The prevalence of myopia remains stable under tighter COVID-19 social restriction in preschoolers receiving a school-based eyecare program.

PURPOSE: This study investigated the impact of different levels of COVID-19 social restrictions (social distancing in 2020, large-scale home confinement in 2021) on myopia prevalence and behaviours in a preschool population with school-based eyecare programme. METHODS: Repeated cross-sectional surveys were conducted between August and December in 2019, 2020 and 2021. Children aged 5-6 years received ocular examinations, and questionnaires were answered by caregivers before the day of the examination. The main outcome measures were the changes in after-school time spent on homework, screen-based devices and outdoors. Secondary outcome was the change in myopia prevalence (spherical equivalent [SE] ≤ -0.5 D in either eye after cycloplegia). RESULTS: A total of 9997 preschoolers were included in the analysis. Under tighter restrictions, more preschoolers spent ≥1 h/day on screen-based devices (42.8% in 2019, 45.2% in 2020, 48.9% in 2021, p < 0.001), and fewer preschoolers spent ≥30 min/day on after-school outdoor activities (49.5% in 2019, 46.0% in 2020, 41.0% in 2021, p < 0.001) on weekdays. A similar trend was found on weekends. While more preschoolers spent ≥2 h/day on screen-based devices (35.3% in 2019, 38.5% in 2020, 43.0% in 2021, p < 0.001), fewer preschoolers spent ≥2 h/day on outdoor activities (41.7% in 2019, 41.7% in 2020, 34.0% in 2021, p < 0.001). The mean SE and myopia prevalence were stable (9.1% in 2019, 10.3% in 2020, 9.4% in 2021, p = 0.707). CONCLUSION: Our study showed dose-dependent effect of social restrictions on near-work and outdoor behaviours at home. The prevalence of myopia did not increase significantly with short-term cessation of school-based eyecare programmes.

Premyopia at Preschool Age: Population-based Evidence of Prevalence and Risk Factors from a Serial Survey in Taiwan.

PURPOSE: Premyopia at a young age carries a great risk of developing early-onset myopia, especially in regions with myopia epidemics, such as the developed areas in East Asia. This study aims to report the prevalence of premyopia and its risk factors in a Taiwan preschool population and lifestyle changes among premyopic preschoolers before and during the Coronavirus Disease 2019 (COVID-19) pandemic. DESIGN: Repeated countywide population-based, cross-sectional study in Yilan County, northeastern Taiwan. PARTICIPANTS: From 2014 to 2020, a total of 23 930 kindergarteners aged 5 to 6 years were identified in the Yilan Myopia Prevention and Vision Improvement Program (YMVIP). Of those, 21 761 (11 335 [52.1%] boys; mean age, 5.15 ± 0.37 years) were included for final analysis. METHODS: Annual kindergarten-based eye examinations and myopia prevention strategies have been conducted since the commencement of the YMVIP in 2014. Refractive error was determined by cycloplegic autorefraction. The data of potential risk factors for myopia were gathered by caregiver-administered questionnaires. MAIN OUTCOME MEASURES: The prevalence of premyopia (spherical equivalent [SE] > -0.5 diopter [D] and ≤ +0.75 D in the eye with less SE value). RESULTS: The prevalence of myopia (SE ≤ -0.5 D), premyopia, and hyperopia (SE > +0.75) was 10.7% (95% confidence interval [CI], 10.3-11.1), 52.0% (95% CI, 51.3-52.7), and 37.3% (95% CI, 36.7-37.9), respectively. Multinomial logistic regression analysis showed that premyopia prevalence was significantly associated with male gender (odds ratio [OR], 1.25; 95% CI, 1.18-1.32), caregiver myopia (OR, 1.46; 95% CI, 1.37-1.56), screen time ≥ 1 hour per weekdays (OR, 1.10; 95% CI, 1.04-1.17), 2-year exposure to myopia prevention strategy (OR, 0.59; 95% CI, 0.54-0.65), and college or higher education level of caregiver (OR, 0.91; 95% CI, 0.85-0.96). Even without large-scale school closure in Taiwan, there was a slight upward trend of increased time spent on screen-based devices during the COVID-19 pandemic. CONCLUSIONS: Our findings showed that premyopia was the most common refractive error in a Taiwan preschool population. Premyopia was also associated with both parental and environmental myopiogenic factors. Longitudinal studies are warranted to examine the lifestyle change and myopic shift of premyopic preschoolers in the postpandemic era.

Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers: A Serial Survey in Taiwan before and during the Coronavirus Disease 2019 Pandemic.

PURPOSE: To report the prevalence of preschool myopia after implementing a policy intervention promoting outdoor activities and the secular trend of myopia before and during the coronavirus disease 2019 (COVID-19) pandemic in a Taiwan preschool population. DESIGN: Repeated countywide population-based, cross-sectional surveys based on the Yilan Myopia Prevention and Vision Improvement Program (YMVIP). PARTICIPANTS: Among 23 930 kindergarteners 5 to 6 years of age from 7 school-year cohorts in Yilan County from 2014 through 2020, a total of 21 761 children (90.9%) were included for analysis. METHODS: Since launching the YMVIP in August 2014, myopia prevention strategies, such as increasing outdoor activities (2 hours/weekday), have been promoted in all kindergartens, and countywide school-based eye examinations, including cycloplegic autorefraction, and caregiver-administered questionnaires have been carried out annually for all participants. MAIN OUTCOME MEASURES: The prevalence of myopia (spherical equivalent, ≤ -0.5 D in either eye) in each of the 7 school-year cohorts of preschoolers 5 to 6 years of age. RESULTS: The prevalence of myopia continuously decreased for 2 years after implementing the YMVIP: 2014 cohort, 15.5% (95% confidence interval [CI], 14.2%-16.8%); 2015 cohort, 13.5% (95% CI, 12.3%-14.7%); and 2016 cohort, 8.4% (95% CI, 7.4%-9.4%). Subsequent cohorts were exposed maximally to these school-based myopia prevention strategies, and the prevalence of myopia remained relatively stable, between 8.5% and 10.3%, even during the COVID-19 pandemic. Multivariate logistic regression analysis showed a dose-dependent association between the duration of exposure to preventive strategies and the prevalence of myopia (up to 1-year YMVIP exposure, odds ratio, 0.86 [95% CI, 0.74-0.99]; up to 2-year YMVIP exposure, odds ratio, 0.56 [95% CI, 0.50-0.63]) after controlling other myopigenic factors. CONCLUSIONS: This population-based evidence showed high prevalence of preschool myopia and an L-shaped decline after introducing strategies to promote outdoor activities in kindergartens. With undisrupted school-based preventive strategies, the prevalence of myopia can be kept stable, even during the COVID-19 pandemic.

PREDICTIVE FACTORS OF VISUAL OUTCOME FOR VITREOMACULAR TRACTION SYNDROME AFTER VITRECTOMY.

PURPOSE: To assess the long-term functional and anatomical outcomes for vitreomacular traction syndrome (VMT) after vitrectomy and to analyze the predictive factors regarding visual outcome. METHODS: A retrospective, consecutive case series of 22 eyes in 22 patients with VMT who underwent vitrectomy to relieve macular edema were studied. Eyes were classified into two groups according to the diameter of vitreomacular adhesion based on spectral domain optical coherence tomography: Group 1 (14 eyes) focal attachment ≤1,500 µm; and Group 2 (eight eyes) broad attachment >1,500 µm. RESULTS: Mean postoperative follow-up was 25.4 months (range, 6-68). The preoperative mean logarithm of the minimal angle of resolution visual acuity was 0.73 (20/107), which significantly improved to 0.49 (20/62) postoperatively (P < 0.01). Seventeen eyes (77%) had Snellen visual acuity improvement ≧ two lines, and nine eyes had improvement ≧ three lines. The improvement of visual acuity was significantly better in Group 1 than in Group 2 (2.7 lines vs. 0.8 lines) (P = 0.03). The preoperative mean central macular thickness was 563 µm ± 176 µm, which significantly improved to 298 µm ± 69 µm postoperatively (P < 0.01). In multivariate analysis, better final visual acuity was significantly associated with Group 1 VMT (P < 0.01) and with shorter symptom duration (P < 0.01). Greater improvement of visual acuity was also significantly associated with younger age of patients (P = 0.02) and with Group 1 VMT (P < 0.01). In linear regression analysis, patients with longer symptom duration had worse final visual acuity (ß = 0.02) and patients of younger age had greater visual acuity improvement (ß = 0.008). CONCLUSION: Most patients of VMT gained significant functional and anatomical improvements after vitrectomy. Group 1 optical coherence tomography pattern, shorter symptom duration, and younger age are significant predictive factors of better visual outcome.