Abstract
The myopia epidemic is a major public health concern, yet the underlying causes and mechanisms of myopia progression remain unclear. Recent studies have reported an association between myopia progression and higher order aberrations (HOAs). However, to our knowledge, no research has reported the relationship between HOAs and environmental factors, which are well-established contributors to myopia progression. In this prospective study, we investigated this association across the COVID-19 pandemic. Children aged 6 to 12 years from one elementary school in Tokyo were enrolled. Non-cycloplegic refraction and ocular biometry were measured. Investigations were carried out every summer from 2018 to 2021. We adopted ocular spherical aberration (SA), third- and fourth-order aberrations (S3 and S4), and total HOAs (THOA) (calculated as the root mean squares from the third- to sixth-order Zernike coefficients) evaluated with a natural pupillary diameter. We analyzed 357 students during 2018 to 2019 (pre-pandemic period), 217 during 2019 to 2020 (pandemic period), and 285 during 2020 to 2021 (post-pandemic period). The time spent outdoors decreased significantly from 100.5 min/day in 2018 to 66.2 min/day in 2020 (p < 0.001). The time spent on near work including digital device usage initially decreased and then increased during the observation period. The time spent on smartphones was correlated inversely with the changes in S3, S4, and THOA in the pre-pandemic period. During the pandemic, the time spent on computers was correlated positively with the changes in the SA, S3, S4, and THOA. In the post-pandemic period, the time spent on reading and studying was correlated positively with the changes in THOA. Remarkably, the outdoor time was not a significant variable during any period. In conclusion, lifestyle factors changed dramatically throughout the pandemic and, particularly near work, may have been associated with the HOAs in children.
Data availability
Y.S. had full access to all the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. The data that support the findings of this study are available from Y.S., but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. However, data are available from the authors upon reasonable request and with the permission of H.T.
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Acknowledgements
We thank Miyuki Kono, Taro Nakamura, the principal of the elementary school; Kazue Sasaki, the school nurse of the elementary school; Toshihiro Abe, the chief coordinator of the school home community; Takashi Tominaga, Natsuko Shimizu, Yuta Shigeno, and Ryo Okumura for assistance with the examination; Ryoko Yamada, Tomoko Omori, Ayaka Ono, Nanae Ebina, Miwa Takatani, Yu Yamamoto, Keisuke Goto, and Kazuma Nimura, for assistance with the measurements, and Lynda Charters for editing the English in this manuscript.
Funding
This work was supported by the Japan Society for the Promotion of Science Kakenhi Grant Number 18K16934 (to E.Y.), Takeda Science Foundation (Osaka, Japan, to H.T.), and JINS Endowed Research Laboratory for Myopia (to K.N.). The sponsors or funding organizations had no role in the design or conduct of this research.
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E.Y. and H.T. made substantial contributions to conception and design. Y.S., E.Y., M.O., and A.H. collected the data. Y.S. and E.Y. analyzed and interpreted data. Y.S., E.Y., and H.T. drafted the manuscript. Y.S., E.Y., H.T., M.O., A.H., K.T., T.K., and K.N. revised the manuscript critically for important intellectual content. Y.S., E.Y., H.T., M.O., A.H., K.T., T.K., and K.N. administrated technical or material support. H.T., K.T., T.K., and K.N. supervised. All authors have read and approved the final manuscript.
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Shimizu, Y., Yotsukura, E., Ogawa, M. et al. Near work affects ocular higher order aberrations in children—a longitudinal study before and after COVID-19: The Tokyo Myopia Study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-44635-w
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DOI: https://doi.org/10.1038/s41598-026-44635-w
