By: Dr. Rupa Wong

As a pediatric ophthalmologist, this is one of the most common questions I get from the parents of my patients. Their kid is gaming 7 hours in a row or watching YouTube videos endlessly – how much device time is bad for their eyes?

I get it. There have been many days in the past where I feel like I’m going to lose my sanity if I don’t have just 5 minutes to myself. This post isn’t about shaming any parent about the amount of screen time they allow their child. There is enough parent guilt already out there. At the end of the day, you have to do what keeps you sane, so that you can recharge. But, using screens as a consistent babysitting strategy is something I would advise against.

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Here are the recommendations by the American Association for Pediatric Ophthalmologists & Strabismus and the American Academy of Pediatrics:

This includes a TV being on in the background as someone is caring for your child. Not even educational programming such as Baby Einstein, etc. Nothing. Nada. Zilch.

This should be high quality educational content and should be watched together with the caregiver. Not just handing your child an iPad and letting them watch in their rooms. I’m guilty of this. More when my daughter was 5 years old, because she started kindergarten a year early, we allowed her to do things our boys did at that age. However, she was a year younger and we weren’t as mindful of that as we should have been.

You may want to create a Family Media Plan* so that you can develop a strategy that works for your family. It’s all about creating something that fits your family life and that you think is achievable. For our house, that means no device time at meals, nor on weekends.

So, a new study** demonstrates a link between UNSUPERVISED screen time in toddlers and decreased white matter in the brain, including areas of language processing. This can be because if kids are spending a lot of time on devices, they aren’t reading with their parent, playing outside, singing, etc – all the activities that do help language and white matter development.

There have also been associations with attentional problems and obesity and excessive screen time.

Nearsightedness, also called myopia, is the inability to see things far away clearly.  And in the past few months, two more studies have demonstrated a link between device time (over 3 hours) and increased nearsightedness in kids. The study found that the prevalence of myopia tripled over the 20 year period and increased by 5 fold in younger kids. And, kids who spent more than 3 hours on near work activities were most at risk for becoming nearsighted. However, they did use a strict definition of myopia (-0.25 sphere), which is less than what is commonly used elsewhere.

In truth, as an ophthalmologist, it doesn’t really matter to me how thick a child’s are. But, being highly myopic (over a -5.50 prescription) carries with it vision threatening risks like retinal tears, detachments, cataracts, glaucoma and myopic maculopathy, later in life, and that’s what we want to avoid.

It’s nothing specific about your phone or tablet or computer that makes your child nearsighted. It's that it's being used up close. And that near work is associated with becoming nearsighted.

Another study noted an increase in nearsightedness in kids during distance learning because of the pandemic. So, we are seeing the repercussions of screen time usage on children’s vision.

Your blink rate is decreased when you read or are on a device. Our eyes depend upon an adequate tear film to lubricate the surface of the eyes and that relies upon a good blink to squeeze the tears out.

With excessive near work, the muscles of focusing, accommodation, are working hard. If you don’t take breaks, then they can actually spasm, causing blurry vision. Follow the 20-20-20 rule. Every 20 minutes, take a 20 second break, looking at something 20 feet away. This allows your child’s eyes to reset and refocus (this is great for parents too!)

Occasionally, kids may report headaches from the excessive focusing required for screens.

There are some tips and tricks you can do to protect your children’s eyes while using a device.

1. Set a timer – This is really helpful in our house. We set a timer for one hour on the device and the children know that have to hand over the ipad when the timer goes off. If they don’t, or if they whine – they lose the chance to have device time the following weekend.
2. Follow the 20-20-20 rule – Every 20 minutes, encourage your kids to take a 20 second break where they look at something 20 feet away. This will reduce eye fatigue and strain.
3. Remind your kids to blink.
4. Create a family media plan and times/zones in your house and family where devices are not allowed.
5. Alternate digital books with physical books.
6. Have your child spend at least 2 hours a day outdoors. This has been shown to slow nearsightedness in several studies and it’s free!

RUPA WONG, MD

Dr. Rupa Wong is a wife, mom to 3 kids, entrepreneur and the managing partner of Honolulu Eye Clinic for the past 13 years. In addition to building a successful practice on Oahu (she's been featured as a Best Doctor since 2010 and was even featured on the cover of Honolulu magazine), Dr Wong has numerous passion projects including founding a women's medical conference, Pinnacle Conference and a membership site, The Attending Lounge, dedicated to empowering female pre-meds, med students and residents with the mindset necessary to grow into confident attending physicians. She has also started a mama and me clothing line, Aryana Clothing, which uses Indian block print techniques as a way to make time stand still for a month with our littles. Dr. Wong is active on social media where she discusses harmonizing work and life, as well as the gaps in business knowledge that medical school does not address. She serves on the Board of Directors for Big Brothers Big Sisters Hawaii, Project Vision and Association for Health Care in Social Media.

RESOURCES:

*Family Media Plan

**Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children