Digital Eye Strain in Kids

Digital Eye Strain (DES) is a group of signs and symptoms associated with the extended use of electronic devices at near distance. DES has been reported as far back as the early days of personal computers, but its incidence is increasing at an alarming rate as our society's dependence on screens is being fueled by both technological advancements and once-in-a-lifetime events, like the COVID-19 pandemic. As with that public health crisis, children are again uniquely vulnerable and exposed to the effects of DES. Fortunately, there are a number of daily, at-home interventions available to lessen the complications of DES.

The symptoms most commonly reported in DES include eye strain, watering of eyes, headache, tired eyes, burning sensation, red eyes, irritation, dry eye, foreign body sensation, blurred vision, and double vision. There are many factors behind these symptoms:

• The eye surface symptoms like eye strain, watering, burning, redness, foreign-body sensation are related to a reduced blink rate, which has been observed to be as low as 1/10th the normal rate.
• The temporary blurred vision at near or distance, difficulty refocusing from one to the other, and even double vision is a result of insufficient adjustment or convergence.  
• Finally, the symptoms that don’t involve the eye like headache, neck stiffness, and shoulder or back pain are a result of poor ergonomics and posture while using digital devices.

All of these symptoms are common among both adults and kids, but there are even a few more concerns unique to kids. There is early data indicating that myopia progression (or increase in near-sightedness) is connected to prolonged screen use, with year-over-year increases in myopic prescriptions more than doubling the pre-COVID rate. In addition, there is evidence that increased screen time is associated with higher risks of an unhealthy diet, cognitive outcomes, interpersonal relationships, and quality of life among children and young adults.

With all of these broad-spanning negative impacts of DES and prolonged screen time, it is imperative for parents and caregivers to educate themselves and become mindful of ways to limit harm while nurturing technological growth in an increasingly digital world.

Here are real-world strategies to minimize DES:

• Limit average daily screen time to a reasonable amount; less than 4 hours per day if able.
• Improve screen hygiene: ensure proper ambient lighting, optimize digital device positioning, adjust image parameters (resolution, text size, contrast, luminance), and take frequent breaks (20/20/20 strategy - every 20 minutes, look away at something at least 20 feet away for 20 seconds).
• Sit upright at a desk or table with screens approximately 20 inches from the eyes. The height of the screen should be positioned lower than the height of the eyes, such that the viewing distance is 15–20° below the eye level.
• Blink more consciously. Frequent blinking of eyes minimizes the chances of developing dry eyes.
• Reduce screen brightness to match surrounding brightness and set contrast to around 60-70%.
• Apply anti-glare screen covers to reduce the amount of light reflected from the screen.  
• Track screen time to set real targets.
• Wear glasses if indicated.

If you have specific questions or concerns about your child's risk for or experience with DES, please contact your friendly neighborhood eye care professional - pediatric ophthalmologist or optometrist - and make an appointment for a complete evaluation.