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Researchers around the world are closely watching for a potential ripple effect of the Covid-19 pandemic: an uptick in vision problems in children, many of whom are spending less time outside, and more time than ever in front of screens during work and play.

“We think that this is going to be a doozy of a year for myopia with the pandemic and all the increased screen time that kids are getting,” said Allison Babiuch, a pediatric ophthalmologist at the Cleveland Clinic who has seen an increase in children with myopia, also known as nearsightedness, in her practice in the past year.

A recent study published in JAMA Ophthalmology of over 120,000 children in China found that the prevalence of myopia increased up to three times in children aged 6 to 8 in 2020 compared to the previous five years. Rates of myopia, already the most common eye condition worldwide, have been increasing steadily for several decades. By some estimates, nearly half of the global population will be myopic by 2050.

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It’s still too early to tease out the exact effects of the pandemic, but experts said they suspect the dramatic changes to children’s routines are increasingly impacting eyesight. Since the pandemic began, screen time has reportedly risen significantly among children. In an August survey of 899 parents, 70% reported that their kids were spending at least four hours a day on electronic devices.

“Half my day is spent with parents asking about Zoom and if it’s bad for their kids, and should they stay off the computer,” said Tawna Roberts, a pediatric optometrist at the Byers Eye Institute at Stanford University in California.

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Not only has the pandemic increased screen time, it has also kept children indoors. Time spent outside has been found to reduce the risk of myopia and, in combination with treatments such as certain medicated eye drops or contact lenses, may also help slow its progression. Even with correction, myopia may continue to progress until the eye itself stops growing around age 20.

Although its exact cause is unknown, both genetic and environmental factors are thought to be responsible for the issue, which happens when light entering the eye doesn’t focus correctly on the retina in order to produce a clear image. Genetics play a significant role in shaping the eye and hundreds of genes have been identified that may contribute to myopia.

And research shows that the earlier it starts in children, the more likely it is that they will have a more severe refractive error as adults. However, timely detection and treatment are able to slow this progression and significantly reduce a patient’s risk for developing glaucoma, retinal detachment, and other vision-threatening complications.

And as with other types of medical care, getting in for an eye appointment is more complicated during Covid-19.

“Almost everyone on the phone is like, ‘I’m just going to wait until I get the vaccine,’ or, ‘I’m going to wait until I don’t have to wear a mask.’ They’ll say, ‘I see fine, I feel fine, so I’m not going to come in,’” said Amy Ruzicka, an optometrist at the Bascom Palmer Eye Institute at the University of Miami in Florida.

And many school-age children are also missing vision screenings, which are currently required in schools in 42 states but have temporarily been suspended by some due to the pandemic. For many children, especially those in low-income families, those screenings are crucial to identifying vision impairment. Left undetected and untreated,  vision problems can affect academic performance.

Experts said there are simple steps to preserve the eyes, such as having good lighting at home and following the 20/20/20 rule when using electronic devices, which means taking a break every 20 minutes to look at an object at least 20 feet away for 20 consecutive seconds. But they also said there’s a need for broader public health measures even after the pandemic subsides, such as schools incorporating more time spent outdoors.

“As a medical community, we’ve been so focused on thinking about the short term consequences of the pandemic,” said Megan Collins, a pediatric ophthalmologist at the Johns Hopkins Wilmer Eye Institute in Maryland. “We have to have on our radar the fact that there are some unanticipated short- and long-term impacts for the eye that we need to be monitoring.”