Myopic Progression Associated with COVID-19 Pandemic in Korean Children with Myopia Using 0.01% Atropine Eyedrops

<b>Background:</b> To evaluate the effect of the COVID-19 pandemic on myopic progression defined in terms of refractive change and axial length elongation in Korean children with myopia using 0.01% atropine eye drops. <b>Methods:</b> A retrospective review was performed on the medical records of 73 children aged 4 to 15 years with a baseline myopia of -0.50 diopters (D) or more who had used 0.01% atropine eye drops for more than 12 months before the onset of the COVID-19 pandemic in South Korea. The rate of myopic progression was compared between two periods: the pre- and post-pandemic eras, the latter of which was defined by the initiation of remote schooling in March 2020. At each visit, cycloplegic autorefraction and axial length were measured using a Zeiss IOL Master. Patients answered a questionnaire regarding their time spent on near work (computer, smartphone, reading, homework, after-school workbooks, drawing, etc.) and outdoors. <b>Results:</b> During the pandemic, in terms of refraction, myopia progressed at an average rate of -0.45 D/y, which was significantly faster than before the pandemic of -0.22D/y (<i>p</i> = 0.037). In contrast, axial length elongation was 0.22 mm/y and 0.19 mm/y before and after the pandemic, respectively, which was not significantly different (<i>p</i> = 0.546). Time spent on using computers, smartphones, and other near work significantly increased, while outdoor time had significantly decreased after the pandemic (paired <i>t</i>-test, all <i>p</i> < 0.001). The change in annual refractive myopic progression rate during the pandemic compared to the pre-pandemic period did not significantly correlate with changes in computer time, smartphone time, or other near work time (<i>p</i> = 0.134, 0.210, 0.863, respectively). However, the change in outdoor time showed a negative correlation with the change in annual myopic progression rate (r = -0.239, <i>p</i> = 0.041). <b>Conclusions:</b> Among Korean children aged 4 to 15 years receiving 0.01% atropine, the rate of myopic progression increased significantly in terms of refraction during the COVID-19 pandemic compared with the pre-pandemic period, whereas axial length progression did not change significantly.