The COVID stories that consume most of our attention concern its tragic death toll and the anxiety that pervades our efforts to respond to the threat, or even just live through it. But a global phenomenon also brings with it second-order effects—unanticipated “consequences of consequences” playing out in the background. 

For instance, the shelter-at-home orders yielded a research bonanza for environmental scientists. Since March, they’ve been recording pollution levels that reflect actual, rather than hypothetical, low levels of auto emissions. They’ll now be able to model the effects of reduced traffic with much greater accuracy.

What second-order effects do we see in eye care? For one, COVID has brought telehealth to mainstream practice. While impractical for most clinical responsibilities, telehealth should stick around for follow-up visits and other aspects of care that don’t require specialized equipment. 

It also decimated CE conferences. Meeting planners are nervously waiting to see if attendees will be content with, or even prefer, virtual events as a staple of education from now on.

But I wonder if COVID’s biggest unforeseen effect is to essentially launch a giant clinical trial of myopia’s environmental influences. The literature says children need at least two hours of outdoor time each day to mitigate myopia development. We’re now six months into a pandemic that fundamentally reshaped of our daily routines. With schools and daycares closed, and summer camps and vacations off the table for most families, we’re all spending enormously more time indoors. As school reopening looks dicey, some kids could be forced to live for a year under circumstances least conducive to emmetropization: home-schooling in front of a screen for hours a day with outdoor time severely limited.

Being the father of a four-year-old, this has crossed my mind more than once. With no other kids to play with thanks to social distancing and not even an open playground to enjoy, we’re lucky to keep my son outside for 30 minutes a day. The rest of his time is devoted to an endless array of near vision tasks indoors.

If my son ends up myopic when he might not have otherwise, that’s unfortunate but certainly negligible compared with the horrific first-order COVID consequences. Still, myopia was already a pandemic in its own right before COVID barged in and potentially kicked it into high gear. 

I can understand if you’ve had enough myopia control articles for a while. It surely has dominated optometric education of late. But, for those who are interested, this month’s article, “Add Multifocals to Your Myopia Toolbox” is a good place to start. The authors lay out a plan for making this technique work in your practice—something few ODs are doing despite all the media coverage. As noted in the article, only 6.8% of all contact lens fits in 2018 were for myopia control, which amounted to just 2.3% of contact lens fits for kids. 

COVID will be brought under control one day. Will myopia? The need for interventions, and the opportunities they offer, are manifestly clear.