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Digital Devices Top Children's Wish Lists — But Will They Hurt Their Eyes? Tips to Avoid Digital Eye Strain

j0316887_3181e7b0By Nathan Bonilla-Warford, VSP Provider

Children are using computers and digital devices more than ever. A recent Nielsen study shows the iPad is the number one requested item from children ages 6 through 12, followed by other portable electronic devices such as smart phones and gaming players. For older children, a computer is the most requested item. Twenty years ago, most of these electronic devices didn’t exist, and for many children, exposure to computers was limited to a weekly computer lab at school.  Today, children use computers daily at school and at home.  From desktops, to video games, iPads, e-readers, smart phones and other digital devices, the time spent in front of a screen is quite significant. A recent Kaiser Family Foundation study found that children ages 8 to 18 spend an average of 7.5 hours a day consuming electronic media.

All of this electronic usage can adversely affect the eyes and vision. VSP Vision Care, the largest not-for-profit vision insurance company, defines Computer Vision Syndrome (CVS) as “any number of eye or vision-related problems that can occur from computer use.” Symptoms include blurry vision from focusing difficulties, dryness and irritation of the eyes, headaches due to eyestrain, and even neck and back pain from adopting bad posture to better see the computer screen. Although often directly related to the use of a computer, sometimes these symptoms reveal deeper vision and eye health problems.

While some believe CVS is an adult problem, resulting from long days at the office, medical professionals need to keep in mind that children can also suffer from CVS and they should help kids build good habits when using a computer on a daily basis.

Many effects of computer use on vision are short-term. In general, the eyes function best when looking at something in the distance, like a house or a tree on the horizon, when there is no accommodative demand. When the eyes look at something close-up, they accommodate to change focus and converge to maintain alignment position, and this takes a small amount of effort. However, over time, this effort adds up, potentially leading to blurry vision, asthenopia (eye strain) or frontal headaches. Also, when at the computer – especially if looking up towards the screen – the eyes blink less and tend to dry out, causing blurriness, burning and discomfort. Unfortunately, these symptoms usually continue once computer use stops.

It’s important to make sure that parents observe their children when using a computer or a handheld game. Additionally, make sure to ask your patients if they’re experiencing any symptoms. Children will generally not complain about vision problems for several reasons. First, children are not as self-aware as adults, especially if they’re engaged in an activity they enjoy. Second, even if a child is aware of discomfort or other symptoms, he or she may think it’s normal. Finally, some children may be afraid that if they mention CVS symptoms, time on the computer or handheld game will be limited.

Using computers may also have long-term effects for growing children. While the long-held suspicion that computer monitors emit radiation that could be harmful to the eyes is false, there are other concerns regarding prolonged computer use.  For example, there is currently debate and research regarding eyestrain due to computer use.  Some believe that it could lead to the development of near-sightedness, also called myopia. In the last thirty years, the prevalence of myopia in the United States has increased to 66 percent. While older studies suggested that close reading and computer use have been thought to promote the development of myopia, recent studies show computers and reading don’t play a significant role. However, clinical studies are still needed on the use of handheld games.

Here are some preventive recommendations that can be made for any child to help prevent vision problems from electronic devise usage:

Watch the time
While there are educational benefits to some electronic entertainment, judicious exposure is best for small children. The American Academy of Pediatrics recommends that kids under two years old not watch any television and that those older than two watch no more than 1 to 2 hours a day of quality programming. This is a good recommendation for any electronic device, including smart phones, tablets, video games and computers. Because children will not keep track of this, parents must set clear limits in advance and monitor the time.

For older kids, to avoid fatigue and short-term CVS symptoms, consistent breaks are important. As with adults, the “20/20/20 Rule” is a good reminder. Every 20 minutes, stop and look at something 20 feet away for at least 20 seconds.

Eye and vision exams

It’s important that a child has the best vision possible when using the computer, playing video games or reading. This starts with a comprehensive eye and vision evaluation that includes dilation of the pupil. The American Optometric Association recommends the first exam takes place between the age of six and twelve months, followed by exams at age three and before kindergarten and every year after that. Because every child is different, encourage parents to discuss the amount of computer use with the doctor, who will determine if there are any eye or vision problems contributing to CVS symptoms or learning difficulties. If the doctor prescribes glasses, parents should ask specifically if they should be used at the computer or not.

Make the computer desk “kid-sized”

Most children use computers that are setup for adults, resulting in poor posture. Because kids are smaller, they often have to crane their necks and look up at the screen. This may lead to dry eyes, blurry vision and neck discomfort. Recommend that parents have their child sit at a small desk with a chair with good back support. The next best thing is to get a chair with adjustable height.

Working distance

The closer the eyes are to the object they’re looking at, the more the eyes have to accommodate. Children who get very close to the screen are more likely to experience CVS symptoms. This is especially true for hand-held games with very small screens. A good rule is to apply the Harmon Distance (the distance between the elbow and first knuckle) as a guide. If a child holds video games or books closer than their Harmon Distance, it could signal a vision problem.

Get them outside!
Kids are active, and it’s good to get them out of the house for a while. Not only does outdoor play feel good and promote social interaction, creativity and imagination, but there’s research that outdoor play helps prevent the development of nearsightedness. It’s not yet known if this is due to reduced time doing near-work, increased exercise time while outside, or simply the sunlight itself. Sunglasses and sunscreen are recommended to reduce exposure to UV light.

Undoubtedly, computers benefit us in many ways and there’s a place for computers in the lives of children.  Fortunately, with awareness and preventive steps vision problems and symptoms from computer and electronic devise usage can often be reduced or eliminated.

Nathan Bonilla-Warford, OD, FAAO completed his residency in Pediatric and Binocular Vision at Illinois College of Optometry. He is in private practice in Tampa, FL and can be reached at

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