RECOGNIZING AND MANAGING THE IMPACT ON CHILDREN'S EYES

The closing of schools has pushed millions of students online. While necessary, we are concerned about the effect of such extensive computer use on children's eyes. This sudden move to remote learning brings many more to their screens for extended periods. Younger students may now face computer vision problems at an earlier age as a result. We are not suggesting that schools should not teach online - Zoom and other platforms have been a wonderful way for students to study while being connected with peers. However, adequate precautions should be put into place. We encourage you to read our three publications on these topics.

⦁   Computer Vision Syndrome And How To Avoid It
⦁   Eye Problems Related To Excessive Computer Use By Children
⦁   Tips To Minimize Adverse Effects Of Screen Time On Children's Eyes

COMPUTER VISION SYNDROME AND HOW TO AVOID IT

Computer vision syndrome refers to symptoms occurring with computer use. They can include headaches, eyestrain, blurry vision, dry eyes, irritated eyes, eye fatigue, light sensitivity, neck, back and shoulder pain, and double vision. These symptoms also occur in children. It is reported that children have a lower degree of self-awareness and often do not notice discomfort or other symptoms associated with computer vision syndrome. Therefore, parents must provide guidelines. A recent study reported that 30% of parents found that children experienced at least one of the following symptoms after more than two hours of screen time per day: headaches, neck/shoulder pain, eyestrain, dry or irritated eyes, reduced attention span, poor behavior, or irritability.

Any of these symptoms could affect academic performance, mood and social interactions. In addition to the vision/eye symptoms, excessive screen time may cause disruption in the sleep/ wake cycle, which may lead to daytime drowsiness and poor performance in schoolwork. Weight gain, obesity and related health problems have also been shown to be associated with screen use.

Limiting children's time on computers is not always an option in the midst of the COVID-19 restrictions and online schooling. Diligence must be undertaken to ensure protection of our children's eyes and to prevent future problems.

The responsibility of parents or childcare providers will be to provide the optimal setting for children, to comply with the attached tips for setup, and to instruct them on developing the necessary habits for maintaining comfortable computer use. A computer positioned for an adult will not be a proper setup for a child. Monitor the child's distance from the computer. When sitting too close to the computer, the eyes must accommodate more to focus, causing strain, which may lead to eye fatigue, or headache or a crossing of the eyes. Look for squinting, frowning or rubbing of the eyes, and avoidance of reading which are all signs of eye strain.

Viewing a computer is different from reading a printed page. Often the letters on the computer are not as precise or sharply defined, the level of contrast of the letters to the background is reduced and the presence of glare and reflections on the screen may make viewing difficult. Studies comparing the performance of an editing task when the material was either presented on a computer or in hard copy form reported fewer errors and faster completion of the task when viewing printed material. Another study found that subjects reported significantly greater blur during the computer task when compared with a hardcopy printout of the same material. An important question that has not been answered is whether some students who unknowingly experience computer vision symptoms will have decreased achievement with the change to online schooling versus others who are free of these symptoms.

During this time, it will be difficult to limit and monitor screen use. But setting up ergonomic guidelines now may help avoid problems.

Both the American Academy of Optometry and the American Academy of Ophthalmology recommend childhood eye exams regardless of whether children pass the school vision screening test or if they have no complain.. Some of the vision problems detected in an examination are low degrees of nearsightedness, farsightedness, astigmatism, difficulty using the two eyes together, and dry eyes. Because children's vision can change frequently, they should have examinations annually. Proper education and early examinations will help to place each child in the best position for a lifetime of computer use.

EYE PROBLEMS RELATED TO EXCESSIVE COMPUTER USE BY CHILDREN

Two major changes in children's eyes are occurring because of increasing use of screen time. They are dry eyes and increasing myopia (nearsightedness). The excessive amounts of time spent on computers, other devices and television can result in lifelong consequences for the eyes.

DRY EYE

The condition of dry eye was previously thought to be a condition occurring in older people; however, over the past decade The Korb Dry Eye Center has found increasing numbers of children exhibiting the signs of dry eye, findings which are now also supported in other studies. Most often, the children are not reporting a feeling of dryness because they cannot articulate the problem, but upon examination signs of dry eye are seen.

Blinking is the primary mechanism for wetting the eyes. The blink rate slows down significantly with screen time, which induces staring. The action of the blink spreads tears over the eyes. The blink rate must be frequent and the blink action must be complete, with the upper lid meeting the lower lid to make closure, providing wetting of the entire eye to replenish the tears. A secondary action of the complete blink results in the release of oil from glands along the lower lid margin. This oil provides the tear film with its thicker outer layer.

Over time, poor blink habits can result in a feeling of dryness, redness of the white part of the eye and, with examination, signs of dryness, including blockage of the glands along the lower lid margin. This blockage decreases the amount of oil, causing the tears to evaporate more quickly, leading to symptoms.

Parents should observe their children while on screens and determine if they are staring and, therefore, blinking infrequently. It is also important to ensure that breaks are taken. Follow the 20/20/20 rule: every 20 minutes, take a 20 second break to look 20 feet in the distance and to blink multiple times. You will have to remind your child to do this. Using alarms is a great way to remind them when you are working.

It is important for children to have eye examinations to detect problems in the early stage, when changes can be made and treatment begun. It is important for you to understand that once the glands are blocked, they begin to atrophy, which is a permanent problem. Your children need to spend a lifetime on screens, and early education is an important part of self-care. Untreated dry eyes can lead to lifelong problems with discomfort and difficulty with successful contact lens wear. It is easier to prevent a problem than to treat one.

TREATMENTS FOR DRY EYES

A dry eye evaluation may indicate specific treatments including:
Instructions on proper blinking
Treatments to open the blocked glands
Warm compresses to facilitate the release of the oil in the glands along the lid margin
The use of specific lubricants, drops, ointments, gels, or medications

MYOPIA (NEARSIGHTEDNESS)

The second consequence of extended use of screens is related to the development of myopia (nearsightedness) and often with an earlier onset. Myopia occurs when there is an increase in the length of the eyeball, causing light to focus in front of instead of on the retina, creating blurring. If not corrected, this blurring causes further increase in the elongation of the eye and increasing myopia. Research over the 1st 30 years has proven an association between myopia and close work in conjunction with fewer hours spent outdoors.

Most eye care providers are seeing a dramatic increase in the rates of childhood myopia in this country. According to a 2018 survey from the AOA, more than 40% of Americans are myopic, up 25% from only 40 years ago. One in four American parents has a nearsighted child and 75% of these children were diagnosed between the ages of 3 and 12. In China, a 2018 survey of 1 million students between ages 12 and 14 found that 72% had myopia, up from 58% in 2010. Urban areas were more affected than rural areas.

The shift towards younger onset is linked to faster progression and may lead to increasing severity of myopia. Higher levels of myopia have greater risk of serious medical complications over time, including increased risk for glaucoma, retinal detachment, earlier onset of cataracts and myopic macular degeneration. Early intervention can reduce progression of nearsightedness.

Excessive time indoors looking at screens is a definite risk factor. Time outdoors appears to have a protective effect against the onset of myopia, with two hours per day spent outside recommended for best results for children. During this time of increased online learning, it will be difficult to moderate screen use, but making sure that breaks are scheduled and screens are kept at a distance can help and, when it becomes possible, eye examinations.

TREATMENTS FOR MYOPIA CONTROL

In Office:

Use of atropine drops
Progressive soft contact lenses
Progressive spectacle lenses
Orthokeratology, using specially designed rigid contact lenses overnight to reshape the cornea

At Home Interventions:

20/20/20 Rule
Frequent breaks
Time outdoors

TIPSTO MINIMIZE ADVERSE EFFECTS OF SCREEN TIME ON CHILDREN'S EYES

1. LOCATION OF COMPUTER SCREEN
Optimally, the computer screen should be slightly below eye level and placed between 18 - 24 inches from the children's eyes. Align the top of the screen at eye level so that they will be looking down at the screen while working.

2. SIZE OF SCREEN
Large monitors are easier to see and font size can be increased. Small screens necessitating smaller text size frequently require closer distances, increasing visual demands and stress.

3. LIGHTING
Position the computer screen to avoid glare, particularly from overhead lighting or windows. Blinds or drapes on windows may be necessary. Use lower wattage light bulbs in desk lamps.

4. ADJUST SCREEN BRIGHTNESS
Screen brightness should be about the same as the surroundings and contrast should be made as high as possiblet that it feels comfortable.

5. SEATING POSITION
Chair height should be adjusted so the feet rest flat on the floor or on a stool. Good posture is important.

6. REST BREAKS
Follow the 20/20/20 rule: every 20 minutes, take a 20 second break to look 20 feet in the distance and to blink multiple times. A timer could be set for a reminder. For long periods of computer use, rest your eyes for 15 minutes after two hours of continuous computer use.

7.BLINKING
Develop a habit of blinking with complete closure of the eyelids which is necessary for proper wetting of the eyes. Computer use induces staring. With staring, blinking does not occur and eyes become dry.