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Visually Challenged: The Lived Experiences of Grade 11 Students with Myopia in

Response to Online Learning

Diano, Lexine Josh P.

Faustino, Shermilyn M.

Santiago, Niña Sophia DC.

Marcelo H. del Pilar National High School

Senior High School

Science, Technology, Engineering, and Mathematics

Academic Year 2021-2022

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VISUALLY CHALLENGED: THE LIVED EXPERIENCES OF GRADE 11 STUDENTS
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Table of Contents

Title Page …………………………………………………………………………………………1

Table of Contents …………………………………………………………………...…………… 2

Introduction ……………………………………….………………………………………………3

Rationale of the Study ……………………………………………………………………….. 3

Statement of the Problem ……………………………………………………………………10

Significance of the Study …………………………………………………………………… 11

Scope and Delimitation ………………………………………………………...……………13

Definition of Terms ………………………………………………………………………….14

Methodology ……………………………………………………………………………………. 15

Research Design ……………………………………………………………………………. 15

Respondents and Sampling Method ………………………………………………………... 16

Instruments …………………………………………………………………………………. 17

Data Collection Procedure ………………………………………………………………….. 18

Data Analysis ……………………………………………………………………………….. 18

References ……………………………………………………………………………………… 20
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Introduction

Rationale of the Study

A newly discovered virus in Wuhan, China has been reported and suspected to be highly

transmissible in late 2019 (WHO, 2020). A Couple of months after the incident, the number of

cases caused by this virus rapidly increased, which led the World Health Organization to assess

and characterize this disease named, Coronavirus disease 2019 (COVID-19) as a pandemic. This

pandemic caused a global disruption, affecting every aspect of human life in many different ways

(Heng, et al., 2021). One of the sectors affected by COVID-19 is the education system.

Educational institutions worldwide have seriously disrupted and temporarily closed schools and

campuses to prevent further transmission of the virus, affecting over 1.6 billion students across

190 countries (UNESCO, 2020).

More than 60 schools and campuses partially reopened using alternative remote e-learning

modalities in order to reduce learning interruptions and re-establish the normal functioning of

educational activities (Liu, Li, Chen & Dang, 2021). Online learning (also known as e-learning)

is a type of distance education in which technology is used as a facilitator of the learning process

and all instruction is delivered via the internet (Siemens, et al., 2015). Online learning is not new

in civilized countries. However, in developing countries, online learning is uncommon, and there

are numerous challenges and effects in implementing this mode of learning (Heng, et al., 2021).

One of the effects of this is Myopia development among students. Online learning could

potentially be contributing to children's "alarming rate" of myopia, or nearsightedness. (Moyer,

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2022). According to the Mayo Clinic (2018), Myopia (nearsightedness) is a common vision

condition in which you can see objects close to you clearly but not those farther away.

Furthermore, the World Health Organization estimates half of the world's population may be

myopic by 2050.

A study conducted by Liu, Li, Chen, and Dang (2021) showed that e-learning increased

the engagement of students with digital screens, triggering major risks of Myopia development.

The replacement of printed textbooks with digital modules and the shifting of in-person teaching

setup with virtual classes contributed to the significant adverse vision consequences of this

emergency crisis, particularly to the sudden change of eye-use patterns during the pandemic as

well as the behavioral implications for young children whose sensory function is developing at a

vital stage. According to the findings, each diopter hour increase in daily e-learning screen use is

substantially correlated with the development of myopia symptoms among school-aged students

in China. Although school closures may be temporary, increased access to, use of, and

dependence on digital gadgets may have long-term negative consequences for children's

development (Wong, et al., 2021).

The global burden of visual function impairment is projected to rise as a result of

COVID-19-induced online learning (Fan, et al., 2021). A study showed that there was a

significant increase in the prevalence of high and very high myopia among high school students

over a 15-year period, which could become a serious public health issue in China for the next

few decades (Chen, et al., 2018). Myopia and high myopia were found to be prevalent in 84.8

percent and 19.3 percent of 16 to 18-year-olds, respectively. High myopia as a risk factor for
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permanent vision loss in Chinese adults may become more important in the future as the

prevalence of high myopia among teenagers in China rises (Dong, et al., 2020).

In comparison to pre-COVID-19, the mean annual myopia advancement was determined

to be statistically significant during COVID-19 (Mohan, et al., 2022). According to the 2020

school-based photo screenings, the findings of this study imply that home confinement during

the COVID-19 pandemic was associated with a significant myopic shift for younger school-aged

children (6-8 years) (Wang, et al., 2021). As learners continue through the grades, the number of

students with poor vision increases. In addition to the use of the E-learning environment after

class, increased usage of other connected electronic goods (such as smartphones, televisions, and

gaming consoles), increased schoolwork stress and study pressure, and decreased exercise may

be the main reasons for vision loss in students (Zhang, et al., 2020).

According to the study conducted by Huseyin Kaya (2020), the online education eye

health scale in the COVID-19 pandemic was known to be a strong indicator of eye fatigue. The

validity and reliability of the eye health scale related to online education is sufficient in the

COVID-19 period, which was prepared for students who stayed at home during the COVID-19

period and were concerned that their eye health would deteriorate due to increased screen time in

addition to their normal use.

In another study done by Gessesse and Teshome (2020), the prevalence of myopia was

found to be 6.5 percent among secondary school students aged 13–26 years in this study. Higher

age and grade level were both related to a higher prevalence of myopia. Students with a family

history of myopia had a higher prevalence of high myopia. According to Wang et al. (2020),
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Myopia and vision impairment were common among Chinese school children, and their

frequency rose non-linearly with the grade, reaching alarmingly high levels in high school

students, accompanied by a high incidence of high myopia. The rising incidence rate of myopia

and vision impairment is linked to the increasing study burden on school kids at a younger age.

The current study involves investigating the experiences of Grade 11 students with myopia

in responding to online learning within the Philippine setting, particularly at Marcelo H. Del

Pilar National High School. The lack of research studies in the local context further motivated

the researchers to conduct further investigations regarding the actual experiences of the said

students in engaging in online learning.

According to studies, pre-COVID-19 near-work and screen time was more than double

what it was during the pandemic. Increased digital screen time has been linked to the beginning

and progression of myopia, and this situation is likely to deteriorate during and after the

COVID-19 pandemic period. Because of these circumstances, the potential vision health

concerns associated with learning in the current COVID-19 pandemic will almost certainly

exacerbate the already substantial worldwide youth vision crisis, including incidences of myopia.

(Juniar, Putri, Wikassa, & I’tishom, 2022)

The use of computer devices is considered one of the environmental risk factors for the

development of myopia. The new inventions of the last two decades have provided children with

early access to computers, cellphones, and other devices. Furthermore, people of all ages spend a

significant amount of time in front of electronic device screens. Likewise, time spent in outdoor
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environments, which is a protective factor against myopia due to sunlight exposure, has

decreased (Gomes, et al., 2022).

In a survey conducted by Wang et al. (2021) on the progression of myopia in children and

adolescents in Chongqing, China in 2019 and 2020, it is shown that the myopic rate increased in

2020 after the COVID-19 pandemic compared to that in 2019. In Chongqing, China, the

percentage of children and adolescents with myopia increased by 10.40% in 2020 compared to

2019. According to their findings, most students primarily used mobile phones and computers

for online learning.

Near work was a risk factor for myopia due to increased accommodative demand. Long

periods of near-work cause an increase in the prevalence and incidence of myopia in adolescents.

Long-term use of electronic screens, near work, and limited outdoor activities have all been

linked to the establishment and progression of myopia. Home study during COVID-19 may risk

the development and growth of myopia in children and adolescents, particularly in East Asia,

where the prevalence of myopia is high (Ma, et al., 2021). According to Cai, Zhao, Kong, and

Du (2022), during the COVID-19 pandemic, home confinement measures increased axial length

monthly elongation by 35% compared to before the COVID-19 pandemic. Furthermore,

asthenopia increased significantly, and severe asthenopia influenced myopia progression, with a

higher axial growth rate.

During the COVID-19 pandemic, digital platform learning increased exposure time to

electronic screens dramatically, which is unquestionably a risk factor for myopia. Previous

studies on digital-screen use and myopic symptoms found that every 1-h increase in daily
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digital-screen use is associated with a 1.26 odds ratio of higher risks of myopic progression and

that computers and smartphones are more likely to lead to myopia than TV (Liu, et al., 2021).

In the study done by Gebru and Mekonnen (2022), findings showed that the prevalence of

myopia was significantly high in their study area. Myopia was substantially connected with early

schooling, myopic parents, prolonged near the job, short working distance, absence of outdoor

sports activities, and use of a visual display unit. Myopia progressed more fleetly in

schoolchildren during the period when there were further COVID-19 - affiliated lockdown

measures. Still, optic treatment with DIMS was significantly associated with slower myopia

progression compared with SVL treatment during the lockdown period (Choi, et al., 2022).

Myopia is becoming more common around the world, which has sparked interest in ways

to slow its progression. The potential benefits of myopia management outweigh the risks: the

number of people who need to be treated to avoid visual impairment for five years is between 4.1

and 6.8, whereas only around one in 38 people would lose their vision as a result of myopia

control (Bullimore, et al., 2021).

Ding et al. (2022), attested that exposure to training, rather than age, appears to be the

major automobilist of refractive development, at least in the early times of training. Interventions

during this period, involving reductions in educational pressure and increased time outdoors,

may have major effects on the posterior development of myopia. According to the study

conducted by Guo et al. (2020), nearsightedness in schoolchildren may have a considerable

threat of progressing to myopic maculopathy.

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Myopia commonly begins between the ages of 6 and 14. Based on the study conducted by

Yang et al. (2022), the population-grounded substantiation showed a high prevalence of

preschool myopia and an L-shaped decline after introducing strategies to promote out-of-door

conditioning in kindergartens. With undisrupted academy-grounded preventative strategies, the

prevalence of myopia can be kept stable during the COVID-19 pandemic. A study by Gothwal,

Kodavati, and Subramanian (2021) helps to better understand the negative effects of lockdown

on the lives of children with VI and their parents, particularly in terms of education. The study

looked at how key elements affect online literacy and how children with VI participate in these

sessions.

A study conducted by Zhu et al. (2021) focused on comparing the quality of life of senior

first-year scholars with normal vision and with myopia. Findings showed that senior first-year

myopia scholars have a lower quality of life score than scholars with normal vision. Study time,

wearing spectacles, and age are risk factors for quality of life in senior first-year myopic

scholars.

Researchers have noticed that the prevalence of myopia around the world has increased

lately. Previous studies have shown that 9 to 16 years of age is the fastest-growing period for

adolescent myopia. In harmony with previous studies, the researchers found that the prevalence

of myopia in scholars persistently increased as age increased. Until lately, it appeared that the

myopia crisis was flying under ophthalmology’s radar — at least in certain areas of the world.

Still, with a global prevalence doubly that of rotundity, no medical condition can be relatively

compared (Flitcroft, 2022).

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There is an urgent need to pursue this study because the prevalence of Myopia among

young adults is rapidly increasing. According to a study published in the scientific journal

Ophthalmology, if current trends continue, nearly half of the world's population will be myopic

by 2050. Thus, the research study to be conducted aims to investigate and determine the

experiences, hurdles, and struggles of Grade 11 students with Myopia in Marcelo H. Del Pilar

National High School as well as their strategies to cope with their daily routines in online

learning. The study also aims to find suggestions and recommendations to address the

development of Myopia among young adults.

Statement of the Problem

The major objective of the study is to investigate and determine the experiences and

struggles caused by Myopia affecting the students’ response to online learning. The study will be

conducted among selected Grade 11 students with Myopia at Marcelo H. Del Pilar National High

School during the school year 2021-2022. The results of the study will serve as a basis for

proposing interventions, policies, and programs that will address the difficulties encountered by

myopic students related to online learning.

1. What are the most common problems encountered by myopic students?

2. How do myopic students deal with online learning?

3. How does digital screen time affect their vision?

4. How do myopic students cope with the struggles and problems they encountered in

performing academic tasks through online learning?

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5. What practices do myopic students do to prevent severe complications of myopia and

other complications related to their eye vision?

Significance of the Study

The purpose of the study is to investigate and determine the experiences, struggles, as well

as coping mechanisms of Grade 11 students living with Myopia under the online learning

modality in Marcelo H. Del Pilar National High School. Specifically, the study would be

significant to many individuals and groups.

School Administrators

The findings of the study would enable them to know the experiences and struggles of

myopic students as well as propose policies and interventions to help and assist the said students.

The results will also be useful to create awareness among the rest of the learners about the

development risks of Myopia as well as to further improve the implementation of online learning

modalities in their school.

Ophthalmologists

The findings of the study would enable them to determine to what extent their Myopic

patients have compliance and confidence in managing their Myopia. The findings will also be

helpful in creating possible treatment or prevention drugs to decrease the development of

Myopia among young adults.

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Teachers

The study would help teachers to understand the situation as well as the aspects that

influence their students' learning performance. Furthermore, the findings of this study will be

beneficial to them by determining efficient teaching methods.

Parents

The results will increase parental understanding of the responsibilities of improving and

supporting their children's education. This will also make them aware of the difficulties that their

children are encountering.

Students

The findings will provide them with further information that will assist them to understand

more about myopia. This study will also benefit them by allowing them to know what are the

early stages of myopia and how they can prevent further eye-related complications.

Future Researchers

The results of the study will serve as a reference for future researchers who have the same

study. This study covers information involving how to help and how to deal with myopia that can

be used for future studies.

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Scope and Delimitation

This qualitative study intends to investigate and determine the lived experiences of Grade

11 students with Myopia in response to online learning. According to Harappa (2021), a

phenomenological study is concerned with describing the lived experiences and investigating the

phenomena that have affected an individual. Like a phenomenological study, this study focuses

on the experiences, struggles, and coping strategies of the students in responding and engaging in

online learning. The respondents of the study consisted of twenty (20) Grade 11 Senior High

School students from Marcelo H. Del Pilar National High School who were diagnosed with

myopia. This study is limited to Myopic Grade 11 students enrolled in the Online Learning

Modality during the School Year 2021-2022. The participants of the study will be selected using

purposive sampling. This usually involves identifying and selecting individuals or groups of

individuals who are particularly knowledgeable about or experienced with a phenomenon of

interest (Cresswell & Plano Clark, 2011).

As said by Xu and Storr (2021), the qualitative researcher is the primary instrument for

data collection and analysis. In this study, the researchers will use interviews and questionnaires

as the main instruments for data collection. The questions will be designed to gather information

from the participants' experiences and struggles in online learning as well as their coping

strategies for these struggles. To ensure appropriateness, the questionnaire will be validated by

professionals and the research adviser before data collection. The student researchers will ensure

that the participants' information and responses are treated confidentially.

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In gathering data, the interviews will be conducted through the use of the online messaging

application, Messenger. Due to the protocols enforced during the pandemic, this platform

provided an opportunity for conducting qualitative research. The participants will be given

options on the date of the interview according to their availability. The respondents’ information

will remain confidential throughout the study. Thematic analysis will be used to analyze the data

gathered. As said by Braun and Clarke (2006), thematic analysis is a method for identifying,

analyzing, and reporting patterns within data. The study seeks to identify how myopic Grade 11

students adapt to online learning and to recommend possible solutions to the struggles they are

encountering.

Definition of Terms

Myopia

According to Carr and Stell (2017), Myopia (near-sightedness) is the most prominent

refractive visual impairment in children. It is characterized by the blurring of distant objects and

is most usually caused by abnormal elongation of the eyeball, which causes the refractive image

created by the cornea and lens to fall at the front of the photoreceptors of the retina.

Online Learning

Online learning (e-learning) is a type of distance education in which technology is used

as a facilitator of the learning process and all instruction is delivered via the internet (Siemens, et

al., 2015). This type of learning includes the utilization of digital modules and online virtual
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conferencing applications, which are the primary tools used in online learning.

Ophthalmologist

A medical or osteopathic doctor who specializes in eye and vision care is known as an

ophthalmologist. An ophthalmologist diagnoses all eye problems, performs eye surgery, and

prescribes and fits prescription glasses and contact lenses (Churchill & Gudgel, 2022).

Prevalence

The proportion of a population with a particular characteristic at any given period. It is

deduced by comparing the number of people found to have the condition with the total number

of people studied and is generally expressed as a bit, a chance, or the number of cases per person.

Methodology

Research Design

The researchers will utilize phenomenology in the conduct of the study. In defining

phenomenology, Neubauer, Witkop, and Varpio (2019) stated that phenomenology is a type of

qualitative research that focuses on the investigation of a person's lived experiences in the world.

Furthermore, Bliss (2016) defined a phenomenological study as a study that is concerned with

ordinary human experiences in order to learn about people's common sense knowledge and the

significance they assign to their own and others' experiences. It necessitates a researcher's

emphasis on people's experiences of a phenomenon in order to collect thorough data that serves
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as a basis for reflective structural analysis, which reveals the substance of the experience.

Moreover, Hegel defined phenomenology as "conscious awareness of what is perceived, sensed,

and known from one's experience" (Moustakas, 1994). Lourer (1967) claimed that the unique

source of absolute existence is based on what a person thinks, feels, and observes, similar to

Hegel's explanation of phenomenology. Since the study aims to investigate and determine the

lived experiences, challenges, and struggles of Grade 11 students with Myopia in response to

online learning, the researchers consider a phenomenological approach suitable for use.

Respondents and Sampling Method

The respondents of the study will be selected from Grade 11 students who are diagnosed

with Myopia and enrolled in Marcelo H. Del Pilar National High School. The researchers will

utilize purposive sampling in selecting the participants of the study, particularly criterion

sampling. As stated by Patton (1990), criterion sampling is used wherein criteria are set to

determine the possible participants of the study. Furthermore, Mathstopia (2021) stated that

criterion sampling allows the researchers to obtain more information from smaller samples. This

kind of sampling is a time-saving and cost-free method since the data collected from samples is

based on several criteria and can be used for a variety of purposes. The first criterion is that the

participant must be diagnosed with myopia and visually challenged regardless of sex. The second

criterion is that the participant must be a Grade 11 student enrolled under the online learning

modality. The third and last criterion is that the participant must be enrolled in Marcelo H. Del

Pilar National High School.

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The respondents will consist of twenty (20) Grade 11 students diagnosed with Myopia

who are enrolled in the Online Learning Modality at Marcelo H. Del Pilar National High School.

The sample size will be selected according to Cresswell (2013), who states that a

phenomenological study requires five (5) to twenty-five (25) participants. This will aid

researchers in sufficiently describing the phenomenon of interest and the research questions at

hand, as well as uncovering a range of responses from respondents. The researchers will select

myopic grade 11 students as the participants of the study since the pandemic severely changed

their educational situations, resulting in a more complex and challenging educational setup.

Instruments

The researchers will conduct a semi-structured interview containing questions obtained

from the objectives of the study to recognize challenges experienced by myopic grade 11

students in performing academic tasks under the online learning modality. According to

Easwaramoorthy & Zarinpoush (2006), an interview is a conversation used to acquire data. A

research interview consists of an interviewer who directs the conversation and asks questions, as

well as an interviewee who answers the questions. Interviews can be conducted in person or

through the phone. The internet is also becoming more popular as a tool for conducting

interviews.

The researchers will prepare an interview guide that will include questions designed to

understand the students' lived experiences, difficulties, and struggles with having myopia in

response to online learning, as well as suggestions for decreasing myopia progression. The
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prepared questionnaire will be subjected to content validity testing by 3 to 5 experts and will be

modified based on their feedback before use.

Data Collection Procedure

Upon the validation of the research-made questionnaire, the researchers will formally write

a letter to the School Principal of Marcelo H. Del Pilar National High School and the respective

class advisers for their consent to conduct the study and gather data from the selected Grade 11

students of their school. The researchers will also provide waivers to the participants, assuring

them that their information, including their names and sections, will be treated confidentially.

Once approved and signed, the researchers will perform interviews through the use of the

online messaging application, Messenger. Interviews will be administered through its features

such as video calls, audio calls, and chat messages. The respondents are allowed to select which

method will be used according to their preference. With the use of the semi-structured interview

guide, the researchers will facilitate interviews to gather desired data and information. Each item

will also be discussed in detail to ensure that the data gathered is accurate.

Data Analysis

The study will be using thematic network analysis to analyze the data gathered. According

to Boyatzis (1998), thematic analysis is a kind of qualitative analysis. It is used to analyze

classifications and show data-related themes (patterns). It presents the data in great detail and

deals with a wide range of topics through interpretations. Thematic Analysis is widely

recognized as the best method for any study that seeks to discover patterns through
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interpretations. It adds a systematic approach to data analysis (Marks and Yardley 2004). The

researchers will be adapting the steps presented by Jack Caulfield (2019) in an article entitled

“How to Do Thematic Analysis | A Step-by-Step Guide & Examples.”

Thematic analysis can be done in a variety of ways, but the most popular method involves

six steps: familiarization, coding, generating themes, reviewing themes, defining and naming

themes, and writing up. In the first step, the researchers will get to know their data by

transcribing audio, reading through the material and taking notes, and familiarizing themselves

with the data they gathered. The researchers will then code the data by highlighting areas of the

text that are typically phrases or sentences and creating shorthand labels, or "codes," to explain

their content. The researchers will collect all of the data into groupings specified by code, and

using these codes, the researchers will obtain a concise overview of the main points and common

meanings that emerge throughout the data. Next, the researchers will search for trends and start

developing themes. Since themes are often broader than codes, the researchers will review them

to ensure that they are relevant and accurate representations of the data. After generating and

reviewing themes, the researchers will then define and name the themes. Defining themes

includes considering exactly what the researchers mean by each topic and how it aids the

understanding of the data while naming themes include coming up with a suitable and simple

name for each topic.

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References

Alhojailan, M. I. (2012). Thematic Analysis: A Critical Review of its Process and Evaluation.

West East Journal of Social Sciences-December, 1(1). Retrieved from

http://westeastinstitute.com/journals/wp-content/uploads/2013/02/4-Mohammed-Ibrahim-

Alhojailan-Full-Paper-Thematic-Analysis-A-Critical-Review-Of-Its-Process-And-Evalua

tion.pdf

Aslan, F., & Sahinoglu-Keskek, N. (2021). The Effect of Home Education on Myopia

Progression in Children During the COVID-19 Pandemic. Eye.

https://doi.org/10.1038/s41433-021-01655-2

Bliss, L. A. (2016). Phenomenological Research. International Journal of Adult Vocational

Education and Technology, 7(3), 14–26. https://doi.org/10.4018/ijavet.2016070102

Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code

development. Psycnet.apa.org; Sage Publications, Inc.

https://psycnet.apa.org/record/1998-08155-000

Bullimore, M. A., et al. (2021). The Risks and Benefits of Myopia Control. Ophthalmology,

128(11), 1561–1579. https://doi.org/10.1016/j.ophtha.2021.04.032

Cai, T., Zhao, L., Kong, L., & Du, X. (2022). Complex Interplay Between COVID-19 Lockdown

and Myopic Progression. Frontiers in Medicine, 9

https://doi.org/10.3389/fmed.2022.853293

Carr, B. J., & Stell, W. K. (1995). The Science Behind Myopia (H. Kolb, E. Fernandez, & R.

Nelson, Eds.). Retrieved June 9, 2022, from PubMed website:

https://pubmed.ncbi.nlm.nih.gov/29266913/
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VISUALLY CHALLENGED: THE LIVED EXPERIENCES OF GRADE 11 STUDENTS
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Chen, M., et al. (2018). The increasing prevalence of myopia and high myopia among high

school students in Fenghua city, Eastern China: A 15-year population-based survey. BMC

Ophthalmology, 18(1). https://doi.org/10.1186/s12886-018-0829-8

Choi, K. Y., et al. (2022). Evaluation of an Optical Defocus Treatment for Myopia Progression

Among Schoolchildren During the COVID-19 Pandemic. JAMA Network Open, 5(1),

e2143781–e2143781. https://doi.org/10.1001/jamanetworkopen.2021.43781

Churchill, J., & Gudgel, D. (2019, March 5). What is an Ophthalmologist? Retrieved from

American Academy of Ophthalmology website:

https://www.aao.org/eye-health/tips-prevention/what-is-ophthalmologist

Congdon, N., Burnett, A., & Frick, K. (2019). The Impact of Uncorrected Myopia on Individuals

and Society. Community eye health, 32(105), 7–8.

Creswell, J. W. (2013). Qualitative Inquiry and Research Design: Choosing Among Five

Approaches (3rd ed). Thousand Oaks, CA: SAGE Publications, Inc.

Cresswell, J. W., & V. L. Plano Clark. (2007). Designing and Conducting Mixed Methods

Research. Thousand Oaks, CA: Sage Publications.

Ding, X., et al. (2022). Exposure to the Life of a School Child Rather Than Age Determines

Myopic Shifts in Refraction in School Children. Investigative Ophthalmology & Visual

Science, 63(3), 15. https://doi.org/10.1167/iovs.63.3.15

Dong, L., et al. (2019). Prevalence And Time Trends Of Myopia In Children And Adolescents In

China. Retina, 1. https://doi.org/10.1097/iae.0000000000002590

 22
VISUALLY CHALLENGED: THE LIVED EXPERIENCES OF GRADE 11 STUDENTS
WITH MYOPIA IN RESPONSE TO ONLINE LEARNING

Enthoven, C. A., et al. (2020). The Impact of Computer Use on Myopia Development in

Childhood: The Generation R Study. Preventive Medicine, 132, 105988.

https://doi.org/10.1016/j.ypmed.2020.105988

Fan, Q., et al. (2021). Online Learning-Related Visual Function Impairment During and After the

COVID-19 Pandemic. Frontiers in Public Health, 9.

https://doi.org/10.3389/fpubh.2021.645971

Foreman, J., et al. (2021). Association Between Digital Smart Device Use and Myopia: A

Systematic Review and Meta-analysis. The Lancet Digital Health. Vol. 3 No. 12

https://doi.org/10.1016/s2589-7500(21)00135-7

Gebru, E. A., & Mekonnen, K. A. (2022). Prevalence and Factors Associated with Myopia

Among High School Students in Hawassa City, South Ethiopia, 2019. Clinical

Optometry, Volume 14, 35–43. https://doi.org/10.2147/opto.s308617

Gessesse, S. A., & Teshome, A. W. (2020). Prevalence of Myopia Among Secondary School

Students in Welkite Town: South-Western Ethiopia. BMC Ophthalmology, 20(1).

https://doi.org/10.1186/s12886-020-01457-2

Gomes, A. C. G., Castro, L. R., Brito, L. M. P. de, Cunha, M. A. da, & Ribeiro, M. V. M. R.

(2020). Myopia Caused by The Use of Electronic Devices Screen: A Literature Review.

Revista Brasileira de Oftalmologia, 79(5). https://doi.org/10.5935/0034-7280.20200077

Gothwal, V. K., Kodavati, K., & Subramanian, A. (2021). Life in Lockdown: Impact of

COVID‐19 Lockdown Measures on The Lives of Visually Impaired School‐Age

Children and Their Families in India. Ophthalmic and Physiological Optics.

https://doi.org/10.1111/opo.12928
 23
VISUALLY CHALLENGED: THE LIVED EXPERIENCES OF GRADE 11 STUDENTS
WITH MYOPIA IN RESPONSE TO ONLINE LEARNING

Guo, Y., et al. (2018). Parapapillary Gamma Zone and Progression of Myopia in School

Children: The Beijing Children Eye Study. Investigative Opthalmology & Visual Science,

59(3), 1609. https://doi.org/10.1167/iovs.17-21665

Guo, Y., et al. (2020). Progression of Myopic Maculopathy in Chinese Children with High

Myopia. Retina, 41 (7), 1502–1511. https://doi.org/10.1097/iae.0000000000003018

Huang, H.-M., Chang, D. S.-T., & Wu, P.-C. (2015). The Association between Near Work

Activities and Myopia in Children—A Systematic Review and Meta-Analysis. PLOS ONE,

10(10), e0140419. https://doi.org/10.1371/journal.pone.0140419

Hu, Y., et al.(2021). Rates of Myopia Development in Young Chinese Schoolchildren During the

Outbreak of COVID-19. JAMA Ophthalmology, 139(10), 1115–1121.

https://doi.org/10.1001/jamaophthalmol.2021.3563

Kushch, Y. (2022). The impact of the COVID-19 pandemic, online-learning on the state of visual

system and psychological state of students. EUREKA: Health Sciences, 1, 49–55.

https://doi.org/10.21303/2504-5679.2022.002277

Liu, J., Li, B., Sun, Y., Chen, Q., & Dang, J. (2021) Adolescent Vision Health During the

Outbreak of COVID-19: Association Between Digital Screen Use and Myopia Progression.

Front. Pediatric. 9:662984. https://doi:10.3389/fped.2021.662984

Liu, J., Li, B., Chen, Q., & Dang, J. (2021). Student health implications of school closures during

the COVID-19 pandemic: New evidence on the association of e-Learning, outdoor

exercise, and myopia. Healthcare, 9(5), 500. https://doi.org/10.3390/healthcare9050500

 24
VISUALLY CHALLENGED: THE LIVED EXPERIENCES OF GRADE 11 STUDENTS
WITH MYOPIA IN RESPONSE TO ONLINE LEARNING

Ma, D., et al. (2021). Progression of myopia in a natural cohort of Chinese children during

COVID-19 pandemic. Graefe’s Archive for Clinical and Experimental Ophthalmology,

259(9), 2813–2820. https://doi.org/10.1007/s00417-021-05305-x

Mayo Clinic. (2018). Nearsightedness - Symptoms and causes. Retrieved from Mayo Clinic

website:https://www.mayoclinic.org/diseases-conditions/nearsightedness/symptoms-caus

es/syc-20375556

Mccrann, S., Loughman, J., Butler, J. S., Paudel, N., & Flitcroft, D. I. (2021). Smartphone use as

a possible risk factor for myopia. Clinical and Experimental Optometry, 104(1), 35–41.

https://doi.org/10.1111/cxo.13092

Mohan, A., et al. (2022). Impact of online classes and home confinement on myopia progression

in children during COVID-19 pandemic: Digital eye strain among kids (DESK) study 4.

Indian Journal of Ophthalmology, 70 (1), 241. https://doi.org/10.4103 /ijo.ijo_1721_21

Moustakas, C. (1994). Phenomenological research methods. Thousand Oaks, CA: Sage.

doi:10.4135/9781412995658

Neubauer, B. E., Witkop, C. T., & Varpio, L. (2019). How Phenomenology Can Help Us Learn

from the Experiences of Others. Perspectives on Medical Education, 8(2), 90–97. NCBI.

https://doi.org/10.1007/s40037-019-0509-2

Ortamlarında, E., Çalışmaları, F., İçin, Y., Çerçeveler, T., Ve Prosedürler, Y., Yüksel, P., &

Yıldırım, S. (2015). Theoretical Frameworks, Methods, and Procedures for Conducting

 25
VISUALLY CHALLENGED: THE LIVED EXPERIENCES OF GRADE 11 STUDENTS
WITH MYOPIA IN RESPONSE TO ONLINE LEARNING

Phenomenological Studies in Educational Settings. Turkish Online Journal of Qualitative

Inquiry, 6(1). https://dergipark.org.tr/tr/download/article-file/199867

Patton, M. (1990). Qualitative evolution and research methods. In Sage.

Sinta Dwi r, J., Innas Safira, P., Tasya, W., & Reny, I. (2022). The impact of digital screen use on

myopia progression in COVID-19 pandemic: A systematic review. World Journal of

Advanced Research and Reviews, 13(1), 210–222.

https://doi.org/10.30574/wjarr.2022.13.1.0009

UNESCO. (2020, March 4). COVID-19 Educational Disruption and Response. Retrieved from

UNESCO website: https://en.unesco.org/covid19/educationresponse

UNICEF. (2021, March 2). COVID-19: Schools for more than 168 million children globally

have been completely closed for almost a full year, says UNICEF. Retrieved from

www.unicef.org website:

https://www.unicef.org/press-releases/schools-more-168-million-children-globally-have-

been-completely-closed

Wang, J., et al.(2020). Prevalence of myopia and vision impairment in school students in Eastern

China. BMC Ophthalmology, 20(1). https://doi.org/10.1186/s12886-019-1281-0

Wang, J., et al. (2021). Progression of myopia in school-aged children after COVID-19 home

confinement. JAMA Ophthalmology, 139(3), 293.

https://doi.org/10.1001/jamaophthalmol.2020.6239
 26
VISUALLY CHALLENGED: THE LIVED EXPERIENCES OF GRADE 11 STUDENTS
WITH MYOPIA IN RESPONSE TO ONLINE LEARNING

Wang, W., et al.(2021). Survey on the Progression of Myopia in Children and Adolescents in

Chongqing During COVID-19 Pandemic. Frontiers in Public Health, 9.

https://doi.org/10.3389/fpubh.2021.646770

Wong, C. W., et al. (2020). Digital screen time during COVID-19 pandemic: Risk for a further

myopia boom? American Journal of Ophthalmology, 223.

https://doi.org/10.1016/j.ajo.2020.07.034

World Health Organization. (2020, March 11). WHO director-general’s opening remarks at the

media briefing on COVID-19 - 11 March 2020. Retrieved from World Health

Organization website:

https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-rem

arks-at-the-media-briefing-on-covid-19---11-march-2020

Yang, Y., et al. (2022). Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers:

A Serial Survey in Taiwan before and during the Coronavirus Disease 2019 Pandemic.

Ophthalmology, 129(2), 181–190. https://doi.org/10.1016/j.ophtha.2021.08.013

Zhang, Z., et al. (2020). Effects of e-learning environment use on visual function of elementary

and middle school students: A two-year assessment—experience from China.

International Journal of Environmental Research and Public Health, 17(5), 1560.

https://doi.org/10.3390/ijerph17051560
 27
VISUALLY CHALLENGED: THE LIVED EXPERIENCES OF GRADE 11 STUDENTS
WITH MYOPIA IN RESPONSE TO ONLINE LEARNING

Zhu, Z., et al.(2021). Study time, glasses utilization and age affect quality of life among senior

first-year Chinese myopia students. European Journal of Ophthalmology, 31(6),

2969–2976. https://doi.org/10.1177/1120672120982528