Research

JAMA Ophthalmology | Brief Report

Association of Daily Wear of Eyeglasses With Susceptibility
to Coronavirus Disease 2019 Infection
Weibiao Zeng, MS; Xiaolin Wang, MS; Junyu Li, MS; Yong Yang, MS; Xingting Qiu, MS; Pinhong Song, MS;
Jianjun Xu, MD, PhD; Yiping Wei, MD, PhD

Invited Commentary
IMPORTANCE The proportion of daily wearers of eyeglasses among patients with coronavirus

disease 2019 (COVID-19) is small, and the association between daily wear of eyeglasses andCOVID-19 susceptibility has not been reported.
OBJECTIVE To study the association between the daily wearing of eyeglasses and thesusceptibility to COVID-19.
DESIGN, SETTING, AND PARTICIPANTS This cohort study enrolled all inpatients with COVID-19
in Suizhou Zengdu Hospital, Suizhou, China, a designated hospital for COVID-19 treatment in
the area, from January 27 to March 13, 2020. COVID-19 was diagnosed according to the fifth
edition of Chinese COVID-19 diagnostic guidelines. The proportion of persons with myopia
who wore eyeglasses in Hubei province was based on data from a previous study.
EXPOSURES Daily wearing of eyeglasses for more than 8 hours.
MAIN OUTCOMES AND MEASURES The main outcomes were the proportions of daily wearersof eyeglasses among patients admitted to the hospital with COVID-19 and among the local
population. Data on exposure history, clinical symptoms, underlying diseases, duration ofwearing glasses, and myopia status and the proportion of people with myopia who woreeyeglasses in Hubei province were collected. People who wore glasses for more than 8 hours
a day were defined as long-term wearers.
RESULTS A total of 276 patients with COVID-19 were enrolled. Of these, 155 (56.2%) weremale, and the median age was 51 (interquartile range, 41-58) years. All those who wore
glasses for more than 8 hours a day had myopia and included 16 of 276 patients (5.8%; 95%CI, 3.04%-8.55%). The proportion of people with myopia in Hubei province, based on aprevious study, was 31.5%, which was much higher than the proportion of patients with
COVID-19 who had myopia in this sample.
CONCLUSIONS AND RELEVANCE In this cohort study of patients hospitalized with COVID-19 inSuizhou, China, the proportion of inpatients with COVID-19 who wore glasses for extended
daily periods (>8 h/d) was smaller than that in the general population, suggesting that daily
wearers of eyeglasses may be less susceptible to COVID-19.
JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2020.3906
Published online September 16, 2020.

Coronavirus disease 2019 (COVID-19), the pathogen ofwhich is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly infectious disease thatbroke out in Wuhan, China, in December 2019 and has spreadto more than 200 countries.1 COVID-19 has been proven to betransmitted mainly through droplets and contact.2 The eye isalso considered an important route of infection.
According to reports published in recent years, the prevalence of myopia in China is now more than 80% of the population. Wearing of eyeglasses is common among Chinese individuals of all ages.3 However, since the outbreak of COVID-19in Wuhan in December 2019, we observed that few patientswith eyeglasses were admitted in the hospital ward. Therejamaophthalmology.com

Author Affiliations: Department ofThoracic Surgery, The SecondAffiliated Hospital of Nanchang
University, Nanchang, China (Zeng,Xu, Wei); Department of Critical CareMedicine, Suizhou Zengdu Hospital,Suizhou, China (Wang, Yang, Song);
Department of Radiotherapy, Jiangxi
Cancer Hospital, Nanchang, China(Li); Department of Computed
Tomography and Magnetic
Resonance Imaging, The First
Affiliated Hospital of Gannan Medical
University, Ganzhou, China (Qiu).
Corresponding Author: Yiping Wei,MD, PhD (weiyip2000@hotmail.
com), and Jianjun Xu, MD, PhD(xujianjun3526@163.com),
Department of Thoracic Surgery, TheSecond Affiliated Hospital ofNanchang University, 1 Min De Road,Nanchang 330006, China.

fore, we collected information on the wearing of eyeglasses
from all inpatients with COVID-19 as part of their medical history and used the data to examine the association between
wearing eyeglasses and COVID-19 infection.

Methods
This cohort study was approved by the ethics committee ofSuizhou Zengdu Hospital, Suizhou, China, and followed theStrengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Patients signed
written informed consent and were not provided with any(Reprinted) JAMA Ophthalmology Published online September 16, 2020

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Research Brief Report

Association of Daily Wear of Eyeglasses With Susceptibility to COVID-19 Infection

incentive or compensation to participate in the study. The study
enrolled patients admitted to the hospital from January 27 toMarch 13, 2020, with the admission criteria of a diagnosis ofCOVID-19. The diagnostics and clinical classification ofCOVID-19 were based on the fifth edition of Chinese COVID-19diagnostic guidelines.4 Throat swab samples were obtained
from patients at admission and tested using real-time reverse
transcriptase–polymerase chain reaction assays to identify
COVID-19 infection. Patients were specifically asked about thereason they wore eyeglasses, the length of time that they wore
eyeglasses during daily activities, and whether they wore
contact lenses or had ever undergone refractive surgery. This
information was recorded by the patients’ treating physicians
while taking their medical history, starting February 4, 2020.
Information on exposure history and clinical symptoms wasextracted from the medical records. People who wore
eyeglasses for more than 8 hours a day were defined as longterm wearers, and these people were considered to wear
eyeglasses when socializing.
To estimate the population myopia rate, we extracted datafrom the Research on Chinese Student Physique and HealthStudy,5 which recorded data from a survey about the physicaland health status of Chinese students, organized by state educational institutions and the Ministry of Health of China in 1985.
We used descriptive statistics to characterize the study sample.

Key Points
Question What is the association between the daily wear ofeyeglasses and susceptibility to coronavirus disease 2019(COVID-19)?
Findings In this cohort of 276 patients hospitalized with COVID-19
in Suizhou, China, the proportion of daily wearers of eyeglasses
was lower than that of the local population (5.8% vs 31.5%).
Meaning These findings suggest that daily wearers of eyeglasses
may be less likely to be infected with COVID-19.

Table. Clinical Characteristics of the Study Patients
Data (n = 276)aAge, median (IQR), y51 (41-58)

Severe illness

14 (5.1)

Male155 (56.2)

Reason for wearing eyeglasses
Presbyopia

14 (5.1)

Myopia16 (5.8)

Wearing glasses >8 h/d

16 (5.8)

Current smokers

42 (15.2)

BMI, median (IQR)

23.7 (22.0-25.4)

Exposure historyb

Results

Recently visited Wuhan

43 (15.6)

Contact with people who had traveled to Wuhanor diagnosed with COVID-19

166 (60.1)

Contact with wildlife

As shown in the Table, a total of 276 patients with COVID-19
were enrolled in the study. The median age was 51 (interquartile range, 41-58) years; 155 patients (56.2%) were male and 121(43.8%) were female. Most patients with COVID-19 were moderately ill, with 14 (5.1%) severely ill. Common symptoms werefever (227 [82.2%]), cough (218 [79.0%]), and fatigue (141[51.1%]). Underlying disease was present in 88 patients (31.9%),
with hypertension the most common, accounting for 47 (17.0%)of all admitted patients. Thirty patients with COVID-19 wore
eyeglasses (10.9%), including 16 cases of myopia and 14 casesof presbyopia. None of the patients in this study wore contactlenses or underwent refractive surgery. All 16 patients with
COVID-19 who wore glasses for more than 8 hours per day had
myopia, accounting for 5.8% (95% CI, 3.0%-8.6%), and the median age was 33 years. Their symptoms, underlying disease,
and COVID-19 severity were not significantly different fromthose of other patients.
The results from previous research5 showed that the mean
rate of myopia among students aged 7 to 22 years in Hubei province was 31.5%. By 2020, these students were aged 42 to 57
years, which is close to the median age of our patients with
COVID-19. The myopia rate of 31.5% is higher than the 5.8%
among our patients with COVID-19.

Median incubation period, median (IQR), dc0
6.0 (4.0-9.0)

Symptoms
Fever

227 (82.2)

Cough218 (79.0)

Sputum production

137 (49.6)

Fatigue

141 (51.1)

Shortness of breath

42 (15.2)

ComorbiditiesAny

88 (31.9)

Hypertension

47 (17.0)

Chronic obstructive pulmonary disease

7 (2.5)Diabetes

14 (5.1)

Coronary heart disease

12 (4.3)

Cerebrovascular disease

6 (2.2)

Cancerd

3 (1.1)Abbreviations: BMI, body mass index (calculated as weight in kilograms dividedby square of height in meters); COVID-19, coronavirus disease 2019;
IQR, interquartile range.
aUnless otherwise indicated, data are expressed as number (percentage) ofpatients.

b

Source of exposure was unknown in 67 patients.

c

Undetermined incubation period for 205 patients.

dIncluded any kind of cancer.

At the time of writing, this study was the only research, to ourknowledge, to assess the association between wearing eye-glasses and COVID-19 infection. Our main finding was that patients with COVID-19 who wear eyeglasses for an extended period (>8 h/d) every day were relatively uncommon, which could
be preliminary evidence that daily wearers of eyeglasses are

JAMA Ophthalmology Published online September 16, 2020 (Reprinted)

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Discussion

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Association of Daily Wear of Eyeglasses With Susceptibility to COVID-19 Infection

Brief Report Researchless susceptible to COVID-19. Considering the prevalence ofCOVID-19, conducting a sample survey among the local population would have been difficult. Instead, we used data froma previous survey for approximate reference and comparison, although the age, region, and educational level of the students in that survey had some differences compared with ourstudy population.
We hypothesized that eyeglasses prevent or discourage
wearers from touching their eyes, thus avoiding transferring
the virus from the hands to the eyes.6 Studies have shownthat normal people will involuntarily touch their eyes about
10 times per hour. 7 Eyes usually lack protection, and anabundance of the SARS-CoV-2 receptor angiotensinconverting enzyme 2 has been found on the ocular surface,8through which SARS-CoV-2 can enter the human body. SARSCoV-2 may also be transported to the nasal and nasopharyngeal mucosa through continuous tear irrigation of the lacrimal duct, causing respiratory infection. 9 According toavailable statistics, nearly 1% to 12% of patients with
COVID-19 have ocular manifestations,10,11 SARS-CoV-2 wasdetected in tears or the conjunctival sacs of patients with
COVID-19,12 and some ophthalmologists were reported to beinfected during routine treatment.13 Therefore, the eyes are
considered an important channel for SARS-CoV-2 to enter thehuman body.11 For daily wearers of eyeglasses, who usuallywear eyeglasses on social occasions, wearing eyeglasses may
become a protective factor, reducing the risk of virus transfer
to the eyes and leading to long-term daily wearers of eyeglasses being rarely infected with COVID-19. Presently, many
COVID-19 guidelines state the need to pay attention to preventing infections through the eyes,14 but most people only
focus on wearing masks and home isolation, ignoring recommendations such as washing hands frequently and avoiding
touching the eyes with the hands.15 The results of this study

can be used as evidence of the importance of these 2 recommendations.

Limitations
Our study had some notable limitations. First, it was a singlecenter study with a small sample size. The numbers of patients who wear eyeglasses and long-term wearers were limited, which limits the extension of the results to a larger
population, so our results need to be verified by large-sample
multicenter studies. Second, the proportion of wearers of eyeglasses was based on data from previous literature and was not
calculated from current local populations. Third, the myopia
rate obtained in previous studies included a small number ofpeople with myopia who did not wear eyeglasses. Information on these people was lacking and partly affected the integrity and validity of our data. Fourth, none of our research
participants wore contact lenses, so the association between
wearing contact lenses and susceptibility to COVID-19 remains to be studied. In addition, further studies are neededto clarify the reasons that wearing eyeglasses may decrease susceptibility to COVID-19.

Conclusions
Our study found that the proportion of inpatients with
COVID-19 who wear eyeglasses for extended daily periods
was lower than that of the general population, suggestingthat daily wear of eyeglasses is associated with less susceptibility to COVID-19 infection. These findings suggest thatthe eye may be an important infection route for COVID-19,
and more attention should be paid to preventive measures
such as frequent hand washing and avoiding touching theeyes.

ARTICLE INFORMATIONREFERENCES

Accepted for Publication: July 28, 2020.

1. Wu Z, McGoogan JM. Characteristics of andimportant lessons from the coronavirus disease2019 (COVID-19) outbreak in China: summary of areport of 72 314 cases from the Chinese Center for
Disease Control and Prevention. JAMA. 2020.
doi:10.1001/jama.2020.2648

Published Online: September 16, 2020.
doi:10.1001/jamaophthalmol.2020.3906
Author Contributions: Drs Wei and Xu had fullaccess to the study data and take responsibility forthe integrity of the data and the accuracy of thedata analysis.
Concept and design: Xu, Yiping.
Acquisition, analysis, or interpretation of data: Zeng,Xiaolin, Junyu, Qiu, Yong, Song, Yiping.
Drafting of the manuscript: Zeng, Xiaolin, Junyu,Qiu, Song, Yiping.
Critical revision of the manuscript for important
intellectual content: Zeng, Yong, Xu, Yiping.
Statistical analysis: All authors.
Obtained funding: Zeng, Xu, Yiping.
Administrative, technical, or material support: Zeng,Junyu, Yong, Xu, Yiping.
Supervision: Yong, Xu, Yiping.
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the physicians
who supported Suizhou Zengdu Hospital, Suizhou,
China, in the fight against coronavirus disease 2019
for their contribution to patient management anddata collection for this study.

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