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Long-term Impact of COVID-19-Related Behavioral Changes on Myopia Progression in Children: A Four-Year Cohort Study

Young Min Park1,2, Hye Young Kim1, Kwanghyun Lee3

  • 1Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

Korean Journal of Ophthalmology : KJO
|March 11, 2026
PubMed

Insights

COVID-19 pandemic behavioral changes, including increased screen time and remote education, accelerated myopia progression in children. These factors outweighed the benefits of low-dose atropine treatment, highlighting the need to manage visual habits.

Area of Science:

  • Ophthalmology
  • Pediatric Medicine
  • Public Health

Background:

  • The COVID-19 pandemic led to significant behavioral shifts, including increased screen time and reduced outdoor activities.
  • These changes are suspected to influence the progression of myopia (nearsightedness) in children.
  • Understanding these effects is crucial for effective pediatric myopia management.

Purpose of the Study:

  • To assess the impact of pandemic-related behavioral changes on myopia progression in children.
  • To determine if these behavioral changes affected the efficacy of low-concentration atropine (LAMP) treatment.
  • To identify key behavioral factors influencing myopia progression during and after the pandemic.

Main Methods:

  • Retrospective longitudinal study of children aged 7-15 years (2019-2023).
  • Analysis of annual spherical equivalent (SE) measurements.
  • Behavioral data collected via questionnaire (mobile device use, outdoor activity, remote education duration).
  • Linear mixed-effects models and repeated-measures ANOVA used for analysis.

Main Results:

  • Myopia progression accelerated during the COVID-19 pandemic compared to the pre-pandemic period.
  • Increased mobile device use and longer remote education duration were significantly associated with faster myopia progression.
  • Changes in outdoor activity did not show a clear association with refractive outcomes.
  • Low-dose atropine demonstrated no significant treatment effect in this cohort.

Conclusions:

  • Pandemic-induced behavioral changes, particularly increased screen time and remote learning, significantly accelerated pediatric myopia progression.
  • These behavioral factors were more influential on myopia progression than low-dose atropine treatment.
  • Addressing visual habits is essential for effective management of childhood myopia.
Abstract

Keywords:
COVID-19Low-dose atropineMyopia

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