HEALTH PLUS MED­ICAL COR­RE­SPON­DENT

Au­gust is Chil­dren’s Eye Health and Safe­ty Aware­ness Month

One in four chil­dren has an un­di­ag­nosed vi­sion dis­or­der ac­cord­ing to the Amer­i­can Acad­e­my of Oph­thal­mol­o­gy (AAO). De­spite the un­set­tling sta­tis­tics, 76 per­cent have not re­ceived a com­pre­hen­sive eye ex­am at the ap­pro­pri­ate time. Re­search from AAO al­so states that “lack of ear­ly in­ter­ven­tion can have de­bil­i­tat­ing con­se­quences”. Ad­di­tion­al­ly, the COVID-19 pan­dem­ic has pre­sent­ed fur­ther chal­lenges, de­ter­ring par­ents from pur­su­ing rou­tine screen­ing and nav­i­gat­ing their chil­dren’s dig­i­tal health, as class­rooms have moved to the vir­tu­al en­vi­ron­ment.

This brings in­to fo­cus, Chil­dren’s Eye Health and Safe­ty Aware­ness Month, com­mem­o­rat­ed in Au­gust, aimed to ed­u­cate par­ents on pro­tect­ing their child’s eye­sight and pre­vent­ing the de­vel­op­ment of vi­sion threat­en­ing dis­or­ders.

Chil­dren should have an eye ex­am at six months and this must be re­peat­ed at age three. Pri­or to start­ing el­e­men­tary school, a com­pre­hen­sive eye ex­am is rec­om­mend­ed. There­after, eye ex­ams be­come nec­es­sary if your child ex­pe­ri­ences vi­sion prob­lems. Our cur­rent teach­ing en­vi­ron­ment, us­ing vir­tu­al class­rooms have al­so in­creased the com­plaints of Dig­i­tal eye strain.

The fol­low­ing signs and symp­toms war­rant con­cern and vi­sion screen­ing:

• Wan­der­ing eyes

• Dry eyes

• Blur­ry Vi­sion

• Squint­ing; clos­ing one eye to read or watch TV

• Hold­ing the book too close to one’s eyes or of­ten sit­ting close to the TV or screen

• Fre­quent eye rub­bing when one is try­ing to con­cen­trate

• Con­sis­tent­ly us­ing one’s fin­gers to guide when read­ing

• Ex­ces­sive tear­ing with­out any tear-caus­ing stim­uli.

• Sen­si­tiv­i­ty to light, which is some­times ac­com­pa­nied by headache or nau­sea.

A good rule of thumb is to have your chil­dren’s eyes ex­am­ined dur­ing “well-child” vis­its. Your child’s oph­thal­mol­o­gist can help de­tect re­frac­tive er­rors such as near­sight­ed­ness, far­sight­ed­ness and astig­ma­tism as well as the fol­low­ing com­mon­ly de­tect­ed dis­eases:

• Am­bly­opia (lazy eye)

• Stra­bis­mus (crossed eyes)

• Pto­sis (droop­ing of the eye­lid)

• Colour de­fi­cien­cy (colour blind­ness)

DIG­I­TAL EYE STRAIN

This isn’t a sin­gle eye con­di­tion, like glau­co­ma or pink eye. It is the name for the symp­toms (sim­i­lar to those list­ed above) that adults and chil­dren ex­pe­ri­ence when they spend too long look­ing at a screen. There are many rea­sons for par­ents to be mind­ful on the ex­tent of screen time they al­low their chil­dren. Amount of screen use per day has been as­so­ci­at­ed with re­duced de­vel­op­men­tal out­comes, obe­si­ty, poor sleep qual­i­ty and re­gressed eye de­vel­op­ment.

The World Health Or­ga­ni­za­tion’s 2019 guide­lines sug­gest no screen time at all for chil­dren be­fore age one, and very lim­it­ed screen time for chil­dren for sev­er­al years af­ter that. The Amer­i­can Acad­e­my of Pe­di­atrics rec­om­mends no dig­i­tal me­dia use in chil­dren younger than 18 months and fo­cus­es on ed­u­ca­tion­al me­dia when chil­dren can start us­ing screens with parental guid­ance. Re­search from Cana­da has al­so found that preschool­ers who had more than two hours of screen time per day had a near­ly eight-fold in­crease in At­ten­tion deficit hy­per­ac­tiv­i­ty dis­or­der (AD­HD).

Ap­ply­ing the 20-20-20 Rule

The eas­i­est way to avoid dig­i­tal eye strain or eye strain from any ex­tend­ed near-fo­cus task like read­ing is to make sure to blink of­ten and to look up from your screen or close-up work every 20 min­utes and fo­cus at least 20 feet away for 20 sec­onds. This strat­e­gy of fre­quent re-fo­cus­ing (com­mon­ly re­ferred to as the 20-20-20 rule) lets the eyes re­lax and re­set.

Eye Com­fort and Safe­ty Tips for Adults, Chil­dren and Screens

The best way to deal with pos­si­ble ef­fects of screens on chil­dren’s vi­sion is to help them set good habits for use. These same tips are good prac­tices for adults and any­one suf­fer­ing from chron­ic dry eyes or eye strain.

• Fol­low the 20-20-20 rule: every 20 min­utes, look at least 20 feet away for 20 sec­onds.

• Set a timer to re­mind the child how of­ten to look in­to the dis­tance.

• Al­ter­nate read­ing an e-book with a re­al book and en­cour­age chil­dren to look up and out the win­dow every oth­er chap­ter.

• Af­ter com­plet­ing a lev­el in a video game, look out the win­dow for 20 sec­onds.

• Pre-mark books with a pa­per­clip every few chap­ters to re­mind your child to look up. On an e-book, use the “book­mark” func­tion for the same ef­fect.

• Avoid us­ing screens out­side or in bright­ly lit ar­eas, where the glare on the screen can cre­ate strain.

• Ad­just the bright­ness and con­trast of the screen so that it feels com­fort­able.

• Use good pos­ture when us­ing a screen. Poor pos­ture can con­tribute to mus­cle tight­ness and headaches as­so­ci­at­ed with eye strain.

• En­cour­age your child to hold dig­i­tal me­dia far­ther away: 18 to 24 inch­es is ide­al.

• Re­mind them to blink when watch­ing a screen.

Co-watch when­ev­er pos­si­ble

If chil­dren are go­ing to have screen time, the best thing you can do is to watch the show or game with them to help them un­der­stand what they’re see­ing. Com­ment on things you no­tice, ask ques­tions about what is hap­pen­ing and if some­one on a show is singing a song, sing along with your child. En­gage with them and re­peat con­cepts af­ter the show is over so they are more like­ly to re­tain that in­for­ma­tion.

Choose me­dia wise­ly

Look to par­ent­ing groups for re­views about age-ap­pro­pri­ate apps, games and pro­grams to guide you in mak­ing the best choic­es for your chil­dren.

Lim­it your own phone use

Bal­anc­ing on­line and of­fline time is ex­treme­ly im­por­tant. Chil­dren will do what they see their par­ents do­ing. At a young age, par­ent(s) is/are the most im­por­tant per­son(s) in their life, so they will mod­el what­ev­er be­hav­iour they are see­ing. If they see that you are be­hind a screen all day every day, then they will see that it’s ac­cept­able and will want to do the same.

Em­pha­size the big three: sleep, healthy nu­tri­tion and ex­er­cise

All three are es­sen­tial to op­ti­mal brain growth, over­all de­vel­op­ment and health and well­ness for chil­dren and adults alike. Ex­ces­sive screen time can im­pact all three. Chil­dren who spend more time in front of screens have been shown to eat more fast food and less fruits and veg­eta­bles and get less sleep and ex­er­cise. There­fore, it is par­tic­u­lar­ly im­por­tant to in­cor­po­rate healthy lifestyle choic­es as part of the dai­ly rou­tine, as well as bal­anced screen time to achieve op­ti­mal eye health.