October 26, 2014 | POSTED BY | Clinical Optometry, Events
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It’s way too common these days that we see a two-year old playing on an iPad of their own in a restaurant instead of coloring with real crayons on the menu. They’re more fascinated by the tablet with the lights and sounds, and mom is happy since the child isn’t throwing a tantrum in public. Since this technology has only been around for 5 years or so, it’s hard to predict the long term risks on the child’s eyes, but the results we can draw are staggering.

Kids are becoming more and more myopic.

Since the 70’s, more and more children have become myopic. Researchers correlate this to a combination of increased near demands and lack of going outside. Increased time spent focusing at school (necessary) and on devices (voluntary) will cause a developing eye to lengthen to see better at the distance it does most of its work at. If that’s up close, the emmetropization process is disrupted. Highly myopic children may be seen pulling the device excessively close to their face, bringing it to their focal point. This is often why high myopia is generally detected more by parents compared to hyperopia and other BV conditions that affect learning. Other research shows that simply spending time outside: not even exercise, just sunlight every day-will decrease the likelihood of
developing myopia. Theoretically, our ancestors needed to see at distance only (not near) and adapted as emmetropes accordingly. More of an excuse for all kids to go outside to exercise and just play!

Many are unnecessarily medicated.

Often kids are using phones and tablets much closer than the standard 40 cm working distance, increasing the accommodation needed to see them clearly. If the child has an uncorrected refraction (especially hyperopia!) they will be straining excessively at near. They will likely complain at school (but not with their tablet) since paper text size can’t be increased but on a tablet the size is easily enlarged. Kids are unlikely to report asthenopia or diplopia: they will just avoid the task in general (i.e. won’t want to do work in school). This can be reported as parents or teachers as “hyperactivity” and the child may be put on unnecessary stimulant medication when they really need glasses. A hyperopic child given plus at near will finally be able to focus on their near tasks without strain, and won’t avoid them. Math will be less interesting than an ipad to EVERY child – but that doesn’t mean the treatment should be drugs as the first option.

Many have unknown BV problems. 

In the same vein as uncorrected hyperopes: Many kids may have a binocular issue (many kids silently suffer from an accommodative or convergence insufficiency) that hasn’t been diagnosed. Kids with CI will have a hard time converging their eyes to see up close and their accommodation will work overtime to see up close, again causing excessive strain. They usually won’t complain, but likely they will avoid activities like reading. However, in the day of the pinch and zoom this isn’t as big of a problem and this can actually mask the problem. Kids who are myopic will likely do better at near than at distance (the same way they would with a book) but they are more likely to want to play with an ipad than read a standard book: they’re more interesting. When said myopic child gets corrected for distance, they will likely suffer accommodative stress since they have never used their accommodation due to their “built in plus.” It’s also not uncommon to see children with large phorias decompensate into tropias, especially at the blue-ipad-3-color-spectrum-chartsend of the day. Parents may notice their child’s eye “kick out” into a decompensated XT at the end of the day when the child’s high exophoria or CI is too much and the eye turns out.

Retinal issues can occur with blue light.

Excessive LED/high energy blue light has already been proven in adults to affect the retina in multiple negative ways. Since it’s a visible wavelength, it isn’t absorbed by the cornea like UV: but it is high enough of energy to cause damage in high amounts. Adults are getting enough screen time to cause macular and retinal damage. Time will only tell what will happen to the babies that have been staring at high energy LED light since infancy. Newer iPads boast better color resolution, yet this comes at the cost of more high energy blue light to your child’s retina (see graph above)Blue light is disruptive to the cones in the macula leading to AMD: so prospective studies are likely in the works already. Increased blue light transmission to the retina is also associated with disrupted sleep/wake cycles. Since natural blue light is highest in the morning-noon hours (think bright blue skies), the pineal gland suppresses melatonin production and keeps us awake. If the blue light from an iPad is stimulating a 4-year old late at night, they may develop insomnia as a child. This can only set up Junior for increased problems in adulthood if the roots are developing early.

It affects with overall development.

The American Academy of Pediatrics recommends that toddlers under two touch a screen…. NEVER. Even after toddlerhood it should be severely limited, not the few hours some parents report. Of course babies are going to be drawn to it – it’s interesting, colorful and it moves. Even so, it deprives the infant of the multi-sensory toys that they would otherwise play with. Their eyes actually begin to dry out the same way an adult with Computer Vision Syndrome would. When we stare at a lit screen, we blink less and our eyes dry out. Research also suggests that extensive time with screens in early childhood can cause the EOMs to atrophy. Adapting to a 2D world will not teach a young baby how to live in one that is 3D and their stereopsis will likely suffer. Babies that have been overexposed to screens have actually Baby seats with ipad holders such as these shouldn't exist: since infants shouldn't be exposed to screens until after the age of two according to the AAP. been shown to be confused on how to turn pages of real books-they attempt to “swipe.” Learning to draw with a finger on a tablet will not teach a toddler the motor skills he needs to correctly hold a pencil.

Unfortunately, there are no conclusive studies that show us the long term effects of what this technology can do to our eyes and our overall development. What we do know about child development tells us that it’s not the best idea to let an iPad babysit your children. Use the parental controls to limit the amount of time the munchkins can play. Kids of all ages need age-appropriate, multi-sensory playthings, adequate exercise and time to be kids. As I sit here and type this on an iPad: let’s all unplug for a while and go outside…for our eyes and for our health.