Dr.Agarwals Hospital in Chennai sees 5 times year on year increase in the number of acute onset comitant esotropia – a sudden and unexpected outbreak of squint eye in the last two years of COVID-19 pandemic
The onset of myopia (nearsightedness) among children has been increasing by about 25% while the annual myopia progression has been abnormally high at 100% 

Chennai, 5th August , 2021: There has been a five times year-on-year increase in the number of acute onset comitant esotropia, a sudden and unexpected outbreak of squint eye cases, among children in the city in the past two years. Equally alarming is the 100% myopia progression and 25% increase in the onset of myopia every year in the past two years, according to Dr. Manjula Jayakumar, Senior Pediatric Ophthalmologist, Dr. Agarwals Eye Hospital, Chennai. 

The main causes are increased screen time and lifestyle changes of children characterized by a lack of adequate exposure to sunlight and reduced physical activities. 

Interacting with media in a virtual press meet, organized by Dr. Agarwals Eye Hospital, one of Indias largest networks of eyecare centers, on the occasion of Children’s Eye Health and Safety Awareness Month, observed every August, Dr. Manjula Jayakumar, said, There has been an unprecedented increase in the number of acute onset comitant esotropia among the pediatric population during the recent pandemic years. In Chennai, we get to see 1 or 2 cases in a year before COVID-19 but today there are more than 10 cases. The progression of myopia has been another cause of concern. We find nearly 100% progression among children. The onset of myopia has also increased by 25%. 

Among the key risk factors are sustained near work – which traditionally refers to activities such as reading and writing with the distance between the object of focus (books, for instance), and eyes being less than 33 cm. According to the World Society of Paediatric Ophthalmology and Strabismus (WSPOS) consensus, sustained near-work has more implications in myopia, and could lead to conditions such as squint eye.

Dr. Manjula Jayakumar added that during the lockdown period, the near-work often involves computers, laptops, and mobile phones or tablets, taken up without frequent breaks and increased screen time for academic or other purposes. This visual stress could lead to squinting and has an accelerating effect on myopia progression. Both books and other paper-based materials, as well as light-emitting digital devices, pose an equal risk to myopia progression. But the light-emitting digital devices pose other problems like dry eye and photosensitivity.
 
Talking about the need for promoting good eye health measures, Dr. Manjula Jayakumar, said that according to the World Society of Paediatric Ophthalmology and Strabismus consensus, sustained near-work has more implications in myopia progression than the total number of hours

with frequent breaks. This means if a child spends an hour in front of a computer screen or mobile phone without a break, he or she has more chances of developing eye-related complications than a child who spends three hours but takes frequent breaks, she said.  

Dr. Manjula Jayakumar suggested that when online classes are not avoidable, parents can ask children to use laptops/desktops – instead of mobile phones, as the distance of eyes from these digital devices would be more, compared to mobile phone screens. It is important to ensure sunlight exposure for 1 to 2 hours a day with outdoor play if possible. A healthy, and well-balanced diet will promote overall development.

On the latest treatments for myopia, Dr. Manjula Jayakumar said that for myopia progression, the solutions are low dose atropine eye drops, progressive addition lenses, multifocal spectacles, special contact lenses like orthokeratology and RGP contact lenses. But cases of acute onset comitant esotropia are not reversible. Hence, strabismus surgery has to be done to restore binocular vision.

She said that severe myopia has complications like early-onset cataracts, open-angle glaucoma, retinal detachment, atrophic myopic maculopathy, and myopic strabismus fixus. Myopia progression is also an economic burden for the individual and country. Ophthalmologists are striving to reduce myopia progression by modulating environmental factors.