey (CISS) scale and questionnaires were also performed. Besides, the axial length and refractive errors before the COVID-19 were got from outpatient case files. The effect of strict home confinement on myopia was assessed by comparing monthly axial elongation before COVID-19 and during strict home confinement. Spearman correlation analysis was performed to explore the correlation between potential influencing factors and myopia progression.

Results

Axial length's monthly elongation during strict home confinement was 35% higher than normal periods (0.046 vs. 0.033 mm/month, P = 0.003). The proportion of severe asthenopia doubled (P = 0.020). For myopia progression, heredity, close indoor work time and electronic products were risk factors. Besides, the protective factors were age, rest time after continuous eye usage, sleep time and distance from eye to computer screen.

Conclusions

During COVID-19, the decline in outdoor activities and increase of exposure time to digital screens accelerated the progression of myopia by 1/3.

Psychological Distancing Usage Uniquely Predicts Reduced Perceived Stress During the COVID-19 Pandemic

Social distancing during the COVID-19 pandemic has presented millions of people with extraordinary challenges that are associated with significant amounts of stress. Emotion regulation is crucial during this crisis as people seek to mitigate the stress and uncertainty of the present moment. In this study, we surveyed a nationally representative sample of 297 adults from the United States on their levels of perceived stress related to the COVID-19 pandemic as well as their level of engagement of different emotion regulation strategies during the pandemic. We performed multiple linear regression analyses to assess which regulation strategies were associated with individual differences in perceived stress. Among all emotion regulation strategies, psychological distancing, which involves thinking about stressful circumstances in an objective, impartial way, was uniquely associated with reductions in perceived stress due to COVID-19 across individuals. This effect was not moderated by age, gender, socioeconomic status, race/ethnicity, or trait-related difficulty in regulating emotion. Conversely, situation modification was associated with significantly greater perceived stress overall. These results suggest the broad applicability and utility of psychological distancing during pandemic-related social distancing as part of an adaptive emotion regulation toolkit and motivate the investigation of interventions involving psychological distancing in this context.

The Impact of Study-at-Home During the COVID-19 Pandemic on Myopia Progression in Chinese Children

Background: To assess the impact of study-at-home during the COVID-19 pandemic on myopia development in Chinese schoolchildren. Methods: This historical cohort involved two groups with a total of 154 children. The exposed group was formed from 77 children aged 8 to 10 years who studied at home in the 7-month period during the COVID-19 pandemic (follow-up period: January - August 2020) and did not study at home in the 7-month period before the COVID-19 outbreak (baseline period: July 2019 - January 2020). Seventy-seven children who did not undergo study-at-home (baseline period: 7 months in 2015, follow-up period: 7 months in 2016) were included in the control group. Cycloplegic refraction, axial length and uncorrected visual acuity were measured 3 times. The questionnaire mainly focused on collecting visual habits. Results: Myopia progression was similar between the two groups in the baseline period. However, in the follow-up period the exposed group had a greater change in refraction toward myopia (-0.83 ± 0.56 D) than the control group (-0.28 ± 0.54 D; p < 0.001). In addition, the exposed group exhibited a significantly greater change in refraction toward myopia in the follow-up period (-0.83 ± 0.56 D) than in the baseline period (-0.33 ± 0.46 D; p < 0.001). Difference-in-difference analysis indicated that study-at-home accelerated the change in refraction toward myopia (t = -0.567; p < 0.001). Conclusions: During the COVID-19 pandemic study-at-home accelerated the change of refraction toward myopia in children.

The Impact of Extended E-Learning on Emotional Well-Being of Students during the COVID-19 Pandemic in Saudi Arabia

Educational institutions in Saudi Arabia extended e-learning until the third semester of the academic calendar to prevent the spread of COVID-19 infection and to achieve 70% inoculation for the Saudi population. This study assesses the impact of extended e-learning and other associated stressors on the emotional health of university students in Saudi Arabia. An online cross-sectional survey collected data between the months of January–March 2021. The emotional signs of stress were measured by using a subset of items from the COVID-19 Adolescent Symptom and Psychological Experience Questionnaire (CASPE). Data about demographic variables, educational characteristics and academic performance were also collected. A regression analysis was performed to determine predictors of emotional health. A total of 434 university students including females (63%) and males (37%) provided responses. One-third of students (33%) indicated that the COVID-19 pandemic and its resulting changes including online distance studies greatly influenced their daily lives in a negative way. The regression analysis demonstrated that female students and students with average academic performance had increased vulnerability to experience emotional signs of stress (p < 0.05). The factors ‘Not going to university’ and ‘Not having a routine life’ were significant predictors of stress responses (p < 0.01) and (p < 0.001) respectively. E-learning during the COVID-19 pandemic made it possible for students to complete their studies as per academic calendar; simultaneously, it increased the vulnerability to experience stress, particularly for female students and students with average academic performance. These findings imply that academic advising and counseling services should be more readily available during digital studies to support at risk students.

Online Learning-Related Visual Function Impairment During and After the COVID-19 Pandemic

This study aimed to review the consequences of increased online learning, which was precipitated by the coronavirus disease 2019 (COVID-19), on visual function, as well as the methods for preventing the associated visual impairment. The recent finding implies that a higher incidence of myopia may be observed during the pandemic than that before. The myopia prevalence was 59.35% in COVID-19, which was higher than that in the normal period. COVID-19-related influence of developing myopia among students should be addressed and under control. Online learning precipitated by COVID-19 is likely to increase the global burden of visual function impairment. This review highlighted useful measures to prevent online learning-related visual function impairments, including the following: (1) desktop illumination of no >300 lx, online learning time for primary, and middle-school students of no more than 20–30 min per session; (2) daily video time for preschool children not exceeding 1 h, and for school-age children and adolescents not exceeding 2 h; (3) after every 30–40 min of online learning, moving eyes away from the screen or closed for 10 min; (4) engaging in outdoor activities for ≥ 2 h a day; (5) suitable screen and learning environment settings and correct postures for reading and writing; (6) sufficient sleep and proper nutrition. Preventing online learning-related visual impairment during and after this unprecedented pandemic will facilitate future ophthalmic practice.