Effects of remote learning during the COVID-19 lockdown on children’s visual health: a systematic review

Abstract

ObjectivesIncreased exposure to digital devices as part of online classes increases susceptibility to visual impairments, particularly among school students taught using e-learning strategies. This study aimed to identify the impact of remote learning during the COVID-19 lockdown on children’s visual health.DesignSystematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesScopus, PubMed and ScienceDirect databases from the year 2020 onwards.Eligibility criteriaWe included cross-sectional, case–control, cohort studies, case series and case reports, published in English, Spanish or French, that approached the effects of remote learning during the COVID-19 lockdown on visual health in neurotypical children.Data extraction and synthesisWe included a total of 21 articles with previous quality assessments using the Joanna Briggs checklist. Risk of bias assessment was applied using the National Institutes of Health quality assessment tool for before-and-after studies with no control group; the tool developed by Hoyet alto assess cross-sectional studies; the Muradet altool to evaluate the methodological quality of case reports and case series; and the Newcastle-Ottawa Scale for cohort studies.ResultsAll but one study reported a deleterious impact of the COVID-19 lockdown on visual health in children. Overall, the most frequently identified ocular effects were refractive errors, accommodation disturbances and visual symptoms such as dry eye and asthenopia.ConclusionsIncreased dependence on digital devices for online classes has either induced or exacerbated visual disturbances, such as rapid progression of myopia, dry eye and visual fatigue symptoms, and vergence and accommodation disturbances, in children who engaged in remote learning during the COVID-19 lockdown.PROSPERO registration numberCRD42022307107.