July 15, 2020
By J. Annette Parker-Herriott, OD, FCOVD
Riddle me this, what do COVID-19 and myopia have in common? According to The Conversation journal1, the prevalence of myopia is increasing nationwide.
As the number of COVID-19 cases continues to rise and fall, studies already show that more time is spent at computers now than before the onset of the coronavirus.2 As if the time we spend on digital devices was not high enough already, reports are showing most children ages 6 to 12 are spending 50 percent more time in front of a screen daily. Kids are spending more time at a desktop, on their tablets, on their phones or connected to TV monitors playing games. Traffic to kids’ apps and websites has increased by 70 percent in the U.S. Adults are doing much of the same. Parents struggle to limit their child’s time on these activities because they are working from home and do not have time to supervise their child’s screen time or TV and gaming time. They feel they cannot tell their child to get off their computer devices when they have their laptop, telephone, tablets, and TV going from 9 to 5 for business (and personal) activities.
As many of us are returning to our practices, how will COVID-19 affect our patient’s vision? What can we expect from kid’s and adult’s visual systems? How much more myopia will we begin to see, and how will we manage the growing number of patients?
We already know that environmental factors play a significant role in myopia progression. Activities such as extensive reading, being on computers, or locking in on near point tasks for extended periods cause stress on both the accommodative and binocular systems. Both systems, when not working correctly, can render an emmetropic patient even more myopic in a short amount of time. Therefore, developing a strategy to reduce the impact of stress on these systems is essential for preventing myopia and its progression. Other consequences that can also result are chronic dry eyes, fatigue, and headaches.
So, what do you need to look for during an exam? First, take a good history. Listen to your patient’s complaints. Sometimes, it is not the obvious complaint of blurred vision that we will hear, but a subtle complaint of getting tired and sleepy after reading, mild headaches after being on the laptop, or problems shifting focus from distance to near and back. These symptoms can be dead giveaways that something could be going on with the accommodative or the vergence systems. Second, it is a good idea to observe the cover test at distance and near carefully. Is the patient esophoric or exophoric at distance or near? Next, you will need to refract and do a binocular balance. This will help to reduce over-minusing a prescription and creating an unwanted accommodative/vergence dilemma.
Yes, we will all be busy from the backlog of patients needing to renew their prescriptions, but we cannot rush through the eye exam and miss getting an accurate refraction. Doing so will only cause more symptoms for your patient and cost you more chair time when your patient returns with the same or worse symptoms. Test the accommodative system. Monocular and binocular accommodative facilities are useful pieces of information to gather and can be quickly ascertained. Knowing this information will allow you to know if the patient is properly focusing at near. A low result in the binocular accommodative facility (BAF) means that there is an underlying vergence issue. A low result in the monocular accommodative facility (MAF) of either eye means there is an accommodative issue. Determining if more plus can be accepted at near can be measured by the negative relative accommodation/positive relative accommodation. Once the refraction and the accommodative and vergence systems have been assessed, you can then decide what treatment method you will want to devise for your patient.
What does the patient need to reduce their symptoms but also reduce their incidence of becoming more myopic by their next exam? Will it be an ADD, does the patient need vision therapy, could the patient benefit from multifocal soft contact lenses or OrthoK? Or will you allow your patient to leave with another pair of stylish glasses that may contribute to their eyes getting worse by the next exam? The ball is in your court; will you make the right treatment decision?
We are essential workers during this pandemic and should use our platforms to educate patients not only about the potential risks of becoming more myopic during COVID-19 but also about the importance of following the CDC guidelines. Children especially need to be reminded about washing their hands when handling their glasses and contact lenses, properly wearing a mask, and avoid touching their face and eyes to prevent contracting the virus.
Until the number of cases of COVID-19 drastically reduce, and we can return to normal daily routines, we all need to take an active interest in our safety and do the best we can to reduce the rate of the myopia pandemic.
1 The Conversation, Dr. Shu-Fang Shih and Dr. Olivia Killeen: Increasing Screen time during the coronavirus could be harmful to kid’s eyesight
2 Axios website: Kids’ Daily Screen time surges during Coronavirus, Sarah Fischer
Annette Parker-Herriott, OD, FCOVD, is in private practice and is the founder, CEO of EnVision Eye Care, Savannah, Ga. Dr. Parker-Herriott is a 1993 graduate of Pennsylvania College of Optometry. Her practice provides specialty services in primary care, pediatrics/vision Therapy, specialty contact lenses, myopia management, dry eye management treatment and management of eye diseases, and more. Dr. Parker-Herriott is a preceptor for Salus University 3rd and 4th year interns. She is married to Jeffery and has two children (Austin & Jaelyn).