Virtual Schooling Led to Acute Ocular Symptoms

Mother helping son during e-learning at home
Mother helping son during e-learning at home
The pandemic safety measure led to more instances of convergence insufficiency in children, a report shows.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of the American Academy of Ophthalmology, held in New Orleans from November 12 to 15, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the ophthalmology experts at the AAO. Check back for more from the AAO 2021 Meeting.


During the worst of the COVID-19 pandemic, when hospitals reported dwindling ICU space, social distancing and virtual schooling were a necessity. And while those methods likely did limit the spread of the virus, they created their own deleterious effects. For developing eyes in school-age children, converting from a 7-hour in-person school day to a 7-hour screen-based school day may have played a role in growing rates of asthenopia and convergence insufficiency, according to a report presented at the American Academy of Ophthalmology 2021 meeting in New Orleans, held November 12-15. 

Researchers asked 110 students (ages 10-17) with no history of ocular pathology, to complete a modified convergence insufficiency symptom survey (CISS), and an asthenopia survey both before and after a virtual school session. 

The report shows that 61% of the participants experienced an increase in symptoms of convergence insufficiency after a virtual school day, with 17% of children categorized as having severe symptoms. The average sum of the CISS scores increased from 5.17 before school, to 9.82 after school (P ≤.0001). 

Computer-based asthenopia, also called ocular fatigue, symptoms also increased in the study, from a score of 1.58 before school, to 2.74 after school (P ≤.0001), with more than half of the participants (53%) recording an increase in asthenopia symptoms.

According to the researchers, the usefulness of virtual schooling may have either run its course, or the measure could benefit from a strategy to protect developing eyes. 

“Healthy children are experiencing acute ocular symptoms from virtual school,” they reported. “Digital education needs to be restructured to reduce ocular symptoms and create a better environment for children’s learning.”

Visit Ophthalmology Advisor’s conference section for complete coverage of AAO 2021 meeting.



Hamburger JL, Lavrich JB, Rusakevich A, et al. The visual consequences of virtual school: acute eye symptoms in healthy children. Paper presented at: The American Academy of Ophthalmology 2021 Annual Meeting; November 12-15; New Orleans. Abstract PA016.