Progression of Myopia in School-Aged Children After COVID-19 Home Confinement

  • Time spent in outdoor activities has decreased owing to home confinement for the coronavirus disease 2019 (COVID-19) pandemic. Concerns have been raised about whether home confinement may have worsened the burden of myopia owing to substantially decreased time spent outdoors and increased screen time at home.

  • The objective of the study is to investigate the refractive changes and prevalence of myopia in school-aged children during the COVID-19 home confinement.

  • A prospective cross-sectional study using school-based photoscreenings in 123,535 children (64,335 [52.1%] were boys) aged 6 to 13 years from 10 elementary schools in Feicheng, China, was conducted. The study was performed during 6 consecutive years (2015-2020). Data were analyzed in July 2020.

  • A total of 194,904 test results (389,808 eyes) were included in the analysis. A substantial myopic shift (approximately −0.3 diopters [D]) was found in the 2020 school-based photoscreenings compared with previous years (2015-2019) for younger children aged 6 (−0.32 D), 7 (−0.28 D), and 8 (−0.29 D) years.

  • The prevalence of myopia in the 2020 photoscreenings was higher than the highest prevalence of myopia within 2015-2019 for children aged 6 (21.5% vs 5.7%), 7 (26.2% vs 16.2%), and 8 (37.2% vs 27.7%) years.

  • The differences in spherical equivalent refraction and the prevalence of myopia between 2020 and previous years were minimal in children aged 9 to 13 years.

  • Home confinement during the COVID-19 pandemic appeared to be associated with a significant myopic shift for children aged 6 to 8 years according to 2020 school-based photoscreenings.

  • However, numerous limitations warrant caution in the interpretation of these associations, including use of noncycloplegic refractions and lack of orthokeratology history or ocular biometry data.

  • Younger children’s refractive status may be more sensitive to environmental changes than older ages, given the younger children are in a critical period for the development of myopia.

Publication date

February 23, 2021


JAMA Ophthalmology

Sponsor Institution

Tianjin Municipal Science and Technology Commission and m Tianjin Medical University Eye Hospital High-Level Innovative Talent Program for Distinguished Scholar


Jiaxing Wang, MD, PhD; Ying Li, MD, PhD; David C. Musch, PhD, MPH; et al
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