Is screentime bad for kids’ eyes?

Is screentime bad for kids’ eyes?

Screens are everywhere. And screens can do amazing things — but they aren’t amazing for your kids’ eyes. So when it comes to your kid, how do you know if screens are causing eye issues? And how do you strike that perfect balance of setting healthy boundaries and making sure kids aren’t missing out on key skills and digital connections?

On this episode of Mayo Clinic Kids, we talk with Dr. Eric Kim, a pediatric ophthalmologist, about how to keep kids’ eyes healthy in a world filled with screens.

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Dr. Angela Mattke: Hi! I’m Dr. Angela Mattke, a pediatrician with Mayo Clinic in Rochester, Minnesota, and I specialize in helping parents make sense of medical issues. On each episode of “Kids Health Matters,” we talk to different medical experts to get the latest pediatric research and recommendations. In this episode, screens and eye health.

Dr. Eric Kim loves eyes. And kids’ eyes specifically. And when you work with kids, that means you get a lot of questions from parents about what their kids are looking at.

Dr. Eric Kim: One of the most common questions I get asked is: How much screen time is too much or too little? Is looking at a screen going to harm my kid’s eyes? Just last week a family came in with a young child and both parents were wearing glasses on the thicker side and the child had failed a vision screen at school. As I saw the patient I learned that the child was in fact a little bit nearsighted.

The medical word for that is myopia. The parents were naturally concerned because they were also nearsighted and had many questions, including, “Why is my child nearsighted? Is it genetic? And does screen use play a role in that?”

That opened up the avenue to have a good discussion about myopia and screen use and how that could play a role in myopia. It’s a challenging discussion because we need to balance the usefulness of screens, acknowledge that it’s really everywhere right now and you can’t avoid it. But also balancing that with understanding the potential consequences of it and developing strategies for using it in a more healthy way.

Dr. Angela Mattke: Screens are everywhere. And unless you live under a rock in the middle of nowhere (in which case, how are you listening to this podcast?), they’re going to be part of your kid’s life.

Estimates vary, but most agree that, on average, kids ages 8 and up are spending 4 to 6 hours a day on screens, if not more. That number gets higher as kids get older. Recently, the World Health Organization and the American Academy of Pediatrics have both released guidelines on screen use for kids. Their concerns? Sedentary lifestyles, sleep disruption, and brain development. But there’s another thing to consider. And that’s eye health.

Myopia, also known as nearsightedness, is increasing worldwide, almost doubling in recent decades — and that includes kids. Are screens to blame? And how do you strike that perfect balance of setting healthy boundaries and making sure kids aren’t missing out on key skills and digital connections? To help us see the light, we’re talking with Dr. Eric Kim. He’s a pediatric ophthalmologist at Mayo Clinic in Rochester, Minnesota. Okay, Eric, let’s talk about the eye. What kind of things are human eyes good for?

Dr. Eric Kim: The primary function of the eye is vision to help us see and take in the world. But if you stop and think about it, that’s a more complex thing than you might realize. For example, did you ever consider that you can see things, way far away on a distant mountain, or you’re driving in a car. And you can see things right in front of you like your phone. Did you ever consider how it can change focus points without you even controlling it consciously. And it helps you track objects, you see a bird flying across the sky or, your toddler stumbling down the stairs and, if you look at something in front of you and you move your head to the left and to the right, you can maintain your focus on that.

Dr. Angela Mattke: Kids, especially younger ones, are still developing eye coordination and things like that. What kind of eye muscles or skills do kids need to build as they mature to have typical vision function?

Dr. Eric Kim: For kids, from the time they’re born until they grow into adolescence their whole body is growing, adapting, and changing, and maturing, and that includes the eyes and the vision system as well. Initially the eyes are still learning to work together. We call that binocular or two eye cooperation or function.

When they’re very young, less than two or three months old, there could even be momentary eye misalignment. For the vast majority of healthy kids and eyes, the eyes learn to function in cooperation. Includes not only vision focusing on objects and seeing things clearly, but also the eyes being aligned and not, for example, crossed in or drifting out and that also plays into development of 3D vision, or being able to discern depth perception to tell that one object is closer than a different object.

Dr. Angela Mattke: Our eyes develop as we get older. But when we zoom out and think about the whole human race, how is the way we use our eyes today different than in the past?

Dr. Eric Kim: If you think about it from an evolutionary perspective humans have had to navigate the world and different terrain and different things to run away from and things to run toward. Our eyes have had to be able to adapt and have the ability to see things at varying distances and speeds.

But nowadays because of the advent of screens and how they’re everywhere and how our use of them is increasing more and more, there seems to be a tendency to focus a lot on near work. And by that I mean focusing on things up close, whether it’s a book, a phone, a tablet, or a computer screen, rather than things at varying distances.

Dr. Angela Mattke: This might not be on everyone’s radar, but nearsightedness is on the rise in adults and kids. Why is that so significant?

Dr. Eric Kim: Nearsightedness or myopia is definitely on the rise. Some reports say up to 90 percent of teenagers and adults in Asia are nearsighted. And all the many different studies going on right now, suggests that the rate of myopia is increasing globally, with some estimates saying that over half the world’s population will be nearsighted or myopic by the year 2050.

Dr. Angela Mattke: Oh my gosh, that’s absolutely astounding to me.

Dr. Eric Kim: That’s staggering because it becomes a public health issue where such a huge percentage of the world will be dependent on glasses to see things clearly. It’s a form of blindness that thankfully can be cured or addressed with glasses or contacts or even laser eye surgery, but if one does not have access to those tools and resource constrained settings, then you’re left functionally blind.

Now this is a huge area of study because of the public health implications. And there are many groups around the world looking into this and they are trying to discern if there are certain factors that are leading to this increased myopia or myopia epidemic and screen time or too much near activity has been implicated as one of the potential instigators or reasons why myopia is increasing worldwide.

We take our eyes for granted, but they’re really kind of amazing. We can go from reading a book to reading road signs in the car. We can watch our kids run down the street. We can dance or jump up and down and still focus on a single object.

And kids are working on developing those skills we take for granted. They’re building the muscles their eyes need to coordinate, so they can see things clearly and perceive depth.

To do all those things we rely on our eyes. We want typical 20/20 vision. That’s why it’s so staggering that half the world could be myopic by 2050. That’s roughly a 50 percent chance it’s you or your kid! With that many people, we need to understand what’s changing, and what that future looks like.

Dr. Angela Mattke: For children and adults that have high degrees of myopia or nearsightedness, what does that mean for their day-to-day life and functioning? You mentioned that some people may experience functional blindness. So what ways does it limit their life?

Dr. Eric Kim: I can speak from my own personal experience. I had myopia before I had laser eye correction. And, with glasses, I could see 2020 perfectly. However, if you wake up in the morning before you stumble around and try to find your glasses on your bookshelf, then things are blurry, and even seeing my friend or family’s faces, you have to get awfully close to see and focus. But myopia, even though in today’s day and age, you have glasses to help correct it and see well. In the times where you’re now wearing the glasses, or you’re looking for them, or you’re out of your contacts depending on how nearsighted you are, you might have to get very, very close to see something clearly. And on a practical level, it’d be very hard to navigate the world.

Dr. Angela Mattke: And there can be different levels of myopia and impairment, too. Kids with less severe myopia might still be able to navigate the world pretty well and kind of fly under the radar. For kids that haven’t been diagnosed, what might be clues that they’re still struggling with vision?

Dr. Eric Kim: Some clues that your child has, or might be myopic or nearsighted would be if you observe your child bringing things really close to their face to see, or scooting themselves and getting close to something else like a TV screen to see. Or the child might say that they’re having trouble seeing things at school when they’re sitting at the back of the classroom and they have to squint or strain their eyes to see. That can be another sign of myopia.

Dr. Angela Mattke: The question that I have, Eric, is we understand that there’s like a relationship between increasing screen time and increasing rates of myopia, but do we understand the mechanism of how that’s occurring?

Dr. Eric Kim: Short answer is we don’t know. And I know that’s not a fully satisfactory answer. Right now, all the major studies have shown it is not necessarily a direct cause and effect, but more of a correlation. As the world’s population becomes more and more myopic, and there’s increasing rates of screen time, there seems to be a connection there, and there’s different theories as to why.

One is that maybe near activity or near focus of the eyes might be playing a role in causing or worsening myopia because when you look at a screen it’s close to you, you’re focusing on something 20 to 30 inches away from you rather than across the street and it’s thought that focusing up close for prolonged periods of time chronically may play a role.

There’s other factors too. There’s certainly a genetic factor where if your parents are very myopic there’s a higher chance that you may be as well, especially if they’re very nearsighted. There seems to be maybe a ethnic or racial predilection as well as the rates of myopia are especially high in Asia, East Asia.

And there’s also a thought that being indoors all day might actually worsen myopia. And as to why some groups have theorized that natural sunlight may be important for the eyes development overall, including to minimize the risk of myopia.

There’s been a big population study out of Asia that increased the amount of children’s time outside by just 40 minutes a day during recess activities. And it shows that that itself helped decrease the amount of myopia progression or worsening. It seems like too much near activity, whether it’s screens, or even your notebook or book, could worsen myopia. And being indoors all the time at the expense of being outside in natural light could also worsen myopia.

Dr. Angela Mattke: There’s clearly a relationship between myopia and increased screen usage. Are there other effects that we see in the eyes from spending a lot of time on screens?

Dr. Eric Kim: Yes and that includes things like eye strain, eye pain, and headaches. Because when you’re looking at a screen for a prolonged period of time, a lot of things happen. One, you tend not to blink as often, so the eyes dry out more. And dry eye itself is a very common problem that can cause eye pain or feeling like you got something in the eye or burning and itchiness and blurry vision. And focusing on a screen too long can also tire out the eye muscles, causing a headache and pain around the eyes.

Dr. Angela Mattke: How much do we know about the long term effects of screens on kids’ eyes? As a parent I’m sitting here terrified and wondering if these negative effects can be reversed.

Dr. Eric Kim: The long term consequences of screen time depends on what we’re talking about. Bad effects like eye strain and eye pain and headaches, thankfully are largely reversible if we adopt certain healthy practices. However, if you’re talking about the fact that screen time may play a role in myopia. Myopia itself, unfortunately, is not reversible and in fact, can worsen over time with increasing screen time.

Dr. Angela Mattke: I guess my follow up question is, if myopia is increasing and it’s irreversible, does that mean our eyes are physically changing?

Dr. Eric Kim: We know that increasing near activity or screen time may be causing myopia and although the exact mechanism how that’s happening is still being studied, we do know that when someone is myopic or nearsighted that’s often connected to the eye being longer in what we call the anterior posterior dimension, or the front and back.

If you look at someone straight on you wouldn’t be able to tell that they had a long eye, unless you were to imagine the eye or take the eye out of their socket. If you were to, you would discover that the eye is in fact longer. And that itself can present a problem, because if someone is very nearsighted and has an abnormally long length that can cause other problems besides just a need for glasses. It can increase their risk of retinal detachments or other retinal issues. It can increase the risk of glaucoma. This can be a big problem for the eye’s overall health.

Being myopic or nearsighted is incredibly common. And that’s kind of reassuring. Because with glasses, contacts, or laser eye surgery, tons of people with myopia thrive every day. The key is to treat myopia. If you notice your kid holding things really close to their face, getting super close to the TV, or having issues sitting in the back of the classroom, those are clues that you might want to do a vision exam.

And do screens cause myopia? The answer is… maybe. We know that on a societal level, increasing myopia and increasing screen time go hand in hand. We know that lots of near work like looking at screens can worsen existing myopia. And this is where it gets super weird — the human eye is also physically getting longer!

We still don’t understand what’s making all these changes happen. But even if we don’t know exactly what’s going on, we do know that good screen habits are important, even for already healthy eyes.

Dr. Angela Mattke: For eye health specifically, what’s the recommended amount of screen time kids should get per day?

Dr. Eric Kim: That’s really the million dollar question that every parent has. And it seems like a lot of parents want me to say zero. They look at me and give me a wink. You know, this is a contentious topic and there’s different schools of thought.

I like to refer to the American Academy of Pediatrics guidelines, which say that under the age of 18 months, there really shouldn’t be any screen time, except for perhaps video chatting with an adult, perhaps a grandma or an out of town friend. Now, as they get older to about 18 to 24 months the official recommendation is to limit screen time to purely educational programming in the presence of a caregiver. Not the child alone. And for children ages two to five, there’s a recommendation to limit non educational screen time to about one hour a day.

For kids a little bit older, ages six and up, there’s no set maximum limit of screen time, but rather a recommendation to encourage healthy habits to limit activities that include screens.

Dr. Angela Mattke: I’ll just follow that up with understanding why the American Academy of Pediatrics really isn’t recommending screen time for kids less than two years of age. There’s so many different apps and other things that are targeted towards parents and they’re described as educational and they say that they’re going to teach your kid things, but what we really know is kids less than 30 months of age struggle with something called the video deficit. They have a hard time understanding what’s occurring in two dimensional, meaning on screens in front of them and putting it into a three dimensional world. In order for kids to truly learn things, and they found this in really good studies, is that there needs to be an adult there to co-view and kind of reteach to them in this three dimensional world what they’re learning.

Then between two and five it used to be two hours or less of screen time per day, but that was a change because even with one additional hour per week of screen time in this preschool age group, we saw increasing rates of higher BMI, getting into zones where we see kids living in bigger bodies. And with that, we do see other health effects going along with it.

We know that kids in this age group need to learn all of their developmental skills through play. They have to learn how to interact with other people. They have to learn how to understand social skills and respond appropriately and work through frustrations and emotions. And they don’t get that if they’re sitting in front of a screen or if we’re using a screen to help modify their emotional responses, especially when they’re upset if we’re using it as a tool to help them calm down. Just to elaborate a little bit more about why those screen time limits were set and they weren’t just some arbitrary numbers as pediatricians like to pull out of a box, they’re actually based on research.

Screens are everywhere. They are a part of our culture, how we socialize. Some kids, even I would say most kids, are even using them in the school setting starting from kindergarten on. How do we really thread that needle of making sure that kids don’t get too much screen time, but also not depriving them of these key opportunities to develop technology skills and interact with their peers?

Dr. Eric Kim: That’s a tough balance to strike because screens are ubiquitous. They’re everywhere. And in today’s day and age you really need to learn how to navigate screens. And certainly there are many benefits. Over the Christmas holidays, I was visiting some family members and my niece was learning how to play piano using a tablet app, and apparently she learned how to play several songs simply from the app, which is incredible.

I don’t want to not acknowledge the benefits of screen time and technology for growth and education and artistic pursuits. At the same time, Angie, you just alluded to many of the harmful effects of too much screen time. What are some strategies to try to enjoy the benefits while minimizing the risks?

I think setting healthy boundaries might be a good starting place. And that could include things like turning off the screens during family meals or family time together. Maybe that can be a sacred time of connecting conversations or listening to your child and sharing stories that can be off limits to screens.

And giving a time and place for screen activity. As a parent myself, I know that it’s really hard to resist the urge to use screen time as a pacifier, as a tool to get the child to calm down or eat their meal. I don’t want to be too judgmental because I understand the challenge of that and I’ve used screens for those purposes at times too, but trying our best not to. If it becomes a crutch or a pattern that could easily slip into overuse of the screens, that can cause real damage to the eyes, to the vision, and to their overall health and development.

Dr. Angela Mattke: I really like that concept of setting boundaries. One of the most important things that parents can learn from early on is using screens as an incentive and not a right. It’s not something they get to do every day. It’s based on behaviors and cooperation and participation, using it as a reward can be really, really effective.

Even with meals. Meals are hard. I remember my oldest being like, “Oh, my gosh! The most challenging two-year-old eater,” and I was afraid he was going to starve to death. And we did resort to some screens at times, but then we would always switch to try and be like, “Well, this will be our reward.”

But that’s really important to set up. It starts as parents being cognizant early on about how they’re going to use screens and trying to stick to that. It’s harder to pull back and set limits when there were never limits set before. As you’re pregnant, as you’re starting to have children, or adopt, or anything like that, start to think about how you want to interact with screens in your family. And obviously, re-evaluating as time goes on, how it’s going to work for you and your family.

Dr. Eric Kim: Another healthy boundary or practice will be to remove screens from bedrooms and limit the use of screens right before bedtime. Some people advise that within an hour of going to sleep, try not to use screens because that can actually disrupt their sleep. It’s thought that the blue light emitted from the screen can interfere with our body’s natural ability to wind down and go to sleep and get a good night’s rest.

Dr. Angela Mattke: I love that. I think all those parents aren’t afraid to set boundaries, thinking about how you want to approach them going forward so that you can set up boundaries as the child gets older for different types of things as it relates to screen limits on their tablet, limits on their cell phone, what they can view, when do they turn them off? Where do they put them at night?

There’s different roles for different families. Maybe one size doesn’t fit all for every family. And just being mindful of that too as we’re seeing each other and other people’s children interacting with screens, try not to be judgmental as much as possible. Are there any settings or modifications parents can make to screens that can make them better for overall eye health?

Dr. Eric Kim: Yes, the good news is that there are steps that you can take to make screen intake more healthy. One is to keep your distance. Rather than holding things three inches from your face, try to shoot for more arms length. Let’s say 25 inches away or more. This is because the closer the object is to your face, the harder your eyes have to work to focus. Pushing the screen back, just several more inches can make a difference in allowing the eyes to not have to strain too hard.

Another thing you can do is to reduce glare. A lot of glass screens can cause glare that can aggravate the eye. You might consider using a matte screen filter. And you might also consider adjusting the lighting. If the screen is very bright, but the rest of the room is dark, your eye has to work harder.

You can help yourself out by decreasing the screen brightness or increasing the surrounding brightness. And also increasing the contrast on the screen so that the darks and lights are more easily distinguished. This is all great advice. And beyond modifying the screen itself, what else can parents and kids do to make screen use healthier?

It’s important to take breaks. One easy rule is the 20, 20, 20 rule. And that means, every 20 minutes, step up and look at something 20 feet away for 20 seconds. That gives you a chance to relax your eyes, because as we said looking at things further away is less taxing on your eyes and then it’s just a chance for your eyes to rest and reset.

And try to remember to blink while you’re engaging in the activity as well. We all know from experience that when you’re engrossed in a book or a screen or a movie, you don’t blink as often actually. Because you’re not blinking as often your eyes will dry out. And you can either try to be conscious of trying to blink more often, or you can also supplement with artificial tears to keep the eyes lubricated.

You can also consider using a humidifier nearby. A lot of homes here in the winter when it’s cold, the heater’s blasting so the air can be dry. Increasing humidity can also help.

Dr. Angela Mattke: That’s excellent. Do you have any other practical tips for just keeping kids eyes healthy?

Dr. Eric Kim: We talked about a lot of ways to keep the eyes healthy for screens. And we also mentioned being outdoors and enjoying natural light for normal eye development and perhaps decrease the risk of myopia. As we’re talking about being outside, we’re saying that some natural light, it seems very important for eye development.

Certainly too much UV light can cause damage to the eyes and even skin cancers around the eyelid and the eyeball itself. Certainly it would be a good idea to wear sunglasses or hats for UV protection if you’re going to be outside for a prolonged period of time. And continued screening of the child’s eyes with the pediatrician or at school is always a good idea. And if there’s any abnormality detected it’s a good idea to get a formal eye exam by your friendly local ophthalmologist.

Dr. Angela Mattke: Awesome. Thank you so much for coming today and sharing all this information.

Dr. Eric Kim: Thanks for having me. It was a pleasure.

Dr. Angela Mattke: For building those healthy screen habits, the American Academy of Pediatrics is a great resource. Kids under 18 months should have no screen time except the occasional video chat. And for kids up to 2-years-old, only screens in the presence of a caregiver. From 2 to 5, try to keep it to an hour a day if it’s not educational.

It’s never too early to think about how you want your family to use screens, and what boundaries you want to set. And different families will make different choices. But it’s important to set some sort of boundary, and stick to it as best you can – or reevaluate it with new information.

When it is time for screens, you can help your kids’ eyes by making sure the screen is at a healthy distance, reducing glare with a screen filter, and reducing screen brightness or turning on the lights. Take those breaks! The 20-20-20 rule — every 20 minutes, stare at something 20 feet away for 20 seconds — is great for all eyes, regardless of age.

That’s all for screens and eye health. But if your kid has something else going on or you have a topic suggestion, send us an email at [email protected] or leave us a voicemail at (507) 538-6272, and we’ll see if we can help you out.

Please remember, this podcast cannot provide individual medical advice and the discussion presented here cannot replace a one-on-one consultation with a medical professional. And hey, if you’re myopic, look on the bright side: you get to do your very own glasses fashion show to pick out the coolest pair. Okay, thanks for listening!

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