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 Table of Contents  
CLINICAL CHALLENGE
Year : 2020  |  Volume : 32  |  Issue : 2  |  Page : 201-202

Commentary on “quarantine myopia:” Revisiting myopia control strategies during the COVID-19 pandemic


Head of the Department, Binocular Vision, Perception and Pediatric Optometry Section, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India

Date of Submission22-Jul-2020
Date of Acceptance22-Jul-2020
Date of Web Publication25-Aug-2020

Correspondence Address:
Dr. Jameel Rizwana Hussaindeen
Binocular Vision/Vision Therapy Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, 18, College Road, Nungambakkam, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_104_20

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How to cite this article:
Hussaindeen JR. Commentary on “quarantine myopia:” Revisiting myopia control strategies during the COVID-19 pandemic. Kerala J Ophthalmol 2020;32:201-2

How to cite this URL:
Hussaindeen JR. Commentary on “quarantine myopia:” Revisiting myopia control strategies during the COVID-19 pandemic. Kerala J Ophthalmol [serial online] 2020 [cited 2020 Sep 29];32:201-2. Available from: http://www.kjophthal.com/text.asp?2020/32/2/201/293322



The Coronavirus disease 2019 (COVID-19) has impacted all aspects of life, and Myopia is no exception. Various research has shown outdoor activities and exposure to natural light to be protective against the onset of Myopia. A minimum of 1–2 h outdoor activity has been an integral aspect of myopia management.[1],[2] The current pandemic has impacted this profoundly, and this is most likely to impact the clinical picture of myopia, though evidences are yet to show up. Few logical options include frequent breaks during the continuous virtual lectures, attending to the virtual classes while also having access to natural light, using digital devices with larger screens to reduce the strain on the visual system, and ensuring optimal working distance. Children who use digital devices for extended hours are likely to develop dry eye-related issues as well.[3] Ensuring frequent and complete blinking should also be part of these conservative management options.

Regarding pharmacological options for myopia control, the current evidence has made the practice of low dose 0.01% atropine as a standard myopia control option. Other optical modalities of myopia control such as specialty contact lenses, ortho-keratology, and combined strategies have not occupied the clinical practice to a large extent, but have potential scope to be explored.

Children who are on low-dose 0.01% atropine need to be followed up regularly despite the constraints such as missing online classes and travel difficulties. If they are unable to reach out to the previous eye care provider, getting the refractive error assessed locally needs to be encouraged to understand myopia progression. Tele-consultation options then can facilitate further conversation. If children show myopia progression despite the pharmacological intervention, comprehensive eye examination including documentation of ocular biometry is mandatory to plan further.[4] It is very important to differentiate true progression from accommodative spasm and quarantine myopia through a cycloplegic refraction.

Children with a history of early-onset myopia which indicates myopia that occurs before 14 years of age and with a family history of myopia are at increased risk for myopia progression.[5] If the myopia progression is documented to be greater than half a diopter within a year, myopia control options need to be initiated. In addition, children who have axial lengths >26 mm need to be followed up at regular intervals, as there is evidence[6] to show that greater axial lengths increase the risk of visual impairment to 25%, compared to 3.8% risk in axial lengths <26 mm. As every diopter of myopia control matters,[7] eye care practitioners need to provide necessary options toward myopia control, and also follow-up closely.

Eye care practitioners need to dissipate information to all concerned stakeholders about the aspects of myopia, digital eyestrain, and visual hygiene measures on a regular basis. This reinforcement will bring in a lot of awareness among the general public.



 
  References Top

1.
Ho CL, Wu WF, Liou YM. Dose-Response Relationship of Outdoor Exposure and Myopia Indicators: A Systematic Review and Meta-Analysis of Various Research Methods. Int J Environ Res Public Health. 2019;16. Published 2019.doi:10.3390/ijerph16142595.  Back to cited text no. 1
    
2.
Lanca C, Teo A, Vivagandan A, Htoon HM, Najjar RP, Spiegel DP, et al. The effects of different outdoor environments, sunglasses and hats on light levels: Implications for myopia prevention. Transl Vis Sci Technol 2019;8:7.  Back to cited text no. 2
    
3.
Moon JH, Kim KW, Moon NJ. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: A case control study. BMC Ophthalmol 2016;16:188.  Back to cited text no. 3
    
4.
Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, et al. IMI–clinical management guidelines report. Invest Ophthalmol Vis Sci 2019;60:M184-203. [doi: 10.1167/iovs. 18-25977].  Back to cited text no. 4
    
5.
Jiang X, Tarczy-Hornoch K, Cotter SA, Matsumura S, Mitchell P, Rose KA, et al. Association of parental myopia with higher risk of myopia among multiethnic children before school age. JAMA Ophthalmol 2020; 138:1-9.  Back to cited text no. 5
    
6.
Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, et al. Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol 2016;134:1355-63.  Back to cited text no. 6
    
7.
Bullimore MA, Brennan NA. Myopia control: Why each diopter matters. Optom Vis Sci 2019;96:463-5.  Back to cited text no. 7
    




 

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