Showing posts with label Ophthalmology. Show all posts
Showing posts with label Ophthalmology. Show all posts

Saturday, September 25, 2021

Development of Myopia in Children Linked to COVID-19 Pandemic

As a result of the COVID-19 pandemic and increased lockdowns, leading to increased use of online courses in education, there have been concerns on the impact on children of increased digital screen time worsening the global burden of myopia.

Xiao Yang, MD, PhD, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, and a team of investigators aimed to investigate changes in the development of myopia in young schoolchildren during the COVID-19 outbreak period in China.

In this study, results showed an increase in the development of myopia during the outbreak period in young schoolchildren, with the proportion of children at-risk of developing myopia also increasing during this time period.


Methods


Ahead of the present study, an ongoing prospective study was initiated in November 2018 to determine distributions and annual changes in refraction and axial length (AL) in schoolchildren.

Accordingly, this study analyzed a subset of the data to evaluate the association between environmental changes during the COVID-19 period and the development of myopia. Through November - December 2018, all grade 1 and 2 students from 12 primary schools in Guangzhou, China were enrolled, with follow-up exams performed annually.

Thus, the subjects were organized into the exposure group (n = 1572) which included students in grade 1 in November and December 2018 who were then assessed from grade 2 (November - December 2019) to grade 3 (November - December 2020) during the COVID-19 pandemic.

On the other hand, the non exposure group (n = 1472) consisted of students in grade 2 in November and December 2018 assessed from grade 2 (November - December 2018) to grade 3 (November - December 2019) in the period prior to the pandemic.

Each visit consisted of the evaluation of uncorrected visual acuity using the Early Treatment Diabetic Retinopathy study chart, accompanied by cycloplegic autorefraction performed using a desktop autorefractor.

In addition, investigators defined myopia as a spherical equivalent refraction (SER) of -0.50 D or less, with emmetropia defined as SER greater than -0.50 D and less than +2.00 D, and hyperopia defined as +2.00 D or greater.

Main outcomes in the study included changes in cycloplegic SER, axial length (AL) elongation, and myopia incidence from grade 2 to grade 3.


Results


Within the study, a total of 2679 eligible students were included in the analysis, with a mean age of 7.76 years and 1422 (53.1%) males.

Of that number, 1207 students were included in the exposure group examined in November and December 2019 and 1472 were in the non exposure group examined in November and December 2018.

Following 1 year, 2121 of the 2679 grade 2 students (79.2%) were reexamined, with 7 students reported receiving orthokeratology treatment and unsuccessful cycloplegic refraction, leaving 2114 students in grade 3. This included 1054 students in the exposure group and 1060 in the non-exposure group.

In grade 2 students, SER and prevalence of myopia were not different between the 2 groups, while the mean AL was 0.11 mm (95% CI, 0.05 - 0.16) shorter in the exposure group.

Then, data show from grade 2 to grade 3, students in the exposure group experienced a larger 0.36 D (95% CI, 0.32 - 0.41, P <.001) myopic shift of SER and 0.08 mm (95% CI, 0.06 - 0.10, P <.001) greater AL elongation, in comparison to the non-exposure group.

Further, the incidence of myopia was 7.9% (95% CI, 5.1 - 10.6, P <.001) higher in the exposure group, compared to the non-exposure group.

Additionally, the mean SER in grade 3 in the exposure group was 0.35 D (95% CI, 0.25 - 0.45) more myopic compared to the non-exposure group. The prevalence of myopia in grade 3 (n = 219 of 1054) was 7.5% higher (95% CI, 4.3 - 10.7) in the exposure group, compared to the non-exposure group (n = 141 of 1060).

Data also show the proportion of children without myopia and with SER greater than -0.50 D and less than or equal to +0.50 D increased from 31.1% (n = 286 of 919 students) to 49.0% (n = 409 of 835 students).


Conclusion


Investigators concluded the period of outbreak of COVID-19 showed accelerated development of myopia in young Chinese schoolchildren, as well as increasing the risk of developing myopia in children without myopia.

They noted their concern that the incidence of myopia may remain high, even after the COVID-19 pandemic outbreak period.

“Moreover, behavior changes, including reduced time outdoors and increased digital learning, may persist beyond the period of the pandemic, heightening the risk of a prolonged acceleration in the progression of myopia,” investigators wrote.

The study, “Rates of Myopia Development in Young Chinese Schoolchildren During the Outbreak of COVID-19,” was published online in JAMA Ophthalmology.


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Wednesday, September 22, 2021

School-Based Vision Program Linked to Improved Student Academic Performance

Due to substantial issues of uncorrected visual impairment from refractive error in school-age children, school-based vision programs (SBVPs) may offer opportunities to improve access to care, particularly in high-poverty neighborhoods.

As a result, a recent study aimed to assess the impact of a citywide SBVP Vision for Baltimore’s school-based vision services, including provision of eyeglasses, student achievement in English language arts and mathematics.

Investigators, led by Megan E. Collins, MD, MPH, Wilmer Eye Institute, Johns Hopkins University School of Medicine, observed students who received eyeglasses through an SBVP achieved better reading scores, with improved academic achievement over 1 year but no sustained impact after 2 years.


Methods


The team performed a cluster randomized clinical trial conducted in Baltimore City Public Schools during school years from 2016 - 2019. It included 127 schools in the study, after exclusion of 24 schools for lack of eligibility.

Each school was stratified and randomized with a 1:1:1 ratio into 3 study cohorts using block randomization. They noted cohorts 1, 2, and 3 received Vision for Baltimore interventions during 1 of 3 school years, including 2016 - 2017, 2017 - 2018, and 2018 - 2019.

The Vision for Baltimore services included vision screening, eye examinations, and eyeglasses, with screenings conducted for all students. Those who failed the screening test were provided a 2-sided consent form offering an eye examination and research participation.

For outcome measurements, investigators used reading and mathematics scores from the i-Ready test and the Partnership for Assessment of Readiness for College and Careers (PARCC) test. Demographic data was obtained from Baltimore City Public Schools.

Investigators noted program effect size (ES) was defined as the difference in score on a particular academic test between intervention and control groups.

The primary study outcome included the 1-year intervention impact, measured by ES, to compare cohort 1 (intervention group) with cohorts 2 and 3 (control) at the end of the 2017 - 2018 program year. In addition, they compared cohort 2 (intervention) with cohort 3 (control).

Further, secondary outcomes included the 2-year intervention impact, measured by comparing cohort 1 (intervention) with cohort 3 (control) at the end of the 2017 - 2018 program year.


Results


After randomization, a total of 42 schools were collected in cohort 1 and cohort 2 and 43 schools were included in cohort 3.

Data show the analytic sample included 2304 students, with 54.7% female (n = 1260) and a mean age of 9.4 years. Patients were mostly Black (n = 1789, 77.6%), followed by White (n = 432, 18.8%) and Latinx (n = 388, 16.8%). Also, 406 students (17.6%) in special education were included.

Further, the team observed an overall 1-year positive impact on the i-Ready reading score (ES, 0.09; P = .02) during the 2016 - 2017 school year.

Similarly, a positive impact on i-Ready reading scores was seen during the 2017 - 2018 school year (ES, 0.12; P = .09) and PARCC test scores during the 2016 - 2017 (ES, 0.04, P = .31) and the 2017 - 2018 school year (ES, 0.04, P = .59).

At 2 years, data show a positive intervention impact on i-Ready reading scores (ES 0.08, P = .23) and mathematics scores (ES, 0.08, P = .20), but were not considered statistically significant.

Furthermore, the team observed a positive impact among female students (ES 0.15, P <.001) and those in special education (ES 0.25, P <.001) on i-Ready reading.

In addition, a positive impact was seen among students in elementary grades on i-Ready mathematics (ES 0.03, P <.001) during the 2016 - 2017 school year. However, the intervention did not show a sustained impact at 2 years or on PARCC testing.


Conclusion


The study concluded the benefit of SBVP at 1 year was not sustained after 2 years, noting students may wear eyeglasses less over time or refractive correction may not be sufficient enough.

“Collectively, these findings underscore that for SBVPs to maximize impact, they must not only provide eyeglasses but also ensure mechanisms for monitoring wear, replacement, and connection to community eye care clinicians for long-term care,” investigators wrote.

The study, “Effect of a Randomized Interventional School-Based Vision Program on Academic Performance of Students in Grades 3 to 7,” was published online in JAMA Ophthalmology.


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