An Optometrist’s Perspective
By Charles Morris and Dr. Stephen Cohen
A Parental Warning
In the 1970s, there were three major network TV stations — 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 parental warning: “Don’t sit too close to the TV. It will ruin your eyesight!”
What would those same moms say today? Could they have pictured an entire generation of children living in the age of technology, spending their days and nights with their nose’s inches away from more screens than any of us could have ever imagined? Phones, tablets, monitors, laptops, watches…and, yes, TVs.
Visit any restaurant and there, in the booth across from you and the table behind you, sit children, their tiny faces illuminated, staring, wide-eyed, at their tablets. Peer under the shade of the passing stroller and chances are you’ll spot an even younger child with a tiny death grip on a phone. They are everywhere. The doctor’s office, the grocery store, the mall, the airport, the coffee shop, the stoplight…children locked in on their digital devices.
Digital device usage in children is clearly on the rise — and the impact on lifestyle and behavior is undeniable. What is the current state of children’s vision? To learn more, I visited one of Arizona’s leading optometrists, who specializes in the diagnosis and treatment of children’s vision issues.
Meet Optometrist: Dr. Stephen Cohen
Dr. Cohen’s optometry practice, Doctor My Eyes, has been trusted by the Scottsdale, Arizona community since 1985. He and his team are known for not only treating pediatric vision issues — but for their groundbreaking role in the application of innovative treatment options for the most rapidly growing vision disease in children — nearsightedness.
I started my conversation 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 by the year 2050, half the world’s population is going to be nearsighted. It’s also estimated to be 57% in the United States. Now, why is that? We haven’t gone through an evolutionary change, but we’ve gone through a lifestyle change. We used to be hunters and farmers, and then we became industrialists. And now a computer is, for lack of a better term, where all our time is spent, engaged in activities within about two feet.”
The Price of Progress
“I remember at the beginning of the pandemic when kids were sent home to remotely learn. 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 a combustion engine. Now we have pollution we have to deal with. You can come up with every example of any advance that occurs, either at a moment in time or over time. We begin to realize, 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 — the impact on vision is just one of those.
I just saw a patient yesterday, a seven-year-old child. I was speaking to 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 is great. Children have access to all this information, but it doesn’t mean that it winds up being healthy for a child.”
Don’t Blink
I have noticed when I see a child with a tablet, many times, they appear to have a blank, hypnotic expression on their face. I asked Dr. Cohen, “Why is that?”
“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 issues. Why? It’s the blinking process that re-wets the eyes with healthy, fresh tears. Today I am seeing eyelid gland dysfunction, a problem in how those glands in the eyelids work to properly wet the surface of the eye in teenagers, 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 things like frequent breaks, change of gaze, remembering to blink, and the use of artificial tears.”
- Take It Seriously.
“Nearsightedness is not an inconvenience. It is a vision disease not to be taken lightly. It can present dangers, especially when it is diagnosed in a young child — and when it progresses over time. Studies have shown that when the condition progresses, prescriptions getting stronger, and a child crosses over a certain level of myopia (-6.00 D, or diopters), the risk of developing serious vision issues later in life increases dramatically. These conditions include myopic macular degeneration, cataracts, retinal detachments, and glaucoma. These conditions not only impair vision, quality of life, but can even lead to blindness.” - Create a Healthy Visual Lifestyle.
Outdoor Time
“Studies have shown that 2.5 hours of outdoor time a day is pivotal. For a child, 2.5 hours spent outdoors decreases the chance of the onset of nearsightedness. So, you may prevent the rock from starting to roll downhill. And 2.5 hours or more spent on devices increases the progression of nearsightedness. Which sounds like a lot, but it’s not. It doesn’t have to be all at once. So, it’s cumulative.
What I tell parents and young children is, spending time outdoors and looking off into the big distances make them a little bit less likely to develop nearsightedness or to develop it 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. Simply put, 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, but 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.” - 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, they’d have a little bit of an increase in the prescription, and we would update it and felt like we did a good job because we got them seeing better. But we were always chasing the change rather than affecting the change.Today there are new treatment options available to children — including spectacles and specialty contact lenses — that not only correct vision but slow the progression of nearsightedness over time. Fortunately, a great deal of clinical research has gone into these options that show them to be effective. So, today I recommend options that actively intervene with the advance of the condition.”
A Shared Responsibility
We all agree that healthy vision is one of life’s greatest gifts. We would also agree that children represent our joy today and our hope for the future. How will they see that future? Whose responsibility is it to protect their vision? It’s ours. The eye care professional, the parent, the schoolteacher, the nurse, the aunt, the friend, and so many more. We have a shared responsibility to make healthy vision choices for our children, who are not yet capable of making those choices for themselves. That’s especially true of the technology we put into their hands.
Let’s make sure your children see the amazing future you envision for them.
