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Original article
Visual complaints during the COVID-19 pandemic in Spain and Portugal
Quejas visuales durante la pandemia de COVID-19 en España y Portugal
F. March de Ribota,
Corresponding author
March.professor@gmail.com

Corresponding author.
, J. Salgado-Borgesb, J. Benitez del Castilloc
a Departamento de Oftalmología, Hospital Universitario de Girona, Girona, Spain
b Clinsborges Ophthalmology, Porto, Portugal
c Departamento de Oftalmología, Hospital Clínico San Carlos, Madrid, Spain
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resource distribution and interests&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0015" class="elsevierStylePara elsevierViewall">Cross-sectional survey through an online email invitation to patients attending ophthalmology clinics in Spain and Portugal from September to November 2021&#46; The study obtained ethical approval following the tenets of the Declaration of Helsinki&#46; The responders had to accept the participation through online informed consent at the beginning of the questionnaire&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Survey</span><p id="par0020" class="elsevierStylePara elsevierViewall">The questionnaire was developed by a group of experts in the field to identify areas of interest during the pandemic&#46; The questionnaire was distributed online and available on a web platform from September to November 2021&#46; The inclusion criteria were respondents older than 18 who received eye care during the pandemic in Spain and Portugal&#46; The patients were referred to a secure website where they indicated their consent to participate after reading an information sheet and accepting the consent&#46; The data was encrypted and anonymous&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Analysis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Statistical analysis was done using SPSS &#40;Statistical Package for the Social Sciences&#41; using descriptive and quantitative statistics with standard deviations&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">3833 participants completed the survey &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; corresponding to 2081 women &#40;54&#46;3&#37;&#41; and 1752 men &#40;45&#46;7&#37;&#41;&#46; 60&#37; referred to increasing dry eye symptoms related to more intense screen time and facemasks&#46; 81&#46;6&#37; of the participants used digital devices for more than 3&#8239;h per day&#44; and 40&#37; for more than 8&#8239;h&#46; In addition&#44; 44&#37; of participants referred to worsening near vision&#46; The difficulty in near vision was identified as the first symptom of presbyopia in 86&#37; of respondents&#46; In the group&#44; the most frequent ametropias were myopia &#40;40&#46;2&#37;&#41; and astigmatism &#40;36&#46;7&#37;&#41;&#46; After 45 years&#44; 75&#37; wore progressive lenses for presbyopia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The respondents that were parents considered that vision was the most important aspect of their children &#40;87&#46;2&#37;&#41; before good buccal hygiene &#40;78&#46;2&#37;&#41; or healthy diet habits &#40;77&#46;2&#37;&#41;&#46; Parents identified using digital devices as a risk factor for myopia &#40;86&#37;&#41;&#59; nevertheless&#44; only 37&#46;8&#37; considered limiting their use&#46; Furthermore&#44; parents considered that they could recognize the manifestations of myopia in their children &#40;74&#46;8&#37;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The participants checked their eyes once a year in 34&#46;9&#37; of cases&#44; every 2 years in 30&#37;&#44; between 2 and 5 years in 17&#46;4&#37;&#44; rarely 1&#44;4&#37;&#44; and only when there were problems in 16&#46;2&#37;&#46; The professionals of reference were ophthalmologists 61&#46;94&#37;&#44; optometrists 45&#46;62&#37;&#44; orthoptists 8&#46;52&#37;&#44; occupational doctors 6&#46;36&#37;&#44; and GPs 0&#46;72&#37; &#40;multiple answers were possible&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The COVID pandemic and the successive lockdowns have changed our daily habits&#46; Hence&#44; the expansion of digital time has increased dry eye and myopia progression&#44; impacting visual complaints&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Digital eye strain &#40;DES&#41; related to dry eye is associated with accommodative vision stress&#44; decreased blinking&#44; visual focus and other aspects like insufficient lighting&#44; bad posture&#44; or uncorrected refractive errors&#46; Usually&#44; the individual is conscious of the situation when the visual needs exceed the task&#46; As a result&#44; patients may complain of dryness&#44; discomfort&#44; blurred vision&#44; fatigue&#44; and headaches&#46; Corrective measures include refraction&#44; treating dry eye&#44; screen time breaks and keeping a correct working distance&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> DES presents to some degree in 90&#37; of screen device users<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and higher in people who use more than 4&#8239;h per day&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> DES prevalence has increased<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> with the increase of digital time between 40&#37;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> to 50&#37;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> of cases&#44; showing dry eye in 78&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> 93&#46;6&#37; of subjects apprised of an increase in digital time since the pandemic&#44; with an increase of 4&#46;8&#8239;&#177;&#8239;2&#46;8&#8239;h per day&#44; resulting in 8&#46;65&#8239;&#177;&#8239;3&#46;74&#8239;h a day&#46; 95&#46;8&#37; of participants experienced some dry eye symptoms&#44; and 56&#46;5&#37; recognized an increase related to the lockdowns&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The results of our study highlight that 81&#44;6&#37; of the subjects used screens for more than 3&#8239;h daily and increased dry eye symptoms to 60&#37; during the pandemic&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Myopia development has increased for extended digital time and near work&#44; having a lifetime impact on children&#46; Promoting healthy habits and outdoor activities in children is essential to correct the myopigenic effects of the pandemic&#46; The outcomes of this study extrapolate that despite 86&#46;8&#37; of the parents recognizing digital screens as a risk factor for myopia&#44; only 37&#46;8&#37; discuss limiting their use&#46; A strong collaboration with eye care professionals&#44; parents and educators is vital to encourage myopia management approaches&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;19</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The study has limitations for the methodology as a survey and the distribution&#46; The online distribution limits the population representativity&#44; and we can expect biases among the participants&#46; In addition&#44; our study was a symptom-based survey unrelated to the eye visit&#44; refraction&#44; or eye problems&#46; The subjective patient opinion may vary the participation engagement and results&#46; The self-perception of screen time may also differ from reality&#46; Subjects with advanced dry eye symptomatology tend to report mild complaints&#44; leading to underdiagnosis in self-reported questionnaires&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0065" class="elsevierStylePara elsevierViewall">Our study points out some visual complaints during the pandemic&#44; including increased dry eye and refractive needs&#46; In addition&#44; this research spotlights the negative influences of screen use on dry eye and myopia progression&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study reports visual health during the COVID-19 pandemic in 2021 in Spain and Portugal&#44; focusing on eye complaints and population habits&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional survey through an online email invitation to patients attending ophthalmology clinics in Spain and Portugal from September to November 2021&#46; Around 3833 participants offered valid anonymous responses in a questionnaire&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Sixty percent of respondents identified significant discomfort related to dry eye symptoms for increased screen time and lens fogging using facemasks&#46; 81&#46;6&#37; of the participants used digital devices for more than 3&#8239;h per day and 40&#37; for more than 8&#8239;h&#46; In addition&#44; 44&#37; of participants referred to worsening near vision&#46; The most frequent ametropias were myopia &#40;40&#46;2&#37;&#41; and astigmatism &#40;36&#46;7&#37;&#41;&#46; Parents considered eyesight the most important aspect of their children &#40;87&#46;2&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The results show the challenges for eye practices during the initial COVID-19 pandemic&#46; Focusing on signs and symptoms that lead to ophthalmologic conditions is an essential concern&#44; especially in our digital society highly dependent on vision&#46; At the same time&#44; the excessive use of digital devices during this pandemic has aggravated dry eye and myopia&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Este estudio reporta los h&#225;bitos de la poblaci&#243;n y las quejas oculares relacionadas con la salud visual en el contexto de la pandemia de COVID-19 a partir de visitas realizadas durante 2021 en Espa&#241;a y en Portugal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Invitaci&#243;n por correo electr&#243;nico a una encuesta transversal online y tambi&#233;n realizada en persona a pacientes de cl&#237;nicas de oftalmolog&#237;a de Espa&#241;a y de Portugal de septiembre a noviembre de 2021&#46; Participaron 3&#46;833 encuestados mayores de 18 a&#241;os con respuestas an&#243;nimas v&#225;lidas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El 60&#37; de los encuestados explic&#243; mucha incomodidad causada por el aumento de los s&#237;ntomas de ojo seco debido al trabajo digital m&#225;s intenso y el empa&#241;amiento de los lentes al usar mascarillas&#46; El 81&#44;6&#37; de los encuestados usaba dispositivos digitales al menos 3 horas en promedio por d&#237;a&#44; y el 40&#37; comenz&#243; a usar dispositivos digitales m&#225;s de 8 horas en promedio por d&#237;a&#46; Adem&#225;s&#44; el 44&#37; de los encuestados sinti&#243; que su visi&#243;n de cerca hab&#237;a empeorado en este per&#237;odo&#46; El primer s&#237;ntoma importante de la presbicia estaba relacionado con la dificultad para leer las letras m&#225;s peque&#241;as de los paquetes&#46; El 86&#37; present&#243; los primeros s&#237;ntomas a los 40 a&#241;os&#46; Las ametrop&#237;as m&#225;s frecuentes identificadas fueron miop&#237;a &#40;40&#44;2&#37;&#41; y astigmatismo &#40;36&#44;7&#37;&#41;&#46; Para los padres&#44; tener buena vista &#40;87&#44;2&#37;&#41; era el aspecto m&#225;s valorado en la vida de sus hijos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los hallazgos brindan una idea de los desaf&#237;os durante la COVID-19 para las pr&#225;cticas oftalmol&#243;gicas&#46; En una sociedad altamente dependiente de la visi&#243;n&#44; es fundamental centrarse en los signos y los s&#237;ntomas que conducen a afecciones oftalmol&#243;gicas&#46; El uso excesivo de dispositivos digitales y el uso de mascarillas durante esta pandemia han agravado algunos&#44; se&#241;alando la importancia de la referencia para planificar una atenci&#243;n ocular eficiente en situaciones similares&#46;</p></span>"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos