Screen Use, Myopia and Digital Eye Strain: Tips for Limiting Screen Time for Kids
Written By: Jason Higginbotham
BSc (Hons) MCOptom Prof Cert Glau Prof Cert Med Ret Prof Cert LV FBDO MBCLA
Updated: 04th November 2024
Exploring Screen Use, Myopia and Digital Eye Strain
In today’s digital world, screen time is a significant part of daily life for children and teenagers, whether for education, entertainment, or socialising. (Is "screenagers" a word yet?) However, excessive screen time can contribute to the progression of myopia (short-sightedness) and cause "digital eye strain", leading to discomfort and even headaches. With effective strategies to limit and balance screen use, parents can help protect their children’s vision and encourage healthy eye habits.
This comprehensive guide provides a detailed look into digital eye strain and it's relationship to myopia.
Feel free to jump to the section that most interests you.
Definition: What is Digital Eye Strain?
Digital Eye Strain, also known as Computer Vision Syndrome, is a collection of symptoms caused by prolonged use of digital screens. This condition includes eye discomfort, dryness, blurred vision, and headaches, resulting from the intense visual demands of screens. Treatments and strategies, such as regular screen breaks and optimising screen settings, aim to reduce these symptoms and improve comfort, promoting healthier screen habits for long-term eye health
Contents
Part 1: The Link Between Screen Time and Myopia in Children? - Jump to Section
If you're new
Part 2: Screen Time Recommendations for Children - Jump to Section
In part 2, we'll look at a number of clinically proven treatment options. The treatment options we discuss are back by science, clinical studies and expert opinion, not on individual case studies. You'll discover a comprehensive list of all myopia treatment options and can read more about them.
Part 3: Putting it all together - what's the best myopia treatment option for your child? - Jump to Section
Having, explored some of the potential options, we'll take a quick look at some of the things you should consider when thinking of a myopia control treatment plan for your child. Of course, once, you have read this section, we strongly advise that you find a specialist eye care professional near you to help.
BONUS: Actions you can take now - Jump to Section
Finally, as you'll discover, modern lifestyles are having a big impact on the myopia epidemic. So, we highlight a few simple tips and tricks that you and your child could adopt to slow down their myopia progression.
Part 1
The Link Between Screen Time and Myopia in Children
What is Myopia?
Myopia, or short-sightedness, is a common vision condition that causes distant objects to appear blurry while nearby objects remain clear. This condition is typically progressive in children and teenagers, often worsening as they grow. With increasing screen time in modern life, myopia rates have risen significantly among young people. The exact mechanisms of this are still being studied.
Why Screen Time Matters
Close-up screen use places a high visual demand on the eyes, especially when held very close to the face. Studies indicate that children who spend a lot of time using digital devices are at greater risk of developing myopia, as excessive near-vision activities can strain the eye’s focusing system and encourage changes in the eye’s shape
Is Digital Eye Strain a recognised condition?
Yes, digital eye strain is indeed a recognised and real condition, widely acknowledged within the eye care and medical professions. Often referred to as computer vision syndrome (CVS), digital eye strain describes a range of eye and vision-related problems that result from prolonged screen use on computers, smartphones, and other digital devices. Eye care professionals, including optometrists and ophthalmologists, recognise it as a legitimate concern due to the growing prevalence of screen time in everyday life and its impact on eye comfort and health.
The Key Symptomns of Digital Eye Strain
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Symptoms: Digital eye strain is associated with symptoms like dry or irritated eyes, blurred or double vision, headaches, and neck or shoulder pain. These symptoms occur due to the high visual demands of screen use, which often includes closer-than-normal viewing distances, glare from screens, blue light exposure, and reduced blinking.
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Recognition by Professional Bodies: Organisations such as the American Optometric Association (AOA) and the Royal College of Ophthalmologists in the UK have recognised digital eye strain and issued guidance on managing its symptoms. These professional bodies note that extended screen time can strain the eye muscles and exacerbate issues like dry eyes and blurred vision.
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Underlying Causes: The causes of digital eye strain are often linked to factors unique to screen use, including the near-point focus required by screens, glare, blue light exposure, and reduced blinking. Studies have shown that people tend to blink less frequently when using digital devices, which can lead to dry eyes.
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Management and Treatment: Digital eye strain can be managed through lifestyle changes and ergonomic adjustments, such as following the 20-20-2 rule (taking a 20-second break every 20 minutes and spend 2 hours outdoors each day), adjusting lighting, and using screen filters or anti-reflective coatings. Eye care professionals may also recommend lubricating eye drops or specialised glasses with blue light filters.
Why Digital Screens Are Different from Books:
Screens tend to emit blue light and are often held closer than printed books, which increases strain on the eyes. Children may also hold digital devices closer than adults, leading to faster fatigue of the eye muscles and potentially contributing to digital eye strain symptoms.
Posture and Eye Strain:
When children use screens for long periods in awkward positions, such as lying down, they are at greater risk of developing not only eye strain but also poor posture habits. This can lead to neck stiffness and discomfort, and even affect breathing efficiency.
Part 2
Screen Time Recommendations for Children
Clinical evidence has shown that a personalised eye care plan can significantly decrease the progression of myopia in children by up to 50%.
World Health Organisation
Based on expert recommendations from the World Health Organisation and other child health bodies, here are age-appropriate screen time guidelines to support visual health
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Under 2 years: No screen time, except for video chats with family members. Limiting screen time encourages active play, which is crucial for eye muscle development.
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Ages 2-4: Limit to a maximum of one hour per day, ideally co-viewed with a parent. Interactive screen time, such as learning games or educational videos watched together, can support learning while keeping screen time short.
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Ages 5-17: Limit non-educational, recreational screen time to no more than two hours per day. It’s also helpful to take frequent breaks and avoid screens for at least an hour before bedtime for better sleep quality.
Year | Average Screen Time | Change Over Previous Year |
|---|---|---|
2014 | 6 hours 23 minutes | ↑ 3.8% |
2015 | 6 hours 20 minutes | ↓ 0.8% |
2016 | 6 hours 29 minutes | ↑ 2.4% |
2017 | 6 hours 46 minutes | ↑ 4.4% |
2018 | 6 hours 48 minutes | ↑ 0.5% |
2019 | 6 hours 38 minutes | ↓ 2.5% |
2020 | 6 hours 54 minutes | ↑ 4% |
2021 | 6 hours 58 minutes | ↑ 1% |
2022 | 6 hours 37 minutes | ↓ 5.2% |
2023 | 6 hours 40 minutes | ↑ 0.8% |
2013 | 6 hours 9 minutes | - |
Screen Time Statistics for Children in the UK and Worldwide
Recent screen time statistics research for the UK and globally, highlight the growing use of digital devices among children and the potential impact on their well-being and eye health
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UK Screen Time Trends
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A recent UK Education Committee report also notes that nearly 25% of children exhibit behaviours consistent with smartphone addiction, and parents report concerns about their ability to manage screen time effectively
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Children in the UK have seen a 52% increase in screen time between 2020 and 2022, largely attributed to the impact of lockdowns and shifts toward digital learning UK Parliament
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The average UK child spends over 6 hours per day on screens across activities like video games, social media, and streaming content. The Independent
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Global Screen Time Averages
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Global daily screen time averages around 6 hours and 40 minutes across all age groups, with the Philippines, Brazil, and South Africa showing some of the highest averages at nearly 9 hours per day - Exploding Topics
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Children aged 8-12 worldwide spend approximately 4-6 hours per day on screens, while teens (13-18) average 7+ hours daily, excluding screen time for schoolwork - The Independent
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In countries with high screen time use, such as Brazil and the Philippines, children and teens report more screen-related symptoms, including eye strain, sleep disruption, and social impacts from excessive screen use. -Exploding Topics
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Social Media and Gaming
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A significant portion of children’s screen time globally is spent on social media and gaming. The average daily time spent on social media is 2 hours and 23 minutes. Exploding Topics
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In countries like the UK and Australia, gaming and social media contribute heavily to screen time, with up to 50% of children experiencing symptoms of digital eye strain due to prolonged use of screens. The Independent
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These statistics underscore the pressing need for guidelines and interventions that promote healthy screen habits to protect children's eye health and overall well-being.
By following these simple rules and creating boundaries around screen time, parents can help their children develop eye-friendly habits and enjoy a healthier balance between digital and offline activities.
Part 3
Screen Time Recommendations for Children
Clinical evidence has shown that a personalised eye care plan can significantly decrease the progression of myopia in children by up to 50%.
World Health Organisation
Based on expert recommendations from the World Health Organisation and other child health bodies, here are age-appropriate screen time guidelines to support visual health
-
Under 2 years: No screen time, except for video chats with family members. Limiting screen time encourages active play, which is crucial for eye muscle development.
-
Ages 2-4: Limit to a maximum of one hour per day, ideally co-viewed with a parent. Interactive screen time, such as learning games or educational videos watched together, can support learning while keeping screen time short.
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Ages 5-17: Limit non-educational, recreational screen time to no more than two hours per day. It’s also helpful to take frequent breaks and avoid screens for at least an hour before bedtime for better sleep quality.
Practical Tips to Limit Screen Time and Protect Eye Health
To help prevent digital eye strain and reduce the risk of myopia, it’s essential to balance screen use with healthy habits. Here are some practical strategies and easy-to-remember rules for setting screen boundaries:
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The Elbow Rule: Encourage children to hold devices at an elbow-to-wrist distance from their eyes. This helps maintain a healthy viewing distance, reducing strain on the eyes. An easy way for children to check this distance is by making a fist, placing it next to their eyes, and ensuring the screen is no closer than where their elbow sits.
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The alternative 20-20-20 Rule: Taking regular breaks is crucial for eye health. Every 20 minutes of screen time, encourage children to look at something at least 20 feet away for 20 seconds. This brief pause allows the eye muscles to relax and refocus, helping to prevent eye strain.
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The Two-Two-Hour Rule: This is a double rule. First encourage outdoor play for at least 2 hours a day, but also limit recreational screen time for school-aged children to two hours per day, as recommended by health experts. This ensures time for other beneficial activities, such as outdoor play, which is essential for eye and physical health.
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Establish Screen-Free Zones: Designate certain areas of the home, like bedrooms and dining areas, as screen-free zones. This helps reinforce healthy boundaries and encourages more face-to-face interaction and relaxation.
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Implement Screen-Free Times: Set consistent screen-free times, such as during family meals or an hour before bedtime, to help children disconnect and unwind.
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Use Device Timers: Take advantage of timers or parental control apps to monitor screen use and enforce breaks, supporting these habits as part of a healthy daily routine.
By following these simple rules and creating boundaries around screen time, parents can help their children develop eye-friendly habits and enjoy a healthier balance between digital and offline activities.
Part 4
Encouraging Outdoor Activities to Balance Screen Time
How Outdoor Time Supports Eye Health
Increased outdoor time provides a natural break from screen-based activities, offering essential relief from digital eye strain—a condition marked by eye fatigue, dryness, and headaches due to prolonged close-up screen use. Time spent outdoors reduces the demand for near-vision focus, allowing the eye’s muscles to relax and recover from the intense visual stress caused by screens.
In addition to reducing digital eye strain, outdoor time has been shown to play a protective role against myopia development and progression. Studies indicate that children who spend more time outdoors experience slower eye elongation, or axial growth, which is a key factor in myopia progression. This combined effect makes outdoor activities a powerful tool for maintaining children’s visual health.
Why Outdoor Time Helps Prevent Myopia
1. Increased Light Exposure and Dopamine Release
Natural daylight is much brighter than indoor lighting, which has been shown to stimulate the release of dopamine in the retina. This neurotransmitter helps inhibit excessive eye growth, which is associated with myopia progression. For instance, the Guangzhou Outdoor Activity Longitudinal Study demonstrated that an additional 40 minutes of outdoor activity per day significantly reduced myopia onset in schoolchildren over a three-year period.
2. Reduced Near-Work Demand and Prevention of Defocus Blur
Outdoor activities allow children to engage in distance viewing, reducing the strain of continuous close-up work and limiting the effects of “hyperopic defocus blur,” where light focuses behind the retina during near work. This blur prompts the eye to elongate further, exacerbating myopia progression. The CLEERE Study found that children who spent more time outside had a lower risk of developing myopia, supporting the protective role of outdoor activities against close-up induced defocus blur.
3. Peripheral Defocus Blur
For children who already have myopia, optical solutions can mimic the natural defocus effect provided by outdoor activities. Defocus Incorporated Multiple Segments (DIMS) lenses, for instance, induce “myopic defocus” by creating different focal points at the periphery of the retina. This effect, similar to distance viewing, slows the eye's elongation. The DIMS Lens Study conducted in Hong Kong showed that these lenses reduced myopia progression by approximately 60% over two years compared to single-vision lenses
Evidence from Additional Studies
Studies like the Sydney Myopia Study and the Handan Offspring Myopia Study both found that children who spend at least 1-2 hours daily outdoors have a reduced risk of developing myopia. The Taiwanese School-Based Intervention Study also supported this by showing that a school-based program promoting outdoor activity successfully delayed myopia onset in primary school children.
"Just 40 minutes of additional outdoor time daily can reduce the risk of myopia onset in children by nearly 23%."
He et al., "Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial," JAMA, 2015 - source
Research on Outdoor Time and Myopia
Multiple studies have found that children who spend at least 1-2 hours daily outdoors are less likely to develop myopia. This protective effect is most evident in children who have not yet developed myopia, making early intervention crucial. However, while outdoor time can help delay the onset of myopia, it may have a limited effect on slowing its progression once myopia has already developed. This is why a combined approach using myopia control lenses like DIMS or multifocal contact lenses, alongside regular outdoor activities, can be effective in managing progression.
Easy Ways to Get Kids Outdoors
To help incorporate more outdoor time into your child’s routine, here are some engaging activities:
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Sports and Physical Games: Encourage involvement in sports like football, cycling, or other physical games that stimulate distance viewing and physical activity.
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Nature Walks or Hikes: Family walks or hikes provide not only outdoor time but also opportunities for bonding and relaxation.
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Gardening or Simple Outdoor Chores: These can be enjoyable ways to get outside regularly and expose children to natural light and varying focal distances.
Part 5
What is the UK Government Doing to Address
Screen Time and Myopia in Children?
Current Guidelines and Recommendations
In the UK, public health bodies, including the National Health Service (NHS) and the Royal College of Paediatrics and Child Health (RCPCH), have offered general screen time guidelines, but there is currently no official government-led policy focused specifically on screen time and eye health in children. However, the NHS and organisations like the World Health Organisation (WHO) recommend limiting screen time, particularly for young children, due to its impact on physical, mental, and visual health. These guidelines align with international research that shows the benefits of limiting screen time to protect against conditions like myopia and digital eye strain.
Potential Actions the Government Could Take
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Implementing Educational Campaigns: Launching public awareness campaigns on the impact of excessive screen use on children’s vision, encouraging eye health practices like the 20-20-20 rule and regular outdoor time.
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Setting Age-Based Screen Time Recommendations: Developing official age-based guidelines and policies on screen time specifically for the UK, ensuring consistency across educational and healthcare recommendations.
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Integrating Eye Health in Schools: Schools could include eye health education in their curriculum, teaching children the importance of screen breaks, maintaining a healthy viewing distance, and the benefits of spending time outdoors.
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Research and Funding: Increasing research funding to study the long-term impact of digital device use on children’s vision and general health. Research could also explore solutions such as classroom design adjustments to reduce prolonged close-up work.
While these steps are yet to be officially implemented, they offer an approach that could help prevent myopia and digital eye strain in children by empowering parents, educators, and communities to make informed decisions about screen use.
Parents Taking the Lead: The Smartphone-Free Childhood Movement: A Grassroots Approach to Reducing Screen Time
With a lack of government action, The Smartphone-Free Childhood movement was recently founded and is gaining traction as a is a grassroots initiative aimed at delaying smartphone use for children and encouraging a tech-light lifestyle in early childhood. The movement advocates for a child’s early years to be spent with minimal screen exposure, which aligns with health expert recommendations that encourage minimal screen time, particularly for children under five. By supporting reduced device use, this movement promotes more active and outdoor play, family engagement, and traditional face-to-face learning and interaction.
Could the Movement Have a Positive Impact on Myopia Prevention?
Yes, reducing children’s access to smartphones could help decrease the onset of myopia and digital eye strain. Research has shown that excessive use of smartphones and digital devices at close distances places a high visual demand on young, developing eyes, potentially leading to early-onset myopia. By limiting exposure to these devices, especially at an age when children are most susceptible to visual strain, the Smartphone-Free Childhood movement could help preserve eye health and protect against vision issues.
Additional Benefits of a Smartphone-Free Approach
Beyond eye health, the Smartphone-Free Childhood movement offers several other benefits, including:
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Supporting Physical Health: Less screen time naturally leads to more physical activity, which is essential for physical development and overall health.
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Improving Mental and Social Well-Being: Children without smartphones are more likely to engage in social, imaginative, and cooperative play, promoting mental and emotional resilience.
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Encouraging Family Connections: A reduced reliance on screens can encourage more family interaction and time outdoors, providing a foundation for healthier habits that support physical and mental health.
The Smartphone-Free Childhood movement thus aligns closely with myopia prevention strategies. By limiting children’s screen exposure, it contributes to a healthier visual environment that balances close-up work with essential outdoor activity. Supporting this movement may provide significant benefits for long-term eye health, making it an impactful approach to managing the growing concerns around children’s screen time.
Are there any similar movements in the US, Canada or Australia?
Yes, similar movements and initiatives focused on reducing screen time and promoting healthier digital habits for children are emerging in the US, Canada, and Australia. Here’s a look at some key initiatives in these countries:
United States
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Wait Until 8th
The Wait Until 8th campaign encourages parents to delay giving their children smartphones until at least eighth grade (around 13-14 years old). This movement, founded by parents, aims to reduce the risk of digital addiction, encourage more time for in-person interactions, and minimise exposure to online risks. It also addresses concerns over excessive screen time and its effects on children’s mental, physical, and eye health, including myopia.
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Campaign for a Commercial-Free Childhood (CCFC)
The Campaign for a Commercial-Free Childhood, a non-profit advocacy group, promotes awareness about the impact of digital media and commercialisation on children. Its Screen-Free Week initiative encourages families to take a break from digital screens for one week each year, focusing instead on activities that foster physical and mental well-being, creativity, and outdoor play. Screen-Free Week has gained popularity and is used by schools and communities to help children experience reduced screen exposure.
Canada
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The Screen Time Action Network
Founded by the Children's Screen Time Action Network, this initiative in Canada and the US advocates for evidence-based screen time guidelines, particularly for children under six years old. It provides resources for families and educators on managing screen use, particularly for young children. This network collaborates with healthcare professionals, researchers, and parent groups to support the development of policies that limit screen time and promote active, outdoor lifestyles.
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Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth
While not solely focused on screen time, Active Healthy Kids Canada publishes an annual report card that examines the effects of screen time on physical health, mental well-being, and eye health in children. This report card is widely cited in health and education policy discussions, encouraging a balanced approach to technology use that includes ample outdoor play and physical activity.
Australia
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Healthy Digital Diet Initiative
This initiative, supported by health experts and educators, offers guidelines and tips to help parents manage their children’s digital habits and reduce screen time. It provides resources on setting screen limits, creating tech-free zones, and encouraging outdoor activities, all aimed at promoting healthier digital lifestyles.
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Australian Screen-Free Schools Movement
In response to rising concerns about screen time, some Australian schools have begun implementing screen-free or low-screen policies. These policies reduce reliance on digital devices during class time, promote outdoor activities, and encourage in-person interactions. Schools adopting this approach aim to support better focus, physical activity, and healthier eye habits in students.
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Nature Play Australia
Although Nature Play is primarily an outdoor play advocacy group, it has taken an active stance on reducing screen time, especially among younger children. The group encourages families to adopt screen-free weekends and promotes nature-based activities as a healthy alternative to digital media. Nature Play has gained substantial support across Australia, particularly as screen time is increasingly linked to reduced outdoor play and increased myopia risk.
These movements in the US, Canada, and Australia are similar to the UK’s Smartphone-Free Childhood initiative, each advocating for reduced screen time, improved eye health, and a balanced approach to technology use in children’s lives. While each initiative has its unique focus, the common goal is to encourage healthier screen habits, with benefits extending to physical, mental, and visual well-being.
These grassroots and policy-driven initiatives align well with myopia prevention and could serve as valuable resources for parents and educators worldwide.
Myopia Focus is campaigning to get the NHS to recognise myopia as an ocular disease and provide better funding for Myopia Management for Children. Please help us by taking 1 minute to sign the peition. Click here
Part 6
Final Thoughts
Building Healthy Eye Habits for Life
In today’s digital world, balancing screen time with eye-friendly habits is essential to support children’s long-term vision health. Excessive screen use can contribute to digital eye strain and accelerate myopia progression, impacting not only eye health but also overall well-being. By setting boundaries, incorporating regular breaks, and encouraging outdoor activities, parents can create a well-rounded approach that reduces visual strain and supports healthier eye development.
Outdoor time has been shown to play a crucial role in preventing the onset and slowing the progression of myopia, thanks to factors like natural light exposure and reduced close-up work. Encouraging even an additional 40 minutes a day outdoors can make a measurable difference, offering protection against eye elongation and associated risks. For children who already experience myopia, tools like DIMS lenses can help control progression, combining with lifestyle changes for a comprehensive approach to managing vision.
Ultimately, establishing a routine that balances digital and offline activities is an investment in a child’s eye health and quality of life. By integrating these healthy habits early on, parents can empower their children to develop screen awareness and outdoor habits that will support eye health into adulthood. With consistent practice, these simple but effective strategies can help maintain children’s vision and minimise risks, setting them up for healthier, more comfortable viewing experiences in the future.
The Author
Jason, BSc (Hons) MCOptom Prof Cert Glau Prof Cert Med Ret Prof Cert LV FBDO MBCLA is an optometrist and dispensing optician renowned for his education and training services, with over 30 years experience. A former Director of Medical & Education at Birmingham Optical Group, Jason, runs ophthalmic consultancy firm, FYEye Ltd assist clients with training both their associate, clinical and management teams as well as providing CET/CPD content and delivery.