Pediatric eye health and digital media: adverse effects

Pediatric eye health is important in all aspects of a child’s life and development. Not simply represented by clarity, vision is a functional system that—when functioning at its best—is flexible and efficient.

Vision is a primary sensory input that affects a child’s learning, development, behavior, and resilience, and is biologically ill-suited to the overwhelming demands of the digital culture in which children find themselves.

Today’s families face the challenges of managing an onslaught of digital media in their lives. Digital media includes a child’s interface with television content, mobile phones, tablets, computers, etc.

Digital media devices and the technology they provide have many benefits, including expanding communication tools, easy and immediate access to information, and the ability to accommodate both our children’s strengths and challenges.

As with all things, the benefits of technology are countered by risks.

Current exposure to digital media has a profound impact on children. We have never had a generation of babies and toddlers with such heightened visual demands and sensory stimulation caused by the cell phones and tablets they interact with every day.

The excessive near demands experienced by children of all ages creates a visual system that is fatigued and unable to function efficiently.

Common Sense Media Research reported in 2021 that entertainment media use alone approached 9 hours per day among teenagers and 6 hours per day among young children.¹ For both adults and teens, screen media use has increased by 17% since the start of the pandemic.¹ These statistics are shocking and often leave parents feeling helpless and out of control when dealing with their children’s screen time habits.

Excessive use of digital media has also been shown to put children at risk of addiction. Device addiction, social media addiction, and gaming addiction are very real and serious consequences seen in the pediatric population.

In 2018, the World Health Organization added a gaming disorder to the International Classification of Diseases.² MRI studies reveal that gaming and smartphone addictions change the physical structure of the brain in a way that parallels drug and gambling addictions.

Related: (VIDEO) Negative effects of digital media on children’s development

The effect of screen time on visual efficiency

As optometrists, we know that the power of the accommodative (focusing) system depends on age. Excessive use of this system without proper visual hygiene weakens the strength and durability of accommodation.

Today’s optometric practices diagnose many patients with accommodative insufficiency due to a world driven by excessive digital demands. These excessive near demands reveal significantly reduced accommodative clinical findings, including visual acuity that is reduced and variable and the detection of low amounts of anti-rule astigmatism.

Recognizing these clinical findings—in addition to the asthenopia, headaches, and fatigue that accompany accommodative issues—are critical to the appropriate management of our patients.

In addition to the accommodative system, we see a natural stress being placed on the binocular vision system. The development of binocular vision begins in the brain, and there are valid neurological concerns that screen-based activity stimulates visual processing more than even sensory processing systems—thereby interrupting the development of binocular vision.

In our practices, we see binocular vision dysfunction in the form of convergence excess and convergence insufficiency, which are affected by the excessive screen time of today’s youth.

A close viewing distance when viewing digital devices also affects the onset of visual symptoms.

Clinical studies show that the near vision distance that often accompanies the use of digital handheld devices becomes even closer with prolonged use.³ A major chief complaint of parents who bring young children in for an eye exam is observing how close the child sees a cell phone or tablet.

The closer the viewing distance—associated with overuse—the more likely increases in diagnoses of accommodative and binocular vision problems, as well as the visual symptoms that accompany them.

There are several treatment options available for accommodative and binocular vision problems. Reading glasses and bifocals are prescribed to support the visual systems and aim to reduce the patient’s visual symptoms. Vision therapy is another treatment option for accommodative and binocular vision issues that aims to improve the efficiency of all aspects of visual function.

It is known that the progression of myopia is influenced by genetic and environmental factors, but digital media also affects the progression of myopia development.

Today’s emphasis on treating myopia—with the goal of minimizing progression—forces an optometrist to examine the screen-time habits of our patients. We know that there are modifiable behaviors that influence the development of myopia.

Scientific research shows that increased exposure to nature has a positive effect on the development of myopia.⁴ The exact cause of this is not fully understood, but time in nature likely contributes to a near limit of demands and will have a more positive impact on the visual system.

In January 2021 JAMA The article shares, “Protection at home due to the coronavirus disease [in] 2019 appeared to be associated with a significant myopic change in children.”⁵ This observation shows the effect of excessive screen time on the development of myopia.

The effect of screen time on child development

Beyond the impact on a child’s visual system, digital media also has a significant impact on the overall development of our pediatric population.

We know that early exposure to digital media negatively affects a child’s intellectual, social and emotional development. The increased use of digital media results more specifically in the reduction of cognitive and language skills. Further, the way children use digital media has a strong correlation with their mental health.

Sleep quality

One area to examine is the impact of technology on sleep quality in young people.

IN Journal of Clinical Sleep Medicineobserved that “adolescents’ poor sleep quality was consistently associated with cell phone use and the number of devices in the bedroom, while in preadolescents it was associated with Internet use and time off.”⁶

Children and adolescents with devices in the bedroom experience decreased sleep duration, increased daytime sleepiness, and decreased academic performance. Poor sleep habits are associated with additional mental health issues.

Unhealthy online habits result in high incidences of anxiety, depression and hyperactivity diagnoses. Structural changes in the brain related to cognitive control and emotional regulation are linked to an addiction to digital media.⁷ Neurological changes observed with digital media addictions correlate clinically with patterns of substance-behavioral addiction.

The path of excessive and unhealthy use of digital media can lead to mental health challenges and addictions in our teenage population. This is a path every family wants to avoid.

Setting boundaries

The best way to achieve balance in one’s family regarding digital media use is to develop rules and boundaries. Each family can try to create a system that works for them.

The use of digital media can be classified into three categories, known as the “3 C’s of media”:

1. Consumption: receiving media passively
2. Creation: active engagement and skill development
3. Communication: using media to connect with another person

A well-balanced approach to digital media limits consumption and communication to 1-2 hours per day. However, it is understood that schools rely heavily on digital devices in their educational model, and this contributes to the stress on the visual system and the impact on development.

Parents should focus on what they can control and create a home environment that supports the benefits of technology and balances screen time in a way that has a positive effect on all aspects of their child’s life.

As Catherine Steiner-Adair, EdD, author of The great disconnect, says: “Parenting in the digital age challenges the ways the human brain—AND heart—can hardly process fast enough. We don’t want to give in without a doubt to adapt to technology.”

Valerie M. Kattouf, OD, FAAO, is an associate professor at the Illinois College of Optometry, where she teaches in the classroom and clinic, works with residents, and conducts clinical research. After graduating from the Illinois College of Optometry, Kattouf completed a residency in Pediatrics and Binocular Vision at the State University of New York Optometric Center. She has years of clinical experience in the areas of infant and toddler vision care, strabismus and amblyopia, concussion, and adult binocular vision disorders. Kattouf is currently the chief of the Lewenson Pediatrics and Binocular Vision Center at the Illinois Eye Institute. She is a member of the American Academy of Optometry and the College of Optometrists in Visual Development, lecturing nationally and internationally. She can be reached at: [email protected] or (312) 949-7279.

References

1. Two years after the pandemic, media use has increased by 17% among young people and teenagers. Common sense media. March 23, 2022. Accessed August 12, 2022. https://www.commonsensemedia.org/press-releases/two-years-into-the-pandemic-media-use-has-increased-17-among-tweens-and – teens

2. Inclusion of “gaming disorder” in ICD-11. World Health Organization. September 14, 2018. Accessed August 12, 2022. https://www.who.int/news/item/14-09-2018-inclusion-of-gaming-disorder-in-icd-11

3. Long J, Cheung R, Duong S, Paynter R, Asper L. Viewing distance and eyestrain symptoms with prolonged smartphone viewing. Clin Exp Optom. 2017; 100 (2): 133-137. doi:10.1111/cxo.12453

4. Lingham G, Mackey DA, Lucas R, Yazar S. How does spending time outdoors protect against myopia? A review. Br J Ophthalmol. 2020; 104 (5): 593-599. doi:10.1136/bjophthalmol-2019-314675

5. Wang J, Li Y, Musch DC, et al. Progression of myopia in school-aged children following COVID-19 home confinement. JAMA Ophthalmol. 2021; 139 (3): 293-300. doi:10.1001/jamaophthalmol.2020.6239

6. Bruni O, Sette S, Fontanesi L, Baiocco R, Laghi F, Baumgartner E. Technology use and sleep quality in preadolescence and adolescence. J Clin Sleep Med. 2015; 11 (12): 1433-1441. Published 2015 Dec 15. doi:10.5664/jcsm.5282

7. Lissak G. Adverse physiological and psychological effects of screen time in children and adolescents: Literature review and case study. Environ Res. 2018; 164: 149-157. doi:10.1016/j.envres.2018.01.015