A five-year retrospective epidemiological study, led by a team of researchers including orthoptist Miriam Conway, and supported by HOYA Vision Care, explored the impact of socio-economic factors and living environments on myopia development in Scottish children aged 3.5 to 5.5 years old. The study looked at refractive error data from between 5,000-7,000 eye exams conducted annually for three years pre-pandemic and two years post-pandemic in primarily Caucasian children. The study found that post-pandemic data revealed an increase in myopia among children, particularly those living in flats/apartments or urban environments.1 The findings align with global concerns about the rise of myopia due to home confinement and increased digital screen time during the pandemic.
The results highlight the need for early intervention to prevent future complications. Myopia progresses faster in children under 12 years old.2 If left untreated, myopia can lead to complications in the future, such as glaucoma, cataracts, retinal detachment or myopic macular degeneration.3
SURPRISED BY DRAMATIC INCREASE
Dr. Conway says she was delighted that the data she had been reviewing on vision screenings in Scotland could complement the work reported by Shah et al., 2023. The new data set included cycloplegic refractions, expanding beyond measuring uncorrected vision, reported in Shah et al.,2023 data that covered a seven-year period, also encompassing a pre- and post-pandemic timeframe.4
The study finds that myopia rates had risen more dramatically than expected after the pandemic, especially when comparing data from before and after the pandemic. This was particularly true of children who were living in apartments or urban environments.
Dr. Conway shares that the increase in myopia was larger than anticipated, with environmental factors like reduced outdoor time and increased near-work activities, such as screen usage, being hypothesized to play a significant role. She and optometrist Rakhee Shah, HOYA’s global scientific and medical affairs manager, echo the concerns that environmental factors can play a big role. But that does not necessarily mean the trend of the pandemic period will continue.
HELPFUL INTERVENTIONS
Dr. Conway notes that some widespread interventions might be having an effect. “China, for example, has implemented major interventions to combat myopia, like mandatory outdoor time and limiting digital exposure.” Research supports that spending time outdoors, particularly in natural environments, can help prevent myopia in children.
Dr. Shah emphasized that there is ongoing global research both to prevent and manage myopia, including understanding the beneficial effects of light exposure and timing of outdoor activities. “Myopia experts are working to address this epidemic,” she says, noting efforts to engage schools, parents, and children in regular vision screenings. “Early detection and consistent follow-ups are critical.”
SCREEN EARLY AND OFTEN
Both Dr. Conway and Dr. Shah stress the importance of early vision screening, which has suffered setbacks due to the pandemic in the U.K. Some screening programs were cut back, and both also worry that if screenings are only offered in a child’s first year of school and not repeated, it’s a missed opportunity. Dr. Conway says in addition to looking for amblyopia, the role of vision screenings for detecting myopia is a valuable tool.
The study’s findings reinforce the need for public conversations about preventing and managing myopia. Dr. Conway believes outdoor activities should be encouraged to mitigate the effects of prolonged indoor time, even during colder seasons. “Let’s not be afraid of winters. Dress children warmly and get the clubs outside,” she says. Actions like that will create better understanding and conversation around the topic.
As Co-Lead for the British and Irish Orthoptic Society Clinical Advisory Group for Vision Screening, she is hopeful that data like this will help support more screening programs to catch amblyopia and refractive error like myopia before it progresses.
Dr. Shah says that HOYA can also add its voice. “From a global perspective, it’s crucial to understand how often children are receiving screenings. Myopia management should be a routine part of child health care, much like dental check-ups.”
The study, presented at the 2024 International Myopia Conference, aligns with prior findings from a similar study in England. Both studies signal an urgent need for action, especially as myopia in children continues to rise post-pandemic.
REFERENCES
- Conway, M.Increasing myopia and associations with deprivation and rural/urban environments in children aged 3.5-5.5 years in Scotland. Presented 25th Sep, IMC 2024. Free paper 3: Risk Factors
- Tricard D, et al.Progression of myopia in children and teenagers: a nationwide longitudinal study. Br J Ophthalmol. 2022;106(8):1104-9.
- Haarman AEG, et al.The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci. 2020;61(4):49.
- Shah R, Edgar DF, Evans BJW. Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data. Ophthalmic Physiol Opt. 2023 May;43(3):454-465. doi: 10.1111/opo.13112. Epub 2023 Mar 3. PMID: 36866712.
- Evans BJW, Pentland L, Evans BEW, Edgar DF, Shah R, Conway ML. Increasing myopia in Scotland at age 3.5-5.5 years: a retrospective epidemiological study. Under review.
