Pediatric eye health and digital media: negative effects

Research on excessive digital media usage finds pediatric vision suffers negative 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 operating at its best— is both flexible and efficient.

Vision is a primary sensory input that influences a child’s learning, development, demeanor, and stamina, and is biologically unsuited for the excessive near demands of the digital culture children find themselves in.

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

Digital media devices and the technology they deliver have many benefits, including the expansion of 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 counteracted by risks.

The current exposure to digital media has a profound effect on children. We have never had a generation of infants and toddlers with such increased near visual demands and sensory stimulation brought on by the cell phones and tablets that they interact with daily.

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

Common Sense Media Research reported in 2021 that use of entertainment media alone approached 9 hours daily in teenagers and 6 hours daily in tweens.1 For both tweens and teens, screen media use increased 17% since the start of the pandemic.1 These statistics are staggering and often lead to parents feeling helpless and out of control when addressing screen time habits and their children.

Excessive digital media use has also proven to risk addiction in children. Addiction to device use, addiction to social media, and addiction to gaming are very real and serious consequences that are noted 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 smart phone addictions change the physical structure of the brain in a manner that parallels drug and gambling additions.

Related: (VIDEO) The negative effects of digital media on pediatric development

Screen time effect on visual efficiency

As optometrists, we know that the power of the accommodative (focusing) system is age dependent. Excess use of this system without the proper visual hygiene wears down the strength and stamina 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 against the rule astigmatism.

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

In addition to the accommodative system, we see an inherent stress put on the binocular vision system. Binocular vision development begins in the brain, and there are valid neurologic concerns that screen-based activity stimulates visual processing more heavily than even the sensory processing systems—thus interrupting the development of binocular vision.

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

A close viewing distance when looking at digital devices also influences the onslaught of visual symptoms.

Clinical studies reveal that the close viewing distance often accompanying the use of handheld digital devices becomes even closer with prolonged use.3 A primary chief complaint of parents bringing young children in for an eye exam is the observation of how close the child views a cell phone or tablet.

The closer the viewing distance—accompanied with excess usage—the more likely an increase in diagnoses of accommodative and binocular vision issues, and the visual symptoms that accompany them.

There are several treatment options available for accommodative and binocular vision issues. Reading glasses and bifocals are prescribed to support the visual systems and aim to decrease the patient’s visual symptoms. Vision therapy is another treatment option for accommodative and binocular vision issues, aimed at improving the efficiency of all aspects of visual function.

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

Today’s emphasis on the treatment of myopia—with a 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 demonstrates that increased outdoor exposure positively influences the development of myopia.4 The exact cause of this is not fully understood, but outdoor time likely contributes to a limit of near demands and will have a more positive impact on the visual system.

A January 2021 JAMA article shares, “Home confinement due to coronavirus disease [in] 2019 appeared to be associated with a substantial myopic shift in children.”5 This observation demonstrates the effect of excessive screen time on the development of myopia.

Screen time effect on child development

Beyond influencing 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. Elevated digital media use more specifically results in decreased cognition and language skills. Further, the way children use digital media has a strong correlation with their mental health.

Quality of sleep

An area to examine is the influence of technology on the quality of sleep among the youth.

In the Journal of Clinical Sleep Medicine, it was noted that “Adolescents' bad sleep quality was consistently associated with the mobile phone use and number of devices in the bedroom, while in preadolescents, with Internet use and turning-off time.”6

Children and teens with devices in the bedroom experience decreased sleep duration, increased daytime drowsiness, and decreased academic performance. Poor sleep habits align with additional issues in the realm of mental health.

Unhealthy online habits result in elevated incidences of anxiety, depression, and hyperactivity diagnoses. Structural changes in the brain related to cognitive control and emotional regulation are associated with a digital media addiction.7 Neurologic changes noted with digital media addictions correlate clinically with the patterns of substance behavior dependence.

The path of excessive and unhealthy digital media use may lead to mental health challenges and addiction in our adolescent population. This is a path that 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 strive to create a system that works for them.

Digital media use can be classified in three categories, known as the the “3 Cs of media”:

1. Consumption: taking in media in a passive manner
2. Creation: active engagement and development of skills
3. Communication: using media to connect to another person

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

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

As Catherine Steiner-Adair, EdD, author of The Big Disconnect, says: “Parenting in the digital age challenges in ways the human brain—AND heart —can hardly process fast enough. We do not want to surrender ourselves unquestioningly 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. Upon graduation 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 chief of the Lewenson Pediatrics and Binocular Vision Center at the Illinois Eye Institute. She is a fellow of the American Academy of Optometry and the College of Optometrists in Visual Development who lectures nationally and internationally. She can be reached at: vkattouf@ico.edu or (312) 949-7279.
References
  1. Two years into the pandemic, media use has increased 17% among tweens and teens. 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 viewing of smartphones. 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 After 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 on children and adolescents: Literature review and case study. Environ Res. 2018;164:149-157. doi:10.1016/j.envres.2018.01.015