Myopic Progression in Children Worsened by Online Learning

Smiling Boy Using Digital Tablet While Lying On Bed In white room
Smiling Boy Using Digital Tablet While Lying On Bed In white room
No significant spherical equivalent refraction changes occurred during the traditional learning period, but they did significantly increase during the online learning period.

Learning modalities that involve spending more time indoors and consistently using a computer may be connected to an increase in myopia in children, according to a study published in Optometry and Vision Science. 

Researchers enrolled 49 children (mean age 10.88±0.85 years, range 9-11 years, 53.1% boys) in a study between November 2019 and November 2020. The team distributed wearable devices, which recorded visual behavior, to all  participants and measured glass wearing time, time spent outdoors, and near viewing time. They also performed spherical equivalent refraction (SER) and axial length (AL) measurements at baseline, 6-months, and 1-year follow-up visits. 

The investigators conducted their analysis using 2 different learning modalities: traditional mode and online mode. Traditional mode involved a school day consisting of 7 classes lasting 40 minutes each. Students had a total of 2.5 hours of rest each school day and took a physical education class. They did not use computers while at school. Online mode involved spending a majority of the school day using a computer. 

The researchers noted that children spent significantly less time outdoors on weekdays during the period of online learning than they did during a traditional school day (6 minutes; IQR, 0-37.50 and 32 minutes; IQR, 13.50-50, respectively, P <.001). Near viewing time was significantly longer in online mode compared with the traditional mode (418.98±108.13 minutes vs 388.39±85.50, P <.001). The team noted that no significant changes in SER occurred during the traditional learning period (P =.21), but a significant decrease in SER did take place during the online mode (-2.33±0.81 D to -2.94±0.83 D OD). They also highlight the finding that while no significant changes in AL occurred from baseline to 6 months or from 6 months to 1 year, the change from baseline to 1-year follow-up was significant (P =.01).

“This study provides evidence of the association of learning mode and myopia progression,” according to the investigators. “Accelerated progression of myopia in online class mode may be related to increased near-viewing time and decreased time spent in outdoor activities.”

Study limitations include a small sample size and a lack of nonmyopic participants. 


Fan Y, Liao J, Liu S. Effect of time outdoors and near-viewing time on myopia progression in 9- to 11-year-old children in Chongqing. Optom Vis Sci. 2022;99(6):489-495. doi:10.1097/OPX.0000000000001898