{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T14:39:04Z","timestamp":1772548744359,"version":"3.50.1"},"reference-count":52,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"SNUBH research fund","award":["02-2022-0032"],"award-info":[{"award-number":["02-2022-0032"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: 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. Methods: A retrospective review was performed on the medical records of 73 children aged 4 to 15 years with a baseline myopia of \u22120.50 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. Results: During the pandemic, in terms of refraction, myopia progressed at an average rate of \u22120.45 D\/y, which was significantly faster than before the pandemic of \u22120.22D\/y (p = 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 (p = 0.546). Time spent on using computers, smartphones, and other near work significantly increased, while outdoor time had significantly decreased after the pandemic (paired t-test, all p &lt; 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 (p = 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 = \u22120.239, p = 0.041). Conclusions: 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.<\/jats:p>","DOI":"10.3390\/life16030407","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T09:45:12Z","timestamp":1772531112000},"page":"407","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myopic Progression Associated with COVID-19 Pandemic in Korean Children with Myopia Using 0.01% Atropine Eyedrops"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3179-3122","authenticated-orcid":false,"given":"Dong Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3864-6977","authenticated-orcid":false,"given":"Jihae","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Daegu Fatima Hospital, 99, Ayang-ro, Dong-gu, Daegu 41199, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0837-2864","authenticated-orcid":false,"given":"Jeong-Min","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Strabismus & Pediatric Ophthalmology Center, Kim\u2019s Eye Hospital, 136, Yeongsin-ro, Yeongdeungpo-gu, Seoul 07301, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1140-6036","authenticated-orcid":false,"given":"Hee Kyung","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1136\/bjo-2024-325427","article-title":"Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: A comprehensive systematic review and meta-analysis","volume":"109","author":"Liang","year":"2025","journal-title":"Br. J. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.preteyeres.2012.06.004","article-title":"The complex interactions of retinal, optical and environmental factors in myopia aetiology","volume":"31","author":"Flitcroft","year":"2012","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1038\/s41433-021-01805-6","article-title":"Myopia prediction: A systematic review","volume":"36","author":"Han","year":"2022","journal-title":"Eye"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Grzybowski, A., Kanclerz, P., Tsubota, K., Lanca, C., and Saw, S.M. (2020). A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmol., 20.","DOI":"10.1186\/s12886-019-1220-0"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1001\/archophthalmol.2009.303","article-title":"Increased prevalence of myopia in the United States between 1971\u20131972 and 1999\u20132004","volume":"127","author":"Vitale","year":"2009","journal-title":"Arch. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1001\/archopht.122.4.495","article-title":"The prevalence of refractive errors among adults in the United States, Western Europe, and Australia","volume":"122","author":"Kempen","year":"2004","journal-title":"Arch. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5579","DOI":"10.1167\/iovs.12-10106","article-title":"Prevalence of myopia and its association with body stature and educational level in 19-year-old male conscripts in seoul, South Korea","volume":"53","author":"Jung","year":"2012","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1016\/j.ophtha.2007.12.019","article-title":"Outdoor activity reduces the prevalence of myopia in children","volume":"115","author":"Rose","year":"2008","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1136\/bjo.2008.150979","article-title":"Outdoor activity and myopia in Singapore teenage children","volume":"93","author":"Dirani","year":"2009","journal-title":"Br. J. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.ophtha.2012.11.009","article-title":"Outdoor activity during class recess reduces myopia onset and progression in school children","volume":"120","author":"Wu","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.exer.2013.04.018","article-title":"Time outdoors and the prevention of myopia","volume":"114","author":"French","year":"2013","journal-title":"Exp. Eye Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kim, D.H., Hwang, J.M., and Yang, H.K. (2025). Topical Dopamine Application on Form-Deprivation Myopia in Rabbits. Life, 15.","DOI":"10.3390\/life15030461"},{"key":"ref_13","unstructured":"UNESCO (2026, February 24). COVID-19 Educational Disruption and Response. UNESCO, 24 March 2020. Available online: https:\/\/www.unesco.org\/en\/articles\/covid-19-educational-disruption-and-response."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3352\/jeehp.2021.18.24","article-title":"Changes in academic performance in the online, integrated system-based curriculum implemented due to the COVID-19 pandemic in a medical school in Korea","volume":"18","author":"Kim","year":"2021","journal-title":"J. Educ. Eval. Health Prof."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100493","DOI":"10.1016\/j.optom.2023.100493","article-title":"Myopia progression in children during home confinement in the COVID-19 pandemic: A systematic review and meta-analysis","volume":"17","author":"Laan","year":"2024","journal-title":"J. Optom."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zhou, W., Li, Q., Chen, H., Liao, Y., Wang, W., Pei, Y., Li, S., Zhang, W., Wang, Q., and Wang, X. (2022). Trends of myopia development among primary and junior school students in the post-COVID-19 epidemic period. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.970751"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Shneor, E., Doron, R., Levine, J., Zimmerman, D.R., Benoit, J.S., Ostrin, L.A., and Gordon-Shaag, A. (2021). Objective Behavioral Measures in Children before, during, and after the COVID-19 Lockdown in Israel. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168732"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ajo.2020.07.034","article-title":"Digital Screen Time During the COVID-19 Pandemic: Risk for a Further Myopia Boom?","volume":"223","author":"Wong","year":"2021","journal-title":"Am. J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8550","DOI":"10.1167\/iovs.14-15839","article-title":"Does vitamin D mediate the protective effects of time outdoors on myopia? Findings from a prospective birth cohort","volume":"55","author":"Guggenheim","year":"2014","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102466","DOI":"10.1016\/j.pmedr.2023.102466","article-title":"Reflections on the dynamic zero-COVID policy in China","volume":"36","author":"Ba","year":"2023","journal-title":"Prev. Med. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ophtha.2015.07.004","article-title":"Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops","volume":"123","author":"Chia","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.ophtha.2018.05.029","article-title":"Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control","volume":"126","author":"Yam","year":"2019","journal-title":"Ophthalmology"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Navarra, P., Buzzonetti, L., Amico, V., Cro, M., and Federico, B. (2025). A systematic review with meta-analysis on the efficacy of 0.01% atropine eyedrops in preventing myopia progression in worldwide children\u2019s populations. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1497667"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e234080","DOI":"10.1001\/jamanetworkopen.2023.4080","article-title":"Prevalence of Myopia in Children Before, During, and After COVID-19 Restrictions in Hong Kong","volume":"6","author":"Zhang","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"M20","DOI":"10.1167\/iovs.18-25957","article-title":"IMI-Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies","volume":"60","author":"Flitcroft","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_26","first-page":"1171","article-title":"One-year myopia control efficacy of spectacle lenses with aspherical lenslets","volume":"106","author":"Bao","year":"2022","journal-title":"Br. J. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1111\/opo.13101","article-title":"Comparing ocular biometry and autorefraction measurements from the Myopia Master with the IOLMaster 700 and the Huvitz HRK-8000A autorefractor","volume":"43","author":"Pedersen","year":"2023","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"12770","DOI":"10.1038\/s41598-022-16985-8","article-title":"A comparison of IOLMaster 500 and IOLMaster 700 in the measurement of ocular biometric parameters in cataract patients","volume":"12","author":"Jiang","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s10384-006-0410-5","article-title":"Axial length measurement using partial coherence interferometry in myopic children: Repeatability of the measurement and comparison with refractive components","volume":"51","author":"Kimura","year":"2007","journal-title":"Jpn. J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1167\/iovs.03-1051","article-title":"Refractive error and visual impairment in urban children in southern china","volume":"45","author":"He","year":"2004","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.ophtha.2007.03.075","article-title":"Refractive errors in an elderly Japanese population: The Tajimi study","volume":"115","author":"Sawada","year":"2008","journal-title":"Ophthalmology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"27","DOI":"10.47102\/annals-acadmedsg.V33N1p27","article-title":"Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000","volume":"33","author":"Lin","year":"2004","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kim, E.C., Morgan, I.G., Kakizaki, H., Kang, S., and Jee, D. (2013). Prevalence and risk factors for refractive errors: Korean National Health and Nutrition Examination Survey 2008\u20132011. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0080361"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/00006324-200104000-00012","article-title":"Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore","volume":"78","author":"Wu","year":"2001","journal-title":"Optom. Vis. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1111\/j.1755-3768.1980.tb05748.x","article-title":"Refraction, nearwork and education. A population study in Newfoundland","volume":"58","author":"Richler","year":"1980","journal-title":"Acta Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/j.1475-1313.2006.00455.x","article-title":"School grades and myopia","volume":"27","author":"Saw","year":"2007","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4363","DOI":"10.1167\/iovs.11-8677","article-title":"The association between time spent outdoors and myopia using a novel biomarker of outdoor light exposure","volume":"53","author":"Sherwin","year":"2012","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1001\/jamaophthalmol.2020.6239","article-title":"Progression of Myopia in School-Aged Children After COVID-19 Home Confinement","volume":"139","author":"Wang","year":"2021","journal-title":"JAMA Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3911","DOI":"10.1007\/s10792-023-02777-0","article-title":"Comparison of myopia progression among Chinese schoolchildren before and during COVID-19 pandemic: A meta-analysis","volume":"43","author":"Luo","year":"2023","journal-title":"Int. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1001\/archopht.123.7.977","article-title":"Relationship of age, sex, and ethnicity with myopia progression and axial elongation in the correction of myopia evaluation trial","volume":"123","author":"Hyman","year":"2005","journal-title":"Arch. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1167\/iovs.03-1151","article-title":"Prevalence, incidence, and progression of myopia of school children in Hong Kong","volume":"45","author":"Fan","year":"2004","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"386","DOI":"10.2188\/jea.JE20140258","article-title":"Five-Year Progression of Refractive Errors and Incidence of Myopia in School-Aged Children in Western China","volume":"26","author":"Zhou","year":"2016","journal-title":"J. Epidemiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"659","DOI":"10.4103\/0366-6999.151669","article-title":"Relevant factors of estrogen changes of myopia in adolescent females","volume":"128","author":"Gong","year":"2015","journal-title":"Chin. Med. J."},{"key":"ref_44","first-page":"1294","article-title":"Analysis on the relationship between adolescent myopia and serum sex hormone","volume":"94","author":"Xie","year":"2014","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1097\/00006982-200208000-00004","article-title":"Expression of estrogen receptor in the choroidal neovascular membranes in highly myopic eyes","volume":"22","author":"Kobayashi","year":"2002","journal-title":"Retina"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Yum, H.R., Park, S.H., and Shin, S.Y. (2021). Influence of coronavirus disease 2019 on myopic progression in children treated with low-concentration atropine. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0257480"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1001\/jamaophthalmol.2023.2855","article-title":"Low-Dose 0.01% Atropine Eye Drops vs Placebo for Myopia Control: A Randomized Clinical Trial","volume":"141","author":"Repka","year":"2023","journal-title":"JAMA Ophthalmol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1111\/opo.13490","article-title":"Does 0.01% atropine have a place as a myopia control therapy?","volume":"45","author":"Yam","year":"2025","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"224","DOI":"10.3928\/01913913-20210217-02","article-title":"Binocular Accommodation and Vergence Dysfunction in Children Attending Online Classes During the COVID-19 Pandemic: Digital Eye Strain in Kids (DESK) Study-2","volume":"58","author":"Mohan","year":"2021","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Pena-Verdeal, H., Noya-Padin, V., Garcia-Queiruga, J., Nores-Palmas, N., Giraldez, M.J., and Yebra-Pimentel, E. (2024). Temporal Variations in Convergence Insufficiency Symptomatic Status among University Students before and after COVID-19: A Longitudinal Analysis from 2018 to 2023. Life, 14.","DOI":"10.3390\/life14070800"},{"key":"ref_51","first-page":"1535","article-title":"Effect of low-dose atropine on myopia progression, pupil diameter and accommodative amplitude: Low-dose atropine and myopia progression","volume":"104","author":"Fu","year":"2020","journal-title":"Br. J. Ophthalmol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"18310","DOI":"10.1038\/s41598-020-75342-9","article-title":"Additive effect of atropine eye drops and short-term retinal defocus on choroidal thickness in children with myopia","volume":"10","author":"Chiang","year":"2020","journal-title":"Sci. Rep."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/3\/407\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T10:34:19Z","timestamp":1772534059000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/3\/407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":52,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["life16030407"],"URL":"https:\/\/doi.org\/10.3390\/life16030407","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]}}}