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Chinese myopia-lockdown study a portent for Australia

A new phenomenon dubbed “quarantine myopia” is making waves in Australia in the wake of a Chinese study that found myopia prevalence was three times higher in six-year-olds during the COVID-19 pandemic.

The cross-sectional study tested 123,535 children and found a substantial myopic shift (−0.3 diopters) for children aged six to eight years after home confinement due to coronavirus.

The study and related editorial published in JAMA Ophthalmology noted the prevalence of myopia appeared to be approximately three times higher in 2020 than in other years for children aged six, two times higher for seven-year-olds, and 1.4 times higher for those aged 8.

Such a substantial increase was not seen in older age groups (9-13 years), despite being offered more intense daily online learning courses. The researchers state this may indicate younger children’s refractive status may be more sensitive to environmental changes.

According to Optometry Australia (OA) chief clinical officer Mr Luke Arundel, the findings were important because children worldwide had done months of home schooling, including in Australia where schools were closed and sport cancelled.

“Researchers have told us for many years now the importance of balancing screen time with green time for kids and that spending time outside in bright light is important to slow myopia development and progression,” Arundel said in an article on the OA website.

“It will be interesting to see if Australian practitioners, particularly in Victoria – where an extended lockdown occurred with time outside limited to just one hour a day – will also see a similar increase in myopia.”

Although Australia does not have the scientific evidence to substantiate the effects of quarantine on children’s eyesight yet, there is growing anecdotal evidence that myopia progression is accelerating here.

In an interview with Insight in December, Dr Philip Cheng, director of The Myopia Clinic in Melbourne, said he noticed a drastic rise in myopia during the final six months of 2020.

Melbourne optometrist Dr Philip Cheng says myopia progression has worsened during the pandemic.

“I’m seeing more children diagnosed with myopia for the first time, young kids with high myopia who have progressed rapidly, and at-risk children with axial length increase. I’ve seen a discernible change, which I think is environmental, as a result of the extended Stage 4 lockdowns in metropolitan Melbourne,” he said.

Like Cheng’s clinic in inner-Melbourne, optometrist Ms Jessica Chi at Eyetech Optometrists in Carlton also noticed an increase in myopia progression last year in patients who had been otherwise stable.

“Generally speaking, we’re seeing more kids with myopia now than in the past – not just East Asian kids but now Caucasian kids too. And after seven months of lockdown in Melbourne, we’re seeing more myopia progression. Why? Kids are spending less time outdoors and more time on screens during home-schooling,” Chi said.

Ms Susan Ang, owner of Eyestore with practices in Bankstown in Sydney, and Kiama, south of Wollongong, said she has noticed myopia progression accelerating amongst her predominantly Asian patient base in her Bankstown practice.

Ms Susan Ang, Eyestore.

She said NSW had six weeks of school lockdown last year, and with parents working from home on devices up to 10 hours a day, kids followed suite.

“I saw a child in February before the practice was closed during lockdown. We re-opened in May and the child came in for their three-month review. The increase in diopters I would normally see over the course of a year, I saw in six months,” she said.

She said kids that were following a myopia management treatment plan fared better than those opting for single-vision correction or no correction.

“For the patients under my care, those on atropine 0.05% fared the best in combination with orthokeratology, bifocal, or multifocal vision correction,” she said.

“It has fortified my view that some treatment is better than none.”

Ang said the “quarantine myopia” phenomenon was an emerging topic of discussion on Australian optometry forums, with practitioners raising concerns about the rate of change in dioptres among their myopia patients.

“It’s palpable, you can feel that increase,” she said.

The study ‘Progression of Myopia in School-Aged Children After COVID-19 Home Confinement’ can be found here.

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