What does increased screen time mean for children and teens?

From distance learning to virtual social gatherings, many people have increased their screen time during COVID-19. For families, this has raised new concerns around their children’s vision. How much screen time is too much? Can increased use of smart phones, video game platforms, and computers actually affect children’s eye health?

We asked two optometrists at M Health Fairview Lions Children’s Eye Clinic and an M Health Fairview child and adolescent psychiatrist about potential issues related to increased screen time, what problems families should look for, and when to consider having your child come in for an eye exam.

Blue light exposure and screen location

Optometrists are often asked about the effect of blue light. Emitted from screens – but also from the sun and certain lightbulbs – blue light has the shortest wave length and highest energy of the visible light spectrum. The primary claims about blue light are that it can affect sleep, cause eye strain, and can damage the eyes, according to M Health Fairview Optometrist Andrew Ritter, OD, FAAO.

“There have been no large-scale studies supporting the claim that blue light causes actual damage to the eye. The impact on sleep is the best studied of those three claims,” Ritter said. “If you’re viewing screens late into the evening, it stimulates your brain and keeps you awake.”

To reduce the impact of blue light exposure on sleep, Ritter recommends stopping screen use before bedtime and downloading apps that dim the screen or change the light balance of your computer or phone. These solutions block more blue light than special blue-light glasses, another common approach.

But the primary cause of eye strain related to screen time is not blue light, Ritter said. Instead, it is screen proximity, or how close a screen is to a person’s face. Focusing on nearby objects for a long period of time can cause eye strain, which is when your eyes tire from overuse. It can also often lead to headaches. 

“When we’re focusing on anything up close, our eyes have to converge – or point together – and focus. We’re flexing all those muscles in our eyes and we end up straining them,” said Ritter. “You could do the same thing if you were working intensely on a puzzle during the pandemic.”

A possible link to nearsightedness

Early evidence suggests that increased screen time may be linked to myopia, or nearsightedness. Screen proximity, rather than blue light exposure, is likely the main factor here, according to M Health Fairview Optometrist Meredith Stallone, OD, MS. This link can be especially concerning for children, as nearsightedness progresses faster in them than in adults.

“As a child grows, their eyes grow larger. Once a child develops myopia, we expect it to progress somewhat over time because of this normal growth pattern,” Stallone said. “However, there is some early evidence that increased screen time may exacerbate this myopic progression beyond what is expected.”

Nearsightedness can also be associated with other eye problems as people age. These include cataracts and retinal detachments.

M Health Fairview has one of the largest pediatric ophthalmology programs in the country, and our specialists can help families navigate everything from dry eye to glaucoma. Learn more.

How to practice proper screen hygiene

Because screen proximity over extended periods of time can cause eye strain and other issues, our experts recommend taking regular breaks. Stallone encouraged families to teach their children the “20-20-20 Rule.”

“Every 20 minutes take a 20-second break and look at something 20 feet in the distance,” she said. “You also want to make sure children are sitting with proper posture and that there’s good lighting in the room. The background lighting should be about equal to the screen brightness.”

“Natural lighting may also be effective in delaying the onset of nearsightedness. Consider setting up your child’s desk in a room where they can get natural light, and take breaks outside as a family,” said Stallone, adding that it’s important to wear sunglasses while outdoors. 

Stallone also encouraged families to think about the quality of their children’s screen time. Educational use of computers or video visits with family members can be helpful or necessary. But parents should consider reducing the number of hours kids use screens for entertainment. She encouraged families to follow screen time guidelines set by the American Academy of Pediatrics – including no screen use other than video chatting for infants under 18 months, with time limits increasing slowly with age.

Impact on mental health

Too much screen time can take a physical and emotional toll on children and teens in other ways – including poor sleep. Jessica Cici, MD, medical director of child and adolescent psychiatry with M Health Fairview, recommends establishing house rules such as no phone use overnight or no screen time one hour before bedtime.

“We want to balance screen time, which can be a great way to connect with friends and family,” she said. “But kids also need to have in-person activities, like arts, music, and physical activity. These activities help kids socially, as well as reduce depression and anxiety.”

Stallone agrees on the importance of physical activity and getting outdoors – both for mental and physical health.

When should you come in for an eye exam?

Children may have a hard time communicating an eye or vision problem, but there are certain signs of eye strain or nearsightedness that families can look out for:

• Holding objects very close to the face, or standing close to the television
• Squinting
• Rubbing eyes
• Watery eyes
• Headaches

If a child seems to have a hard time seeing things that are far away, or is experiencing any other ongoing vision impairments, Stallone recommends bringing them in to an optometrist for a comprehensive exam.

“We look at each eye to make sure they’re both seeing well. Reduced vision often goes unnoticed in children if they have one eye that sees well,” she said. “We also dilate the pupils, so that we can examine the retina and optic nerve. When we dilate the eyes, we’re able to get the most accurate prescription if a child needs glasses.”

For children showing symptoms of eye strain like watery or red eyes, optometrists can also work with families to determine if artificial tears could help.