Myopia risk behaviour related to the COVID-19 lockdown in Europe: The generation R study

Purpose: To battle the spreading of the COVID- 19 virus, nationwide lockdowns were implemented during 2020 and 2021. Reports from China revealed that their strict home confinements led to an increase in myopia incidence. The Netherlands implemented a more lenient lockdown, which allowed children to go outside. We evaluated the association between COVID- 19 restrictions, myopia risk behaviour and myopia progression in Dutch teenagers.Method: A total of 1101 participants (mean age 16.3 +/- 3.65 yrs) completed questionnaires about their activities before, during and after lockdown (March- October 2020). We used a repeated-measures ANOVA to compare time use between these time periods. Ocular measurements were acquired before the COVID- 19 pandemic when participants were 13 years old; only 242 participants had ocular measurements at 18 years of age at the time of this analysis. Linear regression analyses were used to evaluate the association between lifestyle factors and myopia progression.Results: Children were on average 16.2 (1.03) years of age during lockdown. Total nearwork increased from 8.11 h/day to 11.79 h/day, and remained higher after lock down at 9.46 h/day (p < 0.001). Non-educational nearwork increased by 2.22 h/day (+49%) during lockdown and was associated with faster axial length progression (B 0.002 mm/h/year; SE 0.001 p = 0.03). Before and during lockdown, the mean time spent outdoors was similar (1.78 h/day and 1.80 h/day, respectively). After lock down, time spent outdoors decreased to 1.56 h/day (p < 0.001).Conclusion: The Dutch lockdown significantly increased digitised nearwork in adolescents but did not affect outdoor exposure. The changes in time spent performing nearwork remained after the lockdown measures had ended. We expect that the COVID- 19 pandemic may lead to an increase in myopia prevalence and progression in European children.