Kids and Screens: An Eye Doctor's Review of the Science

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Kids Eyes and Screens

As a doctor and a parent, I know how worried we are about the amount of screen time our kids are exposed to. Research published in JAMA pediatrics in 2022 shows worldwide the average child spends 4.1 hours per day in front of a screen - a 52% increase from pre-pandemic levels. Studies looking at American children's use of screens show even more staggering numbers; the CDC reports the average American 8-10 year old is spending 6 hours in front of a screen, and the average 11-14 year old is spending 9 hours. Should we be concerned?

The good news is that there is no scientific data showing that a human eye could be permanently blinded or the retina tissue permanently damaged by looking at digital devices. Let's review what we do know about screen time and it's risk for our children:

The Question of Blue Light
Much has been made about the high energy blue light emitted from device screens, but the amount of blue light exposure from a screen is actually much less than that of sunlight. Research from Ohio State University found that even a cloudy day outside has 10 x the amount of blue light exposure than that emitted from a screen, and a sunny day would have 100 x the amount of blue light exposure. Because of a lack of research finding that blue light from a screen could actually damage the retina, the American Academy of Ophthalmology does not recommend blue light glasses for health protection of the eyes. 

While blue light blocking glasses have been reported by some to reduce glare and light sensitivity, there is a lack of consistent literature showing any meaningful benefit. A recent study reported that blue light glasses were no more effective at reducing computer-related glare, eye strain, or light sensitivity than simply dimming the screen brightness or using "night mode" settings on devices.

In my own practice, I offer patients samples of anti-reflective coatings, tinted lenses, and blue blocking lenses to try while looking at their own devices. Some patients notice a difference; some do not. If this technology helps your eyes feel more comfortable, then having it in your glasses makes great sense, but we also discuss focusing on good computer ergonomics - reduce screen brightness, sit at least an arm's length away, take frequent breaks, position yourself so the screen is no higher than your eyebrow height - as essential for reducing the risk of eye strain and discomfort.

What Concerns Do Exist
Research from nearly 2,000 children aged 8-14 showed that more smartphone and device use was associated with more self-reported complaints of eye strain and discomfort. The most common symptoms included:
  • blurry vision or double vision (fluctuating - not permanent vision damage)
  • irritation, burning, redness
  • eye strain or tired eyes feeling
Using devices > 4 hours per day was associated with the highest rate of symptoms: 60.2% reported eye strain/tired eyes, 46.3% reported blurry distance vision after screen time or studying, 41.9% reported burning/irritation/redness, and 38.1% reported headaches. 

Screen use does make eyes feel uncomfortable - and one of the core reasons is because it makes our eyes drier. Studies show we blink as much 42% less often when we are using a device. Blinking is essential for the release of tear film from our eyelid meibomian glands onto the eyes' surface - when we don't blink, we don't release tears, and the result is drier eyes. The best way to help reduce the risk of discomfort with screen use is to take frequent breaks. The 20/20/20 rule has been popularized to help guide device users in better ocular comfort - every 20 minutes, take a 20 second break to blink and look 20 feet away (out a window, down a hallway, etc). 

20/20/20 Rule

Dry eye is more than just temporary discomfort - if the meibomian glands become blocked or damage it can lead to a lifetime of battling ocular discomfort. Research has found even very young children now often have signs of meibomian gland damage. This study looked at 172 children between the ages of 6-17 and found that 86% of patients that reported 4 or more hours of screen use had "severe" meibomian gland atrophy. 

What About Myopia?
Can screen use increase the risk of your child becoming near sighted (myopia), or their near sightedness worsening? Research does suggest a correlation, though it's hard to separate the impact of screen use specifically versus overall time spent indoors. When school-aged children were doing mostly virtual and online schooling (resulting in a significant increase in screen time usage), one study found  a 10.49% increase in the rate of myopia among their population versus pre-COVID levels. It is unclear if screen use specifically increases the risk of myopia, but we do know that spending more time outdoors and having better sleep schedules is correlated with a reduced risk of myopia. To help reduce the risk of developing myopia, parents should strive for their children to get:
What Can Parents Do? 
Limiting screen time and setting frequent break intervals is essential to reducing this eye strain and dry eye damage.  Excessive screen use has been associated with a number of concerns for children's overall well-being, above and beyond their ocular health and vision. Studies have found increased screen time to be correlated with:
The World Health Organization recommends:
  • no screen time for children 1 year old or less
  • no more than 1 hour for children ages 2-4 
  • for children 5 and older set limits for screen use and encourage frequent breaks

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