‘Vision defects among children on the rise’: Experts weigh in on the impact of Covid-19 pandemic on young eyes

Recently, doctors from the All India Institute of Medical Sciences Eye centre said that amid the pandemic, kids and school children have come under the radar for various types of vision defects - with most cases being of myopia, or short-sightedness. According to the National Programme for Control of Blindness & Visual Impairment, at 29 percent, refractive errors form the major cause of visual impairment among people in the age group of 0-49 years. A number of research papers indicate that myopia is one among the major refractive errors found among Indian children.

A 2020 study ‘Primary eye care in India - The vision centre model', published in the Indian Journal of Ophthalmology states that economic barriers, lack of awareness, fear of surgeries and not feeling the need to visit an eye care centre are some of the major barriers in access to primary eye care in India. While refractive errors at development ages can transition into serious vision ailments with time, they are not attended to or corrected at an early stage by many parents and guardians due to neglect or poor access to affordable eye health services.

Mid-Day Online reached out to city-based experts, Dr. Hasanain Shikari, consultant ophthalmologist and retina specialist, Masina Hospital and Dr Girija Suresh, senior ophthalmic consultant, Fortis Hospital, who shed light on common eye problems among children, which are often neglected and the need for guardians to be extra cautious about kids' eye health amid rapid digitisation.

What are the major vision problems, which mainly go undetected and remain untreated among majority of children in India?

Shikari: The most common eye problems that remain undetected in children are:

1. Refractive errors - Myopia or short-sightedness has seen a rise during the Covid-19 pandemic as children have been attending online classes, spending hours in front of mobile phones, tablet computers and laptops, which have increased the incidents of eye-strain. If untreated this can lead to ‘lazy eyes', which can become a permanent condition if not corrected before the age of 11 years.

Astigmatism is another common condition, which results in blurring of vision or excessive strain on the eyes. Most children with astigmatism are able to manage vision related activities, however they complain of headaches, eye strain and tiredness at the end of the day. Children with allergies may develop astigmatism due to excessive eye rubbing.

2. Eye allergies - Children usually face itching, redness, blurring of vision and discharge overnight, which causes crusting and sticking of the eyelids. This is commonly confused with infection and wrongly treated with inadequate or wrong medications, which can lead to complications threatening the child's vision.

How has the pandemic and lockdown added to vision problems in children? Please explain in detail if exposure to UV light due to home confinement in addition to digital tools has added to any undetected problems not known commonly before.

Shikari: An excessive use of mobile computer devices during the pandemic for home schooling, entertainment and other activities has resulted in a ballooning of the number of kids with Myopia or short-sightedness cases being referred to an ophthalmologist. This initially presents as an eye strain or difficulty in seeing at a distance and is now noticed in children returning to school and being unable to see the white/black boards at a distance. Additionally, being confined indoors without physical activity and sunlight exposure also causes the development and progression of myopia.

Many children have also experienced pseudomyopia, in which the excessive use of mobile devices for hours on end results in a spasm of the eye muscles and as a result they are initially found to have very high myopia. However, by using drops to relax the eye muscles, ophthalmologists are able to conclude that it is not myopia.

Have the heat wave and pollution worsened the situation for kids in terms of itchiness and eye discomfort?

Shikari: Yes, and the current period from February to March and June to July is especially worse for kids with allergies. The dust in the air, urban construction and repair works in the pre-monsoon period also result in kids being exposed to allergic keratoconjunctivitis. Kids usually have itching, redness, watery eyes, and excessive rubbing of the eyes can lead to irreversible damage to the cornea in the long-term. These conditions need to be treated with doctor recommended anti-allergy drops, and steroids in certain advanced cases in addition to using lubricating artificial tear eye drops.

Is there any collaborative effort underway for the diagnosis and treatment of problems such as myopia among children?

Suresh: The government can play a prominent role in diagnosing and treating eye problems. Some countries have an actual curriculum with a dedicated timetable in the school that gives them a break every two hours. These 10-15 minutes break help children to step out and get an adequate amount of sun exposure, which in turn protects them from myopia progression. That is why it is good to educate parents and teachers who play a significant role in preventing eye diseases, including myopia progression, detection of any refractive error, and preventable blindness like amblyopia. In addition, periodic eye check-ups for kids from the age of three years until they complete schooling are highly recommended.

How frequently should parents and guardians take their children for eye check-ups?

Shikari: In a child with vision problems, your ophthalmologist will recommend a follow-up schedule. In cases of myopia for instance, an examination may be recommended every 3-6 months in the initial period of diagnosis. This is especially important in case the child/ward has been diagnosed with "lazy eye". In the age group of 12-16 years of age, when some kids experience a growth spurt, a frequent eye check-up may be essential to ensure that the refractive error is adequately corrected, since an increase in height can result in increase in myopia.

Suresh: With advanced tools and technology, eye testing can be done in children as young as six months. Children who don't have any family history of eye disease should be examined at five or in their preschool phase. If any family member (father, mother, or sibling) has glasses or vision problems, then an eye examination should begin at three. Also, children with any eye disease need to have a periodic eye checkup every six months until the age of ten and then once a year.

How do factors such as awareness, rural and urban divide, and costs of eye-care hinder access to eye health for children in India?

Suresh: Early detection and treatment of vision problems help prevent blindness. In rural areas, as proper facilities for children's eye care are not available, the cases are higher. That is why detecting and treating children's eye disorders require expertise and infrastructure from various stakeholders, including the government. If it is not done appropriately, it can create preventable eye problems, which can in the future be a social and financial burden to the country.

Experts recommend the following dietary and lifestyle changes for maintaining children's eye health:

1. Parents must teach healthy eating habits to children, and they must focus on a diet that includes green vegetables and fruits rich in antioxidants.

2. In terms of lifestyle modifications, the most important change is a conscious reduction in the use of digital screens.

3. Use of digital screens just before bedtime and in the dark without ambient room lighting should be avoided.

4. For online schooling or watching recreational videos, use of larger screens such as computer, desktop or smart TV should be done as this reduces the strain on the eyes. There needs to be adequate ambient shadow-free lighting in the room to also prevent eye strain.

5. Computer Vision Syndrome guidelines should be followed:

a. When using a digital screen, children should be reminded to blink more often to prevent development of dry eyes.

b. 20-20-20 - Every 20 minutes, take a 20 second break and look 20 feet away. This breaks the eye muscle spasm and prevents development of eye strain.

c. Whenever taking a break, splash cold clean water over eyes and use artificial tear eye drops for protection against dryness.

(Disclaimer: This article is not intended as a substitute for professional medical advice, diagnosis or treatment. Mid-day Online does not in any way endorse the accuracy, completeness, efficacy or timeliness of any advice or line of treatment mentioned in this article. Readers must always seek the advice of a certified medical practitioner and/or a mental health professional before deciding on or starting any course of treatment.)