Articles and issues

Background. School closures and the shift to online learning during the COVID-19 pandemic increased screen time and reduced outdoor activity among children, raising concern about faster myopia onset. Population-based data on myopia among Indian schoolchildren after the pandemic are limited. Methods. A school-based cross-sectional survey was conducted between August and December 2025 in 30 government and private schools in urban Delhi selected by stratified cluster random sampling. Children aged 6–15 years underwent visual acuity testing and cycloplegic autorefraction, and parents completed a questionnaire on outdoor time, screen use, near work and parental myopia. Myopia was defined as a spherical equivalent of −0.50 D or less in either eye. Risk factors were examined using multivariable logistic regression accounting for clustering by school. Results. Of 5,400 eligible children, 4,862 (90.0%) completed the examination. The prevalence of myopia was 21.4% (95% CI 19.9–22.9), rising from 9.8% at 6–8 years to 32.2% at 12–15 years, and high myopia was found in 1.1%. Among myopic children, 61.2% were uncorrected or undercorrected. Myopia was independently associated with older age, female sex, private schooling, parental myopia (both parents: adjusted OR 3.12, 95% CI 2.41–4.04), spending less than 1 hour a day outdoors (adjusted OR 2.08, 95% CI 1.66–2.61) and recreational screen time above 3 hours a day (adjusted OR 1.92, 95% CI 1.53–2.41). Conclusions. About one in five schoolchildren in urban Delhi was myopic after the pandemic, a higher prevalence than reported in earlier surveys of the city. School-based programs that increase outdoor time, limit recreational screen use and provide spectacles are needed.

Introduction. Topiramate, a sulfamate-substituted anticonvulsant widely used for epilepsy and migraine prophylaxis, can cause bilateral secondary angle closure through ciliochoroidal effusion. Because the mechanism differs from pupillary block, the condition may be misdiagnosed and treated inappropriately. Case presentation. A 27-year-old woman presented with sudden bilateral blurred vision, ocular pain and headache 9 days after starting topiramate for migraine prophylaxis. Uncorrected visual acuity was 6/60 in the right eye and 6/36 in the left, with an acquired myopic shift of −3.50 D and −3.00 D. Intraocular pressure was 46 and 44 mmHg, and both anterior chambers were uniformly shallow with 360° angle closure on gonioscopy. Ultrasound biomicroscopy showed supraciliary effusion with anterior rotation of the ciliary body in both eyes. Topiramate was stopped, and she was treated with intravenous mannitol, topical aqueous suppressants, atropine and corticosteroids; pilocarpine and laser iridotomy were avoided. Intraocular pressure fell to 18 and 17 mmHg within 48 hours. By 2 weeks the myopic shift and effusions had resolved, the angles were open without synechiae, and uncorrected visual acuity was 6/6 in both eyes. Conclusion. Bilateral angle closure with an acute myopic shift in a patient recently started on topiramate should prompt immediate withdrawal of the drug and treatment directed at ciliochoroidal effusion rather than pupillary block.