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The authors aimed to assess how the increased use of technology during a day of virtual school as a result of the COVID-19 pandemic affected the eyes of healthy children. Children aged 10 to 17 years who attended school virtually at least once per week were prospectively recruited in a three month period. Children with previous ocular or neurological pathology were excluded with the exception of refractive correction. Demographics were obtained from the child’s parents via an online survey. The child was asked to complete an asthenopia symptoms survey and a modified version of the Convergence Insufficiency Symptom Survey (CISS) before and after school in online formats without parental input. Children who scored above 16 on the CISS before school were excluded from the analysis due to a high likelihood of undiagnosed pathology. A total of 110 were included in the analysis, after 28 were excluded. Thirty-seven percent of the cohort wore refractive correction and 22% wore blue-light glasses. Details on the length of time attending school virtually was captured along with the type of device used. The authors report a statistically significant increase in scores of both surveys between before and after school, with 61% worsening. Nineteen children (17%) reported a CISS >16 after school, indicating convergence insufficiency diagnosis. A significant increase of CISS scores per hour of virtual school using linear regression. This study demonstrates the increase of convergence insufficiency and asthenopic symptoms as a result of virtual schooling which corroborates findings from previous studies. One limitation of the study is the lack of a control group of children attending school in-person only. This study demonstrated that behaviour modifying recommendations are required when children are virtual schooling to prevent or reduce asthenopic symptoms.

The visual consequences of virtual school: acute eye symptoms in healthy children.
Hamburger J, Lavrich JB, Rusahevich AM, et al.
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Lauren R Hepworth

University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.

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