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Year : 2020  |  Volume : 68  |  Issue : 11  |  Page : 2383-2384

Commentary: Impact of the COVID-19 pandemic on digital eye strain in children

Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India

Date of Web Publication26-Oct-2020

Correspondence Address:
Dr. Chaitra Jayadev
Vitreo-Retina Consultant, Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bangalore - 560 010, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_3028_20

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How to cite this article:
Jayadev C, Sarbajna P, Vinekar A. Commentary: Impact of the COVID-19 pandemic on digital eye strain in children. Indian J Ophthalmol 2020;68:2383-4

How to cite this URL:
Jayadev C, Sarbajna P, Vinekar A. Commentary: Impact of the COVID-19 pandemic on digital eye strain in children. Indian J Ophthalmol [serial online] 2020 [cited 2022 Sep 28];68:2383-4. Available from: https://www.ijo.in/text.asp?2020/68/11/2383/299075

The authors have highlighted the impact of increasing usage of digital devices during the ongoing COVID-19 pandemic on ocular health in an online survey conducted for adults.[1] Whereas there is no arguing about the ill-effects of this phenomenon in adults owing to changes forcefully affected by the lockdown, an equally or perhaps a more vulnerable cohort that is silently suffering this onslaught of increased digital device use, are children. Children today are growing up in an increasingly visually demanding world. Electronic devices, video games, e-readers, tablets, and laptops, and the ubiquitous mobile phone were already exploited for entertainment and leisure. The COVID-19 pandemic has increased this burden by leaving schools with no choice but to adapt to e-learning platforms. Children now spend an average of 8–12 h a day on some form of digital device. This has increased the threat of digital eye strain (DES), making it an emerging public health problem with an estimated prevalence in the community reported between 22.3% and 39.8%.[2]

Our group has reported that approximately 80% of outpatient visits in the pediatric ophthalmology department in March and April 2020 (at the start of the lockdown) were refractive errors, of which 79% were for myopia.[3] With no definitive end in sight for the pandemic, we are potentially facing an explosive scenario of this “quarantine myopia.” There are predictions of a worsening of the myopic epidemic worldwide and is estimated that over 50% of the world's population will have myopia by 2050.[4] Besides myopic progression, accommodative dysfunction in children is also on the rise due to digital device usage.[5] Accommodation spasm and sudden onset esotropia are important causes. The former presents with an acute, rapid increase in myopia and requires dynamic, cycloplegic retinoscopy, and a comprehensive assessment of the binocular visual field. Receded near the point of convergence, large near exophoria, reduced near the point of accommodation, and lag of accommodation greater than +1.25 diopter sphere demand further assessment for nonstrabismic binocular vision dysfunction.[6] Vision therapy plays a significant role in managing these anomalies.

We have been using three exercises in our practice to manage accommodative dysfunction in children with good results. 1) The Lens Flipper at a distance of 0.4 m [Figure 1] – flip and re-flip a set of +2.0/−2.0D lens flipper ensuring that the text is clear with each flip.[7] 2) The Hart Chart—a pair of similar charts, one at 6 m [Figure 2]a and the other at 40 cm [Figure 2]b are read alternately with one eye occluded. This improves focus for both near and far.[8] 3) Brock String [Figure 3]—a white string (3–10 feet long) with 3–5 beads of different colors. One end of the Brock string is held at the tip of the nose while the other is tied to a fixed point.[9] The child is asked to fixate on one of the further beads to begin with and should see one bead (indicating focus to a single point). The next step is to alternate from bead to bead, working closer and back to exercise the convergence muscles.
Figure 1: Flippers

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Figure 2: (a) Hart Chart for Distance. (b) Hart Chart for Near

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Figure 3: Brock string

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Forced gadget breaks, restriction of online classes with breaks in between sessions, promoting (permitted) outdoor activities, encouraging “family” time with non-gadget-based learning and entertainment are some measures that can be adopted. Sensitizing teachers and parents about these practices can help to check the growing ill-effects of DES.[10] As eye health care providers, we need to promptly identify those children who are at a higher risk of DES and progression of myopia to manage them appropriately. A public awareness campaign to improve safety measures, enhance early detection of DES, and promote good eye health measures in our young citizens is the need of the hour.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Bahkir FA, Grandee SS. Impact of the COVID-19 lockdown on digital device-related ocular health. Indian J Ophthalmol 2020;68:2378-83.  Back to cited text no. 1
  [Full text]  
Sheppard AL, Wolffsohn JS. Digital eye strain: Prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018;3:e000146.  Back to cited text no. 2
Sumitha M, Sanjay S, Kemmanu V, Bhanumathi MR, Shetty R. Will COVID-19 pandemic-associated lockdown increase myopia in Indian children? Indian J Ophthalmol 2020;68:1496.  Back to cited text no. 3
[PUBMED]  [Full text]  
Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology 2016;123:1036-42.  Back to cited text no. 4
Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet 2020;395:945-7.  Back to cited text no. 5
Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, et al. IMI–clinical management guidelines report. Invest Ophthalmol Vis Sci 2019;60:M184-203.  Back to cited text no. 6
Allen PM, Charman WN, Radhakrishnan H. Changes in dynamics of accommodation after accommodative facility training in myopes and emmetropes. Vision Res 2010;50:947-55.  Back to cited text no. 7
Vasudevan B, Ciuffreda KJ, Ludlam DP. Accommodative training to reduce nearwork-induced transient myopia. Optom Vis Sci 2009;86:1287-94.  Back to cited text no. 8
Maxwell J, Tong J, Schor CM. Short-term adaptation of accommodation, accommodative vergence and disparity vergence facility. Vision Res 2012;62:93-101.  Back to cited text no. 9
Hussaindeen JR, Gopalakrishnan A, Sivaraman V, Swaminathan M. Managing the myopia epidemic and digital eye strain post COVID-19 pandemic – What eye care practitioners need to know and implement? Indian J Ophthalmol 2020;68:1710-2.  Back to cited text no. 10
[PUBMED]  [Full text]  


  [Figure 1], [Figure 2], [Figure 3]

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