Is screen time harming children's eyesight?

There has been a significant onslaught in the use of technology by our children and teenagers, as the world around us becomes more reliant on screens, all of the time. Children are accessing screens at school, around the home, in the community and for personal entertainment at younger and younger ages.

At the same time, there has been an unprecedented increase in myopia (short sightedness) in children, with higher numbers and earlier age of onset. So is this correlation or causation? It’s seems sensible to blame the screens, but nothing is ever that simple. Increased screen time can be associated with more near work, more indoor time and less outdoor exposure.

Is myopia caused by screen time, or are they co-existing features of the modern visual environment? The increase in myopia rates occurred before the saturation of screens in society, with rates of short sightedness in East Asia increasing before the technology took hold. (1)  Analysis has showed no significant association between screen time and myopia. But even when no statistical association was found, children who were myopic spent more time using screens.

We do know there is an association that children whom spend limited time outdoors, and more time at near have increased rates of myopia, and it may simply be that the screens have replaced other near work modes. (1) This could be supported by the fact that whilst screen time has dramatically escalated in children, the myopia rates, whilst increasing, have not exponentially exploded.

Part of the challenge to figure this out scientifically, is that to ascertain device usage, most studies use surveys and questionnaires. These immediately compromise the data, and are likely not as reliable as objective measures. Who wouldn’t down play the amount of time they spend on social media! A novel survey used data usage as an objective measure of time spent on the device, and correlated that to frequency of myopia.(2) They found a significant relationship between increased data usage and myopia - the myopes used almost twice as much data per day as non-myopes. As a cross-sectional study, the authors were unable to measure the impact of screen time on myopia progression, but they did find that more data usage co-existed with higher myopic refractive error.

How much are children actually looking at screens?

A Philadelphia study suggested that at age four, half of children had their own TV and three-quarters had their own mobile devices. (3) The data usage study suggested that teenagers dedicate double the time to smartphone use than they do to all other near work, and each younger age group spends more time in bed on the devices than the one before them. (2) I can confirm this one from personal observation in my own home!  A 2011 study suggested 47% of children were spending more than two hours a day on screen time for entertainment, (4) and by 2019 that number had skyrocketed to 98% in the US! (5)

What advice should we be giving you?

When families pay attention to their media consumption and parents monitor their children’s digital access, the amount of screen time reduces along with positive improvements in sleep and school performance.(6)  We know there is a protective effect of outdoor time on the onset of myopia, so it is sensible to recommend outdoor time away from any near activities.

The World Health Organization recommends at least 60 minutes of moderate to vigorous physical activity for school aged children per day, yet a UK survey found that three-quarters of UK children aged 5-12 years spend less time than this outside - which is less time spent outside than prison inmates! Shockingly, 20% of the children surveyed never play outside regularly. When it comes to myopia prevention, though, it’s not the physical activity that is the crucial element, it is likely the light exposure (7) - so to combine both benefits, this physical activity time can be undertaken outdoors.

Our advice:

• Reduce screen time: the Australian Department of Health and the American Academy of Paediatrics recommend less than two hours per day of leisure screen time for school-aged children

• Get at least 60 minutes of moderate to vigorous intensity physical activity: recommended by the World Health Organization for children aged 5-17 years

• Be sun safe and protect from UV when outdoors: especially here in New Zealand.

Need more ideas and help? Check out these brilliant resources.

Close Work and Screen Time for Kids

How Much Time Should My Child Spend Outdoors

References.

1 Lanca, C. & Saw, S. M. The association between digital screen time and myopia: A systematic review. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians 40, 216-229, doi:10.1111/opo.12657 (2020)

2 McCrann, S., Loughman, J., Butler, J. S., Paudel, N. & Flitcroft, D. I. Smartphone use as a possible risk factor for myopia. Clinical and Experimental Optometry n/a, doi:10.1111/cxo.13092

3 Kabali, H. K. et al. Exposure and Use of Mobile Media Devices by Young Children. Pediatrics 136, 1044-1050, doi:10.1542/peds.2015-2151 (2015)

4 Maniccia, D. M., Davison, K. K., Marshall, S. J., Manganello, J. A. & Dennison, B. A. A Meta-analysis of Interventions That Target Children's Screen Time for Reduction. Pediatrics 128, e193-e210, doi:10.1542/peds.2010-2353 (2011)

5 Madigan, S., Browne, D., Racine, N., Mori, C. & Tough, S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatrics 173, 244-250, doi:10.1001/jamapediatrics.2018.5056 (2019)

6 Gentile, D. A., Reimer, R. A., Nathanson, A. I., Walsh, D. A. & Eisenmann, J. C. Protective effects of parental monitoring of children's media use: a prospective study. JAMA Pediatr 168, 479-484, doi:10.1001/jamapediatrics.2014.146 (2014)

7 Read, S. A., Collins, M. J. & Vincent, S. J. Light Exposure and Eye Growth in Childhood. Investigative ophthalmology & visual science 56, 6779-6787, doi:10.1167/iovs.14-15978 (2015)

COVID-19 and it's impact on myopia - what parents can do

The COVID-19 Level 4 Alert has us all in lockdown. This has forced children to "shelter in their homes".  And what do most children do when at home?  They play video games, and look at digital screens for hours and hours.  Lack of outdoor time and extensive near work are both serious risk factors for increasing myopia (shortsightedness) in children. We now know that myopia increases the risk of permanent sight-threatening disease later in life.
     
Will we see a large increase in children developing short-sightedness in the next year?  Will myopic children find that their prescription increases in strength at a faster rate in the coming year due to the COVID-19 lifestyle restrictions.  It is very possible.
 
So what can a parent do to lessen these serious challenges posed by the lockdown?
 
1.  Help your child go outdoors for 1 hour every day, take a walk to the park
2.  Invent interesting outdoor activities and participate with your children, see the links below for ideas.
3.  Get them to read or work on their devices outdoors. High light levels are thought to be a key protective factor of outdoor time in regards to myopia. Even under shade, umbrella, or with a hat and sunglasses, the light levels typically reaching a child’s eye will exceed that of indoors.  If they can’t get outdoors for this, then locate near natural lighting, for example, by a large window
4. Check they take a 10-minute break for every 30 minutes of screen time.
5  Be a model for your children by having healthy screen habits yourself.

Supporting Kids During the COVID-19 Pandemic | Child Mind Institute

250+ Creative Ways to Keep Your Family Sane During the COVID-19 Crisis
 
Good luck and stay safe (and sane).  Our practice is closed at the moment.  If you are concerned about your child’s eyesight or want to learn more about how we can limit myopia progression as they get older, feel free to get in touch with us via phone or email.

Recommendations for healthy young eyes

Recently a concerned school teacher asked me for help. She is noticing changes in work habits of her Year 7 students, aged 11-12. What was our advice and recommendations regarding device use and working habits?

As optometrists we look for clinical guidelines and studies, to give evidence and support to any recommendations. After 4 days in Tokyo at the International Myopia Congress I have met and heard many of the people who are researching and following young people’s eyesight. But clinical studies are often slow to produce results, especially in relation to children.

In terms of preventing myopia (short-sightedness) the biggest recommendation is making sure young children have two hours of outdoors time each day. This has been shown to delay the onset of myopia. Rock solid, with loads of clinical evidence to support this advice.

Here are my recommendations:

Not too close. This is a great one to tell children, first punch yourself in the chin, then don’t let your book/phone/screen come closer to your eyes than your elbow.

Regular Breaks - 20/20. After 20 minutes working/looking at close range, take a break, for 20 seconds.

Good posture makes sense. Hold your phone or screen directly in front, not looking sideways for long periods which is work for your eyes to coordinate.

The challenge and concern for most parents is around restricting the amount of time young people spend on screens. For more informative, research and resources, visit the website Screen Sensible Use, put together by Julie Cullen, a parent and physiotherapist. Julie is collating research and encouraging us all to consider the long term impact of our increasingly digitally focused lifestyle on children’s development. She has excellent references. My Kid’s Vision is an informative website about myopia, with a useful tool to calculate risks of children becoming myopic.

Meantime, apply common sense and if you have any concerns about your young person’s eyesight have them tested.

Considering Myopia Profile - are these eyes at risk?

For much of our working careers helping young people who were myopic (short-sighted) was simply a matter of prescribing glasses or contact lenses. Then adjusting the strength of the prescription as eyesight continued to deteriorate through the teenage years.

These days we know so much more about myopia, and how to we can manage myopia to try to slow down the rate of progression.

The best time to start is before eyes have become myopic, when we can identify young eyes at risk.

This tool shows how we evaluate the risk of a child developing myopia.

The good news - we can modify environmental risk factors.

If you have any questions, or would like to know more please get in touch.

New App to Track Screen Usage

An app has been developed to help manage device use by children. This is another tool trying to delay or prevent childhood myopia (short-sight).

The app, named plano, plays in the background of phones and tablets, reminding children to hold the device at a healthy distance from their eyes and to take regular breaks from the screen.

It also screens for myopia and monitors user behaviour patterns. This information is fed into smart algorithms which generate reports for parents. The aim is to identify changes which indicate eye testing is needed.

Across the globe, the increase in smart device usage seems correlated with rising rates of myopia. This is casuing both a public health and economic problem. At the same time, device dependency, gaming addiction, cyber bullying, diabetes, and lack of outdoor activity are global public health epidemics linked to excessive or inappropriate device usage by children.

“It is critical that we reduce the risk of children developing sight threatening myopia,” says Dr. Mo Dirani, Founder and CEO of plano. “plano aims to work with governments, industry players and other important stakeholders to combat this growing problem.”

Plano launched in Singapore in 2017 and the developers are partnering with Singapore’s Health Promotion Board and establishing broad industry collaborations. More recently, the company expanded into Malaysia and India, and announced plans to launch in Australia. Visit www.plano.co

Ortho-K lenses deliver clear result on the touch field

Rodney College student Georgia Brierly has just returned from a touch competition in Europe, where she represented the NZ Barbarians U18 Girls Sevens team against club sides from Sweden and the Netherlands.

Conveniently Georgia has been able to ditch her glasses thanks to her orthokeratology (Ortho-K) lenses that correct her eyesight as she sleeps. Advances in Ortho-K, mean Georgia no longer has to wear glasses or contact lenses during the day.

Ortho-K involves gently reshaping the cornea of the eye to temporarily modify or eliminate refractive error - including short sightedness or myopia.

While the process has been practised for almost 40 years, results were quite variable and unpredictable. However, in the last 10 years new technology has become available to accurately map the corneal shape and manufacture lenses that will achieve a controlled and precise correction in the eye. In addition, new developments in lens materials have been made that enable safe overnight wear to be possible.

Optometrists fitting Ortho-K soon realised that young people wearing these lenses to correct short- sightedness didn’t progress or get worse like those who wore regular glasses or soft contact lenses. Numerous studies confirmed that wearing Ortho-K lenses stopped or slowed kids from getting more short-sighted.

“Rates of short-sightedness have been increasing worldwide; in the US rates of myopia (short-sightedness) have increased from 25 per cent to 42 per cent in 30 years and by 2050 it is predicted that 50 per cent of the population will be short-sighted, doubling what the rate was in 2000,” Claire McDonald says.

“Our concerns are also the more short-sighted you become, there is more risk your eyes will develop cataracts, retinal detachments, macular degeneration and glaucoma. So Ortho-K offers both short term and long term benefits”.

Ortho-k is now a safe, viable and reversible alternative to refractive surgery. The cornea, while being mouldable, will return to its original shape if lens wear is stopped.

“You simply sleep in your lenses, then wake up and remove them, and enjoy clear vision all day.”

Georgia said she enjoys playing touch while being able to see clearly without having to think about using corrective contact lenses, and her mum, Rachel, tells us “Ortho-K has changed Georgia’s life”.