The prevalence of myopia remains stable under tighter COVID‐19 social restriction in preschoolers receiving a school‐based eyecare program

Abstract Purpose This study investigated the impact of different levels of COVID‐19 social restrictions (social distancing in 2020, large‐scale home confinement in 2021) on myopia prevalence and behaviours in a preschool population with school‐based eyecare programme. Methods Repeated cross‐sectional surveys were conducted between August and December in 2019, 2020 and 2021. Children aged 5–6 years received ocular examinations, and questionnaires were answered by caregivers before the day of the examination. The main outcome measures were the changes in after‐school time spent on homework, screen‐based devices and outdoors. Secondary outcome was the change in myopia prevalence (spherical equivalent [SE] ≤ −0.5 D in either eye after cycloplegia). Results A total of 9997 preschoolers were included in the analysis. Under tighter restrictions, more preschoolers spent ≥1 h/day on screen‐based devices (42.8% in 2019, 45.2% in 2020, 48.9% in 2021, p < 0.001), and fewer preschoolers spent ≥30 min/day on after‐school outdoor activities (49.5% in 2019, 46.0% in 2020, 41.0% in 2021, p < 0.001) on weekdays. A similar trend was found on weekends. While more preschoolers spent ≥2 h/day on screen‐based devices (35.3% in 2019, 38.5% in 2020, 43.0% in 2021, p < 0.001), fewer preschoolers spent ≥2 h/day on outdoor activities (41.7% in 2019, 41.7% in 2020, 34.0% in 2021, p < 0.001). The mean SE and myopia prevalence were stable (9.1% in 2019, 10.3% in 2020, 9.4% in 2021, p = 0.707). Conclusion Our study showed dose‐dependent effect of social restrictions on near‐work and outdoor behaviours at home. The prevalence of myopia did not increase significantly with short‐term cessation of school‐based eyecare programmes.