By Anne Tobyne, OD
Digital device use, from tablets to smart phones, is pervasive in today’s society and plays a routine part of daily life for most individuals. This includes children, many of whom log regular screen time hours to play, learn, and connect, with faces pressed close to their screens.1,2
Numerous studies have reported the connection between the development and progression of childhood myopia and digital device use.2-5 This is an area that came into laser focus during the pandemic when children learned remotely during lockdown and spent more time in front of screens and less time outdoors. 2,3
One example: Xu et al. found children aged 6 to 8 years old in Hong Kong decreased their outdoor time from 1.3 to 0.4 hours per day during the pandemic while screen time increased from 2.5 hours to about 7 hours per day.4,5
Mirrored Findings Across the Globe
Researchers from across the world continue to build on the link between digital device use and the onset of juvenile myopia. A study of roughly 700 schoolchildren aged 6 to 7 in Ireland found at least 2 hours of screen time a day was associated with more myopic refraction, greater axial length, and increased odds of myopia (worse than or equal to –0.50 diopters) and premyopia (not enough hyperopia for their age).6
Another investigation in Spain enrolled approximately 7,500 children who were part of the “Annual School Campaign for Children’s Vision Health.” The research team discovered children with myopia were more likely to spend excessive time on screens and less time engaged in outdoor activities compared to children in the study without myopia.7
A recent paper in Lancet Digital Health provides some additional insight. The research team conducted a systematic review and meta-analysis that looked into smart device exposure and myopia in children and young adults. The investigators found smart device screen time alone or combined with computer use had a significant association to myopia.8
While we know that prolonged near work is associated with increased risk of myopia,9 we also know that children hold and view their mobile devices closer to their eyes than adults.10
Big Tech Joins the Fight Against Childhood Myopia
In June of 2023, Apple announced a new development that would be built into their technologies to help decrease the risk of myopia in kids viewing Apple devices.11
As part of the rollout, new health features on the iPhone, iPad, and Apple Watch encourage healthy behaviors aimed to help reduce myopia. Apple Watch can now measure time spent in daylight through an ambient light sensor. Additionally, the new screen distance feature on iPhones and iPads encourages users to move their device farther away after holding it closer than 12 inches for an extended period.
Digital Eye Strain and Dry Eye Syndrome Prevalence in Children
Research has also explored whether digital device use can impact children’s vision and ocular health beyond myopia. An investigation in India surveyed 217 parents of children attending online classes during the COVID-19 pandemic. Slightly more than half (109) of the children represented in the study had digital eye strain, with about 11% of cases reported as severe. 12
In addition to digital eye strain, digital device use has also been tied to the development of dry eye in children.13
Stay Vigilant and Educate on Risk Factors
A new report from CooperVision found digital device use has only accelerated since COVID.14 This only reinforces that digital device use is yet another risk factor we need to discuss with parents and their children in the exam room.
It’s key to continually educate patients and their families about myopia progression and prescribe treatments backed with sound science. Suggesting parents monitor their children’s screen time and encourage outdoor play is exceedingly important. However, asking parents to model that behavior for their children can be a more difficult ask. But it’s an important topic to discuss. After all, there’s a whole world beyond screens for everyone to explore.
Dr. Tobyne, a Change Agent in The Myopia Collective, grew up in Burnsville, Minnesota and completed her undergraduate studies at Marquette University. She received her doctorate in Optometry from the Illinois College of Optometry. She has a passion for helping the underserved population with vision care and has helped to open a sustainable vision center in Rwanda. Other mission trips include Thailand and Morocco. She is a member of the American Optometric Association and enjoys fitting specialty contact lenses for patients with keratoconus and corneal disease.
