Are Digital Devices Destroying Your Child's Vision?
An Optometrist's Perspective
A Parental Warning
In the 1970s, there were three major television networks: ABC, CBS, and NBC. The Brady Bunch and Columbo dominated the airwaves and held us blissfully captive in our living rooms. In those days, nearly all moms gave their children the same warning: “Don't sit too close to the TV. It will ruin your eyesight!”
What would those same moms say today? Could they have imagined an entire generation of children carrying their own miniature televisions, spending their days and nights with their noses inches from more screens than any of us could ever have imagined? Phones, tablets, monitors, laptops, watches…and, yes, 4K TVs.
Visit any restaurant in any town and you will find children, their small faces illuminated, staring wide-eyed at their tablets. Peer under the shade of a passing stroller, and chances are you'll spot an even younger child with a death grip on a phone. They are everywhere. The doctor's office, the coffee shop, the airport. Children locked in on their devices.
Children are spending more time on screens than any generation before them, and you don't need a study to see how it has changed the shape of a childhood.
But what is happening to their eyes?
To find out, I visited one of Arizona's leading optometrists, a doctor who specializes in diagnosing and treating children's vision problems.
Meet Dr. Stephen Cohen
Dr. Cohen's practice, Doctor My Eyes, has served the Scottsdale, Arizona community since 1985. He and his team treat pediatric vision problems, and they were early adopters of myopia management: the specialty contact lenses, spectacle lenses, and clinical therapies studied for their ability to slow the progression of nearsightedness.
I started with a direct question: “Are digital devices destroying children's vision?”
Dr. Cohen replied:
“There is no question digital devices are having a profound effect on children. Studies have shown that nearsightedness, also known as myopia, is becoming a global epidemic. It is estimated that by the year 2050, half the world's population will be nearsighted. In the United States, the projection is 58%.¹ Now, why is that? We haven't gone through an evolutionary change, but we have gone through a lifestyle change. We used to be hunters and farmers, and then we became industrialists. And now the computer is, for lack of a better term, where all our time is spent, engaged in activities within about two feet.
Now, I want to be fair to the device, because it's easy to make the screen the villain. There is nothing radiating off that screen that injures the eye. What a screen does is hold a child at twelve or fifteen inches for hours at a stretch, and it keeps them indoors while it does it. So, when a parent asks me whether devices are destroying their child's vision, what I tell them is that the screen matters less than what the screen is replacing. And what it replaces is distance, and time outside.”
The Price of Progress
“I remember at the beginning of the pandemic, when kids were sent home to learn remotely. People said, ‘Isn't it great, children have an alternative for learning,’ and they point to the computer without any consideration for the consequences.
That is the pivotal term to me: unintended consequences.
Think about the combustion engine. Now we have pollution to deal with. You can come up with an example of almost any advance, whether it happens in a moment or over decades. We begin to realize that advances come with potential price tags. Technology is no different. With all the time being spent on devices, there are consequences that often aren't thought about, and the impact on vision is one of them.
I saw a patient yesterday, a seven-year-old girl. I was speaking with her mother about digital device use. The mother said, ‘Next year in school, most of their learning is going to be in the classroom, but using devices as well,’ as if this were good news. Children have access to all this information, but that doesn't mean it winds up being healthy for a child.”
Don't Blink
Myopia is a story about distance.
But there is one place where the device itself, not the time it consumes, is doing the damage.
When I see a child with a tablet, they often wear a blank, hypnotic expression. I asked Dr. Cohen why.
“Blink rates are estimated to drop to about half when we are engaged in concentrated gaze, and the eyes also tend to widen. That holds true for children as well. A lack of blinking can cause serious long-term problems. Why? It's the blinking process that re-wets the eyes with healthy, fresh tears. Today I am seeing eyelid gland dysfunction in teenagers, a problem in how the glands in the eyelids work to properly wet the surface of the eye, literally decades before we would normally expect to see a condition like that.
I speak with parents about something I call ‘visual hygiene.’ I encourage frequent breaks, change of gaze, remembering to blink, and the use of artificial tears.”
Three Things You Can Do to Protect Your Child's Vision
Not everything about myopia can be controlled. Genetics plays a real role, and two nearsighted parents raise the odds that their child will be nearsighted too. But parents have more power here than most realize. Here are three things every parent can do.
1. Take It Seriously.
“Nearsightedness is not an inconvenience. It is a vision disease, and it should not be taken lightly. It can present real dangers, especially when it is diagnosed in a young child and when it progresses over time. As the condition progresses and prescriptions get stronger, the risk of serious eye problems later in life rises with it, and it climbs sharply once a child reaches what we call high myopia, or -6.00 diopters.² Those problems include myopic macular degeneration, cataracts, retinal detachment, and glaucoma. They can impair vision and quality of life, and they can even lead to blindness.”
2. Create a Healthy Visual Lifestyle.
Outdoor Time
“Studies have shown that time outdoors matters, and roughly two hours a day is the figure I give parents.³ That time reduces a child's chance of becoming nearsighted in the first place. You may prevent the rock from starting to roll downhill. Two hours sounds like a lot, but it isn't. It doesn't have to be all at once. It's cumulative.
What I tell parents and young children is that spending time outdoors and looking off into the big distances makes them a little less likely to become nearsighted, or to become nearsighted as young.”
The 20-20-20 Rule
“I believe in this simple rule, which is a reminder for parents to make sure children take vision breaks from devices. For every 20 minutes on a device, have them take a 20-second break and look at something at least 20 feet away.
I've always likened it to lifting weights. You lift until you can barely do another rep, then you put it down and take a break between sets, and you're able to come back and lift again. I use that example and say it's the same thing with children's eyes. If you give them that little bit of a break, it helps their eyes recover.”
3. Don't Just Treat. Intervene.
“One of the frustrations of my practice over the years was that a parent would come in with a nearsighted child, the child would have a little increase in the prescription, and we would update it and feel like we had done a good job because we got them seeing better. But we were always chasing the change rather than affecting it.
Today there are treatment options for children, including certain spectacle lenses and specialty contact lenses, that correct vision and also slow the progression of nearsightedness. A great deal of clinical research supports these options. So today I recommend approaches that actively intervene in the advance of the condition.”
About Dr. Stephen Cohen, O.D.
Dr. Stephen Cohen has been in private optometry practice in Scottsdale, Arizona since 1985, after graduating with clinical honors from the Pennsylvania College of Optometry. A past president of the Arizona Optometric Association, he has been recognized as Arizona Optometrist of the Year and has twice been named among the top 10 optometrists in the United States, most recently through CooperVision's Best Practices program. Dr. Cohen has served as a national spokesperson for Johnson & Johnson Vision Care on the effects of UV radiation on the eyes and has been a principal investigator on more than a dozen FDA clinical studies for dry eye and contact lenses. His practice, Doctor My Eyes, has been recognized five times as one of Arizona's top 10 eye care practices, and as the top eye care practice in Scottsdale by City Beat News for five consecutive years.
Sources
1. Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042.
2. International Myopia Institute. IMI Defining and Classifying Myopia white paper. Invest Ophthalmol Vis Sci. 2019;60(3):M20-M30.
3. Xiong S, Sankaridurg P, Naduvilath T, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017;95(6):551-566.
Disclosure: Red Monarch provides marketing services to companies in the vision care and medical device industries, including manufacturers of myopia management products. Dr. Cohen received no compensation for this interview.
