Eye doctors are often the first healthcare professionals to detect systemic conditions which can include diabetes and even some cancers. Perhaps just as important is the fact that your child could have impaired vision and have no idea. It’s common for children to have undiagnosed vision problems because they don’t know enough to speak up when something isn’t quite right. If they have had impaired vision since birth, they would have no frame of reference to know what “normal” is. Even if their vision deteriorated over time, they have a shorter timespan for comparison.

Don’t wait! Schedule your child’s comprehensive vision exam with an optometrist in your area! 

Woman working on a laptop in a darkened room, experiencing a headache.

The closer a person holds a book, phone, or laptop, the harder their eyes have to work to keep that item comfortably clear. As an object is brought closer to the face, accommodation, or focusing, has to increase to keep the image clear (like changing focus on your phone’s camera).  In children, the amplitude (amount of focusing power), sustainability (ability to stay focused on something for a period of time comfortably), and facility (ability to quickly change focus between different distances) should be high. With overuse and with age, the lens has a reduction of both the focusing power and flexibility. Sustaining close viewing distances becomes uncomfortable, which is why many individuals need to wear reading glasses when they get older or have an accommodative dysfunction.

Also, when looking at an object far away, the eyes are parallel to each other. When an object comes closer, the eyes have to converge (cross in) to keep that image single. If the eyes have a problem turning in as a team (eye teaming) and do not both point at an object at the same time, the object will appear double and you will see two of something when it should be one.

Millions of Americans suffer from computer vision syndrome or digital eye strain and it has been magnified with recent events. Symptoms of computer vision syndrome are directly related to spending prolonged hours looking at screens of all kinds and include eye irritation, redness, dry eye, blurry vision, double vision, back pain, neck stiffness, eyestrain, and headaches.  

With many children attending school through their devices and parents working on their computers from home, visual hygiene is more important than ever. If your eye doctor has prescribed reading glasses, make sure you use them while doing near work, as this could help with both your eye teaming and your eye focusing. If you or your child have not seen an eye doctor in the past year, make sure you make an appointment right away to get evaluated, especially if you are having any visual discomfort.

Here is a list of things parents and children can do to decrease eye strain and discomfort while spending the day at school or at working from home: 

Keep your distance
Reading material should be no closer than the distance between the center of your middle knuckle to your elbow. This distance is even further when working on something larger such as a computer screen. The closer something is held, the harder your focusing system and your eye teaming system have to work, which can lead to eyestrain, headache, blurry vision, discomfort, double vision, and inability to optimally concentrate on and understand your work. 

Be aware of your surroundings
Many people zone in on the computer screen or tablet and become too concentrated on what is going on directly in front of them (tunnel vision), which can contribute to visual discomfort after some time. To help improve peripheral awareness, you can place stickers on the top, bottom, right, and left of your screen and try to be aware of them at all times while doing your work. If the screen is so large that you can not see the sides when looking straight ahead, that probably means the screen is too big and you will have to move your head side to side to read or look at things from one side of the screen to the other – which can cause discomfort. 

Good posture
Make sure that both feet are touching the floor, your back is touching and supported by a back rest, the top of your screen is slightly below eye level, and the table and chair height is adjusted so your legs are bent in a 90 degree angle with your forearms parallel to the floor. If a child’s feet do not touch the floor, a small pad or step stool can be placed to allow them to rest their legs instead of having them dangel. If the chair is too deep to offer back support, a pillow can be placed between the child’s back and backrest so the child is able to rest their back on the pillow for support. Also make sure that the shoulders are relaxed and not rolled up toward the head. 

Give your eyes a break
Your eyes need a break from focusing, teaming, and taking in information. A general rule to follow is the 20-20-20 rule. Take a 20 second visual break by looking at least 20 feet away, every 20 minutes. There are a great variety of 20 minute timers on the internet or a simple timer on your phone can be set. If you are not on a device, placing a bookmark one chapter (or several pages) ahead can help be a reminder for you to take a break. For some people, being distracted every 20 minutes is just simply…too distracting! So, setting a 30 minute timer is another option. The key is to look at something far away to give your focusing and eye teaming a break. Try to incorporate movement into this break to give by body a rest as well as your eyes. Simple, quick stretching exercises for your neck, back, arms, and legs can be a great addition. Keep in mind, going from looking at a computer screen to a phone (or visa versa) is not a visual break. 

Keep hydrated and Blink
When people concentrate on something visual, they blink less. Blinking is how we keep our eyes moisturised and not blinking enough leads to a dry and irritated feeling and red appearance to the eyes. Staying hydrated by keeping a closed water bottle next to your work station and making a conscious effort to blink are key. To kill two birds with one stone, you can make one of the peripheral awareness stickers on your screen a written reminder to hydrate and blink. Some people may experience more dryness and irritation on the computer with their contact lenses, they should speak with their eye doctor about contacts that provide more moisture to the eye or consider toggling between glasses and contacts. 

Illumination
The room should be neither too dark nor too bright. Natural and even lighting is best. When reading or working on paper, the illumination on the reading material should be about 3x that of the surrounding background and should not produce any glare. This can be achieved by using a gooseneck lamp with an incandescent bulb such as a 60 watt bulb. Using two lamps on either side of the reading material can help eliminate shadows. 

Tilted work surface
For computer screens, the very top of the screen should be slightly below eye level and tilted slightly away from you. For writing and text reading, a 20-25 degree sloping surface (such as a slant desk) should be used. This reduces tension and stress on the eyes, head, shoulders, and back. Remember that the writing / text material should be at least the distance from your knuckle to your elbow away, and further for computer screens. 

Blue light
Ultraviolet (UV) and short wavelength light from the sun is at a significantly much higher concentration than anything you can get from a computer screen. Blue light does interact with, and suppress, melatonin which in turn can interfere with our circadian sleep cycles. There is no clear cut evidence showing blue blocking lenses have any benefit but there anecdotal accounts of patients using blue blocking lenses and feeling less stress and strain on the eyes, especially when on their electronics. Before investing in a pair, you might want to try not stimulating your brain with light 1-2 hours before sleep and also decreasing the amount of blue on your screen (which in effect will do the same as the glasses). This can be done by putting your electronics into ‘night mode’ or decreasing the amount of blue your screen emits. If you’re not sure how to do that, just google it, or download one of a vast variety of free apps available for smartphones, tablets, and computers to do just that. It’s important to note that ‘computer glasses’ are not the same as ‘blue blocking glasses’, an eye doctor may prescribe ‘computer glasses’ specifically for a closer viewing distance to help prevent eye focusing and teaming problems. 

Other tips:
Increasing the magnification on the screen so that text is 110-120% larger can help reduce squinting. Keep the working environment as clean and clear of visual clutter as possible. If you do have children at home, make sure that you are modeling proper visual hygiene behavior for them as they will take their cues from watching you. 

Young Girl Sitting At Desk In Bedroom Using Laptop To Do Homework

In the not so distant past, the American Pediatric Association’s recommendation was that kids spend no more than two hours a day on digital devices. As we send our kids back to school for the 2020-2021 academic year, there is a lot of uncertainty as to the nature of the school day. Clearly whether classes are in person, zoomed, or more likely, a hybrid of both, the odds of being able to limit screen time to under two hours is roughly about zero. This unscientific yet probable statistic is one that has parents worried about potential damage to the visual system of a child whose day is spent predominantly sitting inside, staring at a screen.

What symptoms should parents look for that indicate problems related to excessive computer use, and what steps can families take in order not only to alleviate these problems but to prevent them from occurring at all? 

First let’s talk about some of the symptoms:

1. Pain is the most overt sign signalling that the body is under stress. Headaches that are located frontally and between the eyes are usually vision related while those located at the back of the head, and especially when associated with neck pain, are related to poor posture and suboptimal ergonomics in the child’s workspace. 
2. Another obvious sign of ocular stress is blurred vision. There are a few ways that blurry vision can manifest during the school day:
   • The first is blurred vision that is constant – your child complains that he/she is having trouble seeing from the second they open their chromebook in the morning. This kind of blurring could indicate that your child needs glasses secondary to an uncorrected refractive error such as myopia (nearsightedness), hyperopia (farsightedness) or astigmatism (abnormalities in the eye’s curvature). 
   • If the blurring is intermittent and goes away when your child blinks it could be a sign of dry eye (more on this later). 
   • If your child describes the blurriness as vision that goes in and out of focus or vision that gets blurry at the end of the day this would indicate issues with your child’s binocularity and focusing skills. 
3. Red, itchy, irritated eyes are signs of dry eye disease. Studies have shown that computer use decreases the blink rate which causes the tear film to evaporate and create the dry eye scenario. 
4. A less intuitive symptom of excess computer time is sleep disruption. Light, specifically in this instance blue light, interferes with the production of melatonin which is necessary for good sleep patterns. If your child is using a computer game or social media to relax before bedtime the light emitted from the device can disrupt the natural release of melatonin. 

What can we do to mitigate or even prevent these things from happening to our children’s eyes?

The first step to ensure that your family has a great school year is to make sure your child has a comprehensive eye exam. Your eye doctor will make sure that your child does not need glasses and will further test him/her for abnormalities in binocularity and accommodation. Glasses with an anti reflective coating will be prescribed as needed and vision therapy will be discussed if your child is found to have deficits in the ability of their eyes to work properly together. Evaluation of eye health will determine whether your child has dry eye or is at risk for dry eye due to medications or underlying systemic disease and will prescribe treatment if needed. 

The ergonomics of your child’s workspace are crucial in preventing eye strain and pain as well as musculoskeletal issues related to poor posture. Desktop and larger laptop computer screens should be positioned 20-28” away from their eyes and slightly below eye level by about 4” – never above eye level. Most children will not use a small device for school, but as an aside, small devices should be held 13-20” away. The chair should be comfortable and adjustable with your child’s feet flat on the floor and arms slightly bent and never tilted upwards. 

Introduce your child to the 20-20-20 rule. Every twenty minutes, look at something twenty feet away, for twenty seconds. This helps break focusing at the near point which can contribute to the development of myopia as well as to all of the other symptoms discussed above. Even better than just looking up is actually having your child get up out of the chair and move around, stretching the head and neck, as well as doing some blinking exercises to promote spreading tears on the eyes surface and providing much needed lubrication. 

It’s important to match the brightness of the screen to the ambient brightness of the room. Don’t use a light screen in a darkened room and vice versa because this creates glare and discomfort. Make sure if your child wears glasses there is an anti-reflective coating on them and non glasses wearers can utilize commercially available glare screens for protection. 

Remind your kids to blink while they are on the computer to prevent dry eye caused by evaporation of tears. If you child is experiencing dry eye, use a high quality artificial tear recommended by your eye doctor 3-4x a day. Make sure the workspace is not directly in front of a fan or air conditioner which can further dry out the tear surface. Staying well hydrated during the day is important for overall good health as well as to promote adequate tears, and drinking more will also ensure more bathroom breaks which will allow your child to break visual focus and stretch their muscles. 

It’s important to decrease blue light before bedtime. Blue light is a topic that deserves more than a short paragraph, but in a nutshell, kids should be off their devices 90 minutes before bedtime so that melatonin levels (as discussed above) can reach the proper levels to ensure good sleep. Many devices have a program built into the software that automatically decreases the amount of blue light, and certainly children can wear glasses with blue light blockers, but as a parent myself, it’s extremely important to promote alternate methods of bedtime relaxation that don’t include digital devices. 

Maybe the more impactful message is: think about a life without your vision. Loss of good vision would change your day-to-day from the moment your feet hit the floor in the morning to the moment you closed your eyes at night. You couldn’t get from place to place with the ease you do now, you wouldn’t watch Netflix the way you do now, and Instagram wouldn’t have anywhere the same appeal if you couldn’t see what you were scrolling through.

And then there’s the big stuff. Think about not actually seeing your loved ones, your kids. Think about only being able to explore nature using the remaining senses and never actually seeing it for yourself. Imagine the changes you would have to make in your career and the new challenges you would have to overcome.

While this is a reality for some, think about the steps you could take to prevent it from ever becoming your own. You can act now to protect your eyes as well as your children’s by simply seeing an optometrist annually. 

Get a behind-the-scenes look at the health of your eyes and visual system;
Find out if your vision has changed over time and address it if it has;
Make sure your kids are seeing well to ensure they are able to learn effectively while in school;
Tackle any issues with dry, itchy, or water eyes; ask about floaters; inquire about headaches or other issues;
Get in the habit of seeing your eye doctor regularly, and make sure your kids do, too!

As we begin Save Your Vision Month here are some facts for parents to consider:

Dr. Kathleen Kinzley and Dr. Yujie Chang talk with Boy Scouts and their parents about eye and vision health.

In late 2019 it was announced that the Vision Awareness Badge, which has been popular among Girl Scouts, is now available to Boy Scouts as well.

To promote its widened availability, the New Jersey Society of Optometric Physicians and the New York State Optometric Association partnered with Liberty Science Center at their Boy Scout Event.

Drs. Maria and Harvey Richman, Dr. Kathleen Kinzley, Dr. Yujie Chang, Dr. Saysha Blazier, Dr. Tamara Petrosyan, Dr. Talia Mishkin, and Dr. Nimrah Malik met with Boy Scouts to discuss eye and vision health, the importance of an annual, comprehensive eye exam with an optometrist, and how to earn the Vision Awareness Badge.

To find an optometric physician in your area who offers the badge, use our doctor locator (New Jersey only) here. Check out additional photos from the Liberty Science Center Boy Scout event and other Vision Awareness Badge events on our Facebook page, here!