Last week, the American Academy of Pediatrics released new guidelines regarding screen time and electronic devices for children. Recognizing that not all screen time is harmful, they eliminated the recommendation of no screen time before the age of 2. The new guidelines state that video chatting is acceptable for those 18 months and younger. And for children between 18 months and 5 years old, an hour per day of high quality programming is acceptable, and best when an adult is actively watching, commenting on and reinforcing the programming. Of course, as children grow, the focus shifts to responsible use of electronic devices including time management, social media interactions and age appropriate content. These guidelines are not ground-breaking. It reinforces what we all know intuitively, that human interaction and adult guidance play the biggest roles in a child’s cognitive and social development.
As an optometrist, though, I am also concerned about how digital devices are affecting their eyes. There are three key areas that can be affected and all are equally concerning in my opinion.
1. Digital eyestrain and dry eyes. We all spend hours on our devices, kids are no different. Homework is now online and assignments are submitted electronically. Memorizing vocabulary words and math facts can be done more efficiently on tablet apps. Excess screen time creates strain on our focusing muscles resulting in occasional blur, and tired and red eyes. We also blink less when staring at digital devices, causing more dryness and discomfort of the eyes. I recommend to my patients to follow the American Optometric Association’s guidelines of 20-20-20. Take a break every 20 minutes for 20 seconds and stare at an object 20 feet away. I usually like to set a rule for my younger patients such as take a break after each chapter, look out the window at the mountains or an object as far away as possible and count to 20, remembering to blink. It is also helpful to ensure that computer monitors are not higher than eye level. They should be a little below eye level to prevent less eye exposure to the air, and therefore less drying of the eyes.
2. Blue light and damage to the retina. In the last decade, there has been increasing attention on the correlation between blue light and the retina, the part of the eye that receives electrical signals. Laboratory studies show that exposure for hours at a time at high levels of blue light can damage certain structures of the retina, leading researchers to believe that cumulative exposure can cause damage over years. The evidence is still not definitive, however there is potential for long-term damage, probably more in children (who tend to have larger pupils) and are using devices at a much younger age than their parents. Some doctors are recommending the use of blue-light filtering apps on devices, especially towards the evening, or to invest in a pair of blue-blocking lenses for use on digital devices.
3. Development of nearsightedness. This last one I hold closely to my heart, simply because this is the most common condition I see in children. It doesn’t improve and often gets worse. Once a child is nearsighted, he is usually nearsighted for life, and it’s up to his optometrist to try to slow that down as quickly and as much as possible. Studies clearly show that the longer children spend on near activities (more than 30 minutes) or the closer their working distance (less than 30cm), the more likely they are to become nearsighted. I always encourage outdoor play/sports of at least two hours per day if possible. But with the amount of homework in the older grades, this is nearly impossible. There are ways to slow down the change in nearsightedness, called myopia control, which we will touch upon in a later blog. In the meantime, have children practice the 20-20-20 rule, and to read/work at distances further than 30cm.
Many patients ask whether the use of electronic devices is harming their eyes. That is a difficult question to answer because there is no study that can definitively prove or disprove this idea. However, the eyes were designed to view objects at far, not to be flexed at a fixed distance for long periods of time. If you are concerned for your or your child’s eyes, schedule a visit with your optometrist.