Michael Cole, OD, Child and Family Eye Care Center

AS OUR CHILDREN return to learn after what has seemed like a never-ending summer break due to the COVID-19 pandemic, we are faced with new and unique sets of challenges. I have been incredibly impressed with the ingenuity and flexibility of parents and teachers in our community as we work together to ensure a successful school year. I know that my own children are in very capable hands and trust that those making decisions are doing so with the absolute best of intentions.

While I have listened to multiple discussions regarding different modes of teaching, I have contemplated the effects of considerably increased screen time on our young children’s developing eyes and the impact that it may have on their learning. I am convinced that all children can succeed in their unique learning environments and that the drawbacks of prolonged screen time can be compensated for.

The primary vision concern with extended screen time is the close working distance. In the best circumstances, our eyes are completely at rest when we are looking far away. While functioning within arm’s reach, our visual system is responsible to change focus and maintain that focal distance for the duration of near work. The eyes must also exert themselves to converge to align at the same target. Quick, accurate eye movements are necessary to gather information in a timely manner and must happen simultaneously as the eyes maintain near focus and alignment. This is not achieved without effort, and doing so for extended periods of time often leads to symptoms such as fatigue, eye strain, blurry vision, headaches, and poor attention.

Often, we will find our devices and reading material creeping closer and closer to our faces while we work. The closer an object is, the more fatiguing that working distance becomes. We recommend that devices stay outside our “Harmon distance,” which is defined as the distance between our elbow and our middle knuckle. This is easily estimated by making a fist, placing your fist on your chin, and holding your device no closer than your elbow. The
amount of effort required of the visual system increases exponentially the nearer we are to our material, especially inside our Harmon distance.

One way that we can extend our stamina during near work is by taking frequent breaks. The American Optometric Association recommends abiding by the 20-20-20 rule, which states that for every 20 minutes of near work, one must take a break to look at least 20 feet away for at least 20 seconds. This can be as simple as taking a quick restroom break, going to the kitchen for a drink, or even sending your kids outside to run a lap around the house! Frequent breaks from screens may momentarily interrupt the flow of learning, but these brief pauses can go an awfully long way toward maintaining enough endurance to last the entire electronic school day.

Another option that can greatly enhance performance on screens is optical correction designed for the distance we are working at. Most often glasses are intended to help us see clearly far away, and the evaluation of the visual system during examinations end when distance clarity is achieved. It is imperative that our vision examinations also assess near performance. When indicated by symptoms and examination, our office will often prescribe glasses designed to maximize performance at our patients’ Harmon distance, rather than far away. Many times these glasses are only worn during near work. When the visual system is optimized to work comfortably on screens, frequently the unwanted symptoms due to screens are completely alleviated during the rest of the day. Blue light is a hot topic in our digital world, which has led to “blue light blocking” glasses to become mainstream. High energy light in the short wavelength end of the visual spectrum is especially fatiguing and can lead to disruptions in our sleep cycles. Screens are an additional source of blue-heavy light. While blue light blocking glasses can partially eliminate those wavelengths, glasses that are designed for screens that fail to compensate for the working distance are a lost opportunity for meaningful assistance. There are many better options in prescription computer glasses that have addressed the primary concern of close working distances which also allow for blue light blocking, making the most out of the glasses you wear and invest in.

Another concern of increased near work is the progression of myopia (nearsightedness). Researchers in ophthalmology have recently published articles warning of the impact that online schooling due to COVID-19 may have on levels of myopia in children. It has been well established that prolonged near work, including screens and reading, coupled with decreased outdoor activities leads to increased levels of myopia. It is crucial that children are encouraged to have outdoor play time to help offset the increased near demands on their vision.

In addition to outdoor activities, there are other proactive treatments used successfully for what we call “myopia control,” which is the reduction of the rate of change in myopia levels over time. A favorite option in our clinic is ortho-k contact lens wear. These lenses are worn only at night, correcting your vision while you sleep and allowing for clear vision with no glasses or contacts worn during the day. Other effective options are soft distance-center multifocal contact lenses worn during the day like most contact lenses and low-dose atropine eye drops used once daily.

We are fortunate to have excellent schools and educators in Cache Valley, and we are confident that our children will have memorable and valuable experiences learning during this school year, no matter the setting. We are committed to minimizing the impact of alternative styles of learning and maximizing your child’s performance. If we can be of further assistance or answer any questions regarding your child’s specific learning circumstances and how they affect their vision, please contact our office.