A New Focus on COVID-19 and Children’s Myopia

This post was originally published on St. Louis American

By Sylvester Brown Jr.

Nearly 190,000 African Americans have low vision, according to the National Eye Institute. That number is comprised of Black people who have had a recent vision test.

Unfortunately, a Population Research and Policy Journal study concluded that Black Americans are twice as likely to have no insurance than their white counterparts.

“Without medical insurance, they are less likely to go to a doctor when their vision starts to deteriorate. They are also less likely to get surgery for their eye diseases, which explains this degree of higher prevalence of glaucoma and blindness in this population.”

African Americans are at higher risk for glaucoma at a much younger age than other populations.

Now, there is another concern, and it is a result of COVID-19. It’s referred to as COVID-related myopia.

Myopia, or nearsightedness, is a disease that usually starts in school-aged children and causes the eye to grow too long. Long-sightedness leads to problems with near vision (seeing things that are close up) and the eyes may commonly become tired.

A study published in the Jan. 2021 Journal of the American Medical Association (JAMA) found that home confinement during the pandemic created a significant increase in myopia for children aged 6 to 8 years.

Additionally, studies from Hong Kong, Turkey and the Netherlands also link the pandemic to an increase in myopia among young children.

The problem is also growing in the United States, said Dr. Vito Vricella, lead optometrist and owner of Fenton Family Eye Care.

“Since the start of the pandemic, we’ve observed a marked increase in the number of myopia cases we’re treating.”

Vricella was quoted in a release published by Treehouse Eyes, self-described as “the only healthcare practice in the country dedicated exclusively to treating myopic children.”

As a result of the pandemic, Vricellasaid, “children were forced indoors for social time and virtual learning, and their exposure to screen time skyrocketed up to 14 hours a day, putting their eye health at greater risk for myopia development.”

Treehouse Eyes is a business specializing in Myopia Treatment. For a non-business-related perspective, Dr. James Hoekel, OD, Pediatric Optometrist at St. Louis Children’s Hospital Department of Pediatric Ophthalmology offers an opinion. 

Hoekel said the relationship between increased myopia in children and COVID-related home confinement is a bit more complicated than many in his profession profess.

Yes, there’s an increase of nearsightedness around the world, Hoekel confirmed. And, yes, there’s an indoor component where children are not going outside as much as previous generations. But, the optometrist added, you can’t dismiss genetics.

“If both parents are myopic,” Hoekel said, “then it’s more likely the children will be myopic.”

Hoekel, who’s been involved with FDA ophthalmology studies for almost four years, is not dismissive of a potential myopia epidemic among children that’s related to COVID. He’s just cautious about classifying it as a direct impact on children in America….yet.  

“If you go to Korea the rates are extremely high, like 98%,” Hoekel said. “But our rates are heading toward 50%. We’re not quite there yet but we’re increasing.”

Because of high myopia rates in children in places like Korea, Singapore and Hong Kong, Hoekel said some ophthalmologists and companies like TreeHouse Eyes “are trying all sorts of strategies” like orthokeratology (“ortho-k,”) where special lenses are worn overnight to gently correct the shape of the cornea. 

But Hoekel also mentioned a robust “urban vs rural” discussion in the “myopia world” that predates COVID.

“The rates of myopia in Korea, Singapore and Hong Kong have been going up regardless of COVID,” Hoekel explained. “When we were a nation of farmers, rural-based communities, myopia rates were very low. Then in the rural communities that became technologically advanced, myopia increased.”

This phenomenon led some researchers to believe that technology (cell phones, tablets, and computer screens) caused the increase of childhood myopia. But, Hoekel stressed, what must also be considered is how the advent of technology changed the habits of children who spent time outside.

“If you have a bunch of children who are not outside as much anymore, then they’re more prone to becoming nearsighted,” Hoekel said. “But at the same time, if they’re on more technologically advanced devices, the two things may be happening simultaneously.

“So, which one has a higher environmental factor?” Hoekel continued. “It’s very difficult to parcel out. If Johnny goes nearsighted, it’s probably not because Johnny didn’t play outdoors. If you have heavily myopic parents are even moderately myopic parents, the rate of myopia increases.

“But if Johnny sits inside during a pandemic, watching his tabloid and not going outdoors and playing or not having recess or not having time on the ballfield, then Johnny’s risk of myopic development increases.”

There may be some semblance of truth to the old warning “watching TV up close causes nearsightedness, Hoekel added. What he defines as “near activities” having tablets, phones and reading devices held to the face may contribute to nearsightedness but the science hasn’t made a direct correlation between these activities and rising myopia rates among children, especially American children.

The eye, Hoekel said, “wasn’t meant to stay indoors, it was meant to have this part time indoor/outdoor” dynamic. Therefore, he added, several researchers are looking at sunlight as protective.

“Others are looking at genetics but to me it’s probably a combination, not the root cause that causes a child to go nearsighted.”

The pandemic was certainly “worrisome” for those in the pediatric world,” Hoekel stressed. If, due to COVID restrictions, a child just sat in the house and didn’t go outside to “run track or play ball and just watched near activities at higher rates,” increased myopia may have occurred. But, at this time, there’s more research to be done and there are multiple interventions in clinical research phases still under FDA studies, Hoekel said.

In summary, parents should be aware. If their children seem to have or are complaining of vision problems, they should take them to an optometrist immediately. But, Hoekel intimated; to definitively say that COVID conditions increased myopia among children may be a bit premature.

“It’s probably multifactual in nature,” Hoekel stressed. “It’s not one ideology that’s causing it. Therefore, there’s not one treatment strategy that will eliminate it.”

Sylvester Brown Jr. is The St. Louis American’s inaugural Deaconess Fellow.