Impact of COVID-19 on refractive amblyopia risk factors in 5-years-old children: A nationwide cross sectional study.

PURPOSE: To assess the impact of COVID-19 on refractive amblyopia risk factors (rARFs), among 5-year-old children in Israel. METHODS: We conducted a nationwide, community-based cross-sectional study to evaluate and compare trends in refractive amblyopia risk factors (rARFs) in more than 100,000 children aged 5 years, from urban kindergarten in Israel. The study was conducted from 2013 to 2023, using the PlusOptiX S12 autorefractor, a photo-screening device, to collect refractive measurements. The main outcome was the annual prevalence of rARFs across the ten-year study period. RESULTS: Overall, 101,626, 5 year-old children were included. The prevalence of rARFs declined from 11.4% (164/1445 children) in 2013 to 6.8% (476/6964 children) by 2023, with significant decrease observed during the post-COVID period. The prevalence of children with one rARF decreased from 9.0% to 5.6%, with corresponding reductions in those with two (1.6% to 1.0%) and three risk factors (0.8% to 0.2%). Analysis of each rARFs showed a shift in refractive patterns following COVID-19, with myopia increasing relative to the pre-COVID average, while anisometropia and astigmatism declined, and hyperopia showed a non-significant decrease. CONCLUSION: We observed a decrease in the prevalence of refractive amblyopia risk factors in an unscreened population of children in urban kindergartens over the past decade. Hyperopia, anisometropia, and astigmatism showed reductions during the post-COVID-19 period, while the myopia risk factor increased. These trends may reflect advances in diagnostic technology, greater public awareness, and the implementation of early vision screening, underscoring their importance.