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.