When discussing children’s vision, the question always arises whether our digital screen lifestyles play a role in vision health and comfort. When dealing with digital eye strain (DES) symptoms, the answer is an easy yes. When dealing with childhood myopia and myopia progression, the answer seems to be no…and yes.

“Currently, there is no evidence to support the notion that digital screen use contributes to the onset or progression of myopia in children,” says Long D. Tran, O.D., of St. Johns Eye Associates (two locations in Greater St. Augustine, FL) and a member of the Essilor-sponsored Myopia Task Force.

“However, there is research data suggesting a relationship between high amounts of prolonged near work and increased axial length of the eye. Consequently, this can result in the onset or progression of myopia.”

Some alarming statistics:

• Since the 1970s, myopia rates in the U.S. have nearly doubled, to 42%.
• A 2018 study published by the American Academy of Ophthalmology associated near-vision activities (aka reading, screen time) with myopia.
• The same study found that time spent outdoors (and the changing focus required of the eyes) can slow the progression of nearsightedness in children.

And, though there may not be a direct link to myopia, experts agree that prolonged digital screen exposure isn’t good for kids.

• The World Health Organization just announced new guidelines suggesting no screen time for infants under 1, and no more than two hours a day for kids ages 2-4. The American Academy of Pediatrics is on record as recommending just one hour per day for kids ages 2-5.
• 9% of parents report that their kids experience the symptoms of digital eye strain and dry, irritated eyes, The Vision Council says.

Why the increased focus on myopia? In addition to the alarming rise in the rate of myopia, experts say the earlier the diagnosis, the better the chance at slowing progression.

But this relies on getting the parents involved. Early.

“[Parents] now have the ability to be proactive as opposed to just reactive,” Dr. Tran says. “Parents should understand that there are serious long-term risks associated with myopia, including retinal detachment, glaucoma, and myopic maculopathy. And they need to know that there are safe and effective strategies that can help delay the onset or progression of their child’s myopia.”

EB asked Dr. Tran and Linda Chous, O.D., owner of the child-focused Glasses Menagerie in Minneapolis and the chief eyecare officer of UnitedHealthcare, to share how they tackle the topics of digital screen use and myopia with their young patients and their parents.

“THIS VISION IS (NOT) NORMAL”

Both O.D.s agree that young patients will rarely complain of either DES or nearsightedness—either because they are unaware there is a problem or they are afraid of having their devices taken away.

It’s usually up to the ECP to start the investigation. For Dr. Chous, it means asking the right questions. “Why isn’t Johnny a reader? It may be behavioral, but we want to make sure that it’s not because he has a hard time focusing on the screen, or page, for a prolonged time,” she says.

“Eyecare providers shouldn’t just ask ‘are you having problems reading?’ They should be very specific about the problems the child might be experiencing regarding digital eye strain.”

FOCUS ON PLAY

Dr. Tran educates parents about limiting screen time and encouraging outdoor play. “Research shows that up to two hours of outside play each day may have a protective effect against the onset of myopia, even for those with high amounts of near work,” he notes.

READING BALANCE

Parents want their children to love to read, but how do they balance that with the knowledge that prolonged near vision can be dangerous? “I tell kids to get into the habit of taking a break at the end of every chapter or every 10 pages. Same for video games,” Dr. Chous says. This tactic also appeals to their desire to perform better. “I tell kids they’ll be able to read longer, or play a video game better, if they take breaks.”

LENS SOLUTIONS

Dr. Tran prefers a single-vision lens with a near boost to help reduce accommodative strain during near work, but stresses that “a spectacle lens may not offer enough protection against the onset or progression of myopia.”

Dr. Chous prefers a second-pair lens. “I might self-design a computer lens that has intermediate on the top and near at the bottom. Or I might do a single-vision lens that’s even just a half a diopter or a diopter higher than what their distance prescription is, and they can use that for computer use and for reading.”

DON’T FORGET DRY EYE

It may not just be an accommodation issue. Dr. Chous reminds ECPs to check for dry eye symptoms, as well. “Adults can have problems with dry eye and screen use, and so can kids,” she says. “That’s something that needs to be considered along with all the other things associated with childhood eye problems.”

DON’T FEAR THE REFER

You don’t need to be an ortho-k specialist to help your young myopic patients. You just have to be ready and willing to refer to someone who is.

“I would recommend that doctors do myopia management to the extent that they feel comfortable with in their practice,” says Dr. Chous. “Even if it’s just having the conversation with the parents, and then recommending someone who does myopia management.”

THE FUTURE IS NEAR

Current myopia management protocols are limited to corneal reshaping methods, atropine drops, and multifocal lenses. But there’s a host of other options currently being explored. And a new focus on myopia thinking—such as the creation of the Essilor-sponsored Myopia Task Force—is challenging ECPs to create new treatment protocols.

Drs. Tran and Chous agree that it’s very encouraging.

“[Myopia progression] is not the sentence it used to be,” Dr. Chous notes. “Now, we can tell them we might be able to slow the progression of their nearsightedness.

“We may be able to make it so they’re not sentenced to thick glasses in the future. We may make it so that in the future they may avoid myopic macular degeneration. This is awesome.”