More and more children in the US are now having vision problems. Why you shouldn’t be too quick to blame phones

Myopia in children develops at a young age. According to a pediatric ophthalmologist from Connecticut, USA, looking at a phone or tablet screen too long and too close may play a role in this, but the answer is not so simple.

“We’ve seen an increase in the prevalence of myopia over the last, I would say, 20 years, and it’s expected to continue to increase,” said Dr. Majida Gaffar, chief of ophthalmology at Connecticut Children’s Medical Center.

“I think at one point there was an article that said that by 2050, it would affect about 50% of the population, so it’s definitely common,” Gaffar said. “It’s definitely something that ophthalmologists and optometrists are looking at to slow the progression of the disease.”

According to healthychildren.org, myopia affects about 5% of preschool-age children, 9% of school-age children and 30% of teenagers.

While there is no cause for myopia, the formal name for nearsightedness, there are correlations, such as “close work and diet … environmental factors,” Gaffar said. In addition, a child of a person with myopia is more likely to become nearsighted.

“They decided to reduce the progress, and then some will recommend reducing the time spent close to, for example, video games, iPhones and iPads,” Gaffar said.

“I always tell my patients to limit it as much as possible, even if they haven’t found that it causes myopia,” she said. “But it’s something that’s been on the rise in children over the last 15 years, so it could be quite possible.”

“I just don’t think they’ve studied it enough, simply because in scientific terms… the iPhone usage by kids hasn’t been around as long as the iPads and the iPhones,” Gaffar said. “So even though iPhones have been around for a while, the actual use of them by kids for gaming and entertainment and things like that is also relatively new.”

Myopia typically progresses at a rate of 1 to 1.5 diopters per year, Gaffar said, referring to the unit of measurement used in glasses prescriptions.

“If we know that the parents have high myopia, so we already know that the child has some family patterns of inheritance, that increases the likelihood that they will have myopia,” Gaffar said. “What I will recommend to patients, or I will just start talking about it at a younger age, is how can we slow down the progression so that they don’t have as much myopia as their parents.”

Say a parent has glasses lenses that are minus 5 or minus 6, “and the child is 5 years old and is about to start kindergarten with lenses that are minus 3, how can we prevent the child from having lenses that are minus 6, minus 8 or more?” Gaffar said.

To slow the progression of myopia in a child, “there are a lot of things on the market, but ophthalmologists go for eye drops,” such as low-dose atropine eye drops, she said. “There have been a lot of randomized controlled trials that have proven that they do slow the progression of myopia,” she said.

“And then, more recently, people started using contact lenses to reduce the progression of myopia,” Gaffar said. “These are contact lenses, just like the soft contact lenses you normally wear, but they’ve been shown to reduce the progression of myopia.”

Doctors don’t fully understand how eye drops and contact lenses reduce myopia, she said, although lenses change the way light hits the retina.

Gaffar explains that the cause of myopia is the length of the eye and the shape of the lens at the front of the eye.

“The longer the eye, the more likely you are to have myopia,” she said. “If you have myopia, you’re more likely to have a longer eye. And the lens is also where the refractive power comes from. So the shape of the lens can also cause myopia, astigmatism, all of that.”

As Gaffar explains, myopia is related to the length of the eye, from the cornea to the retina, while astigmatism is related to its shape.

“I could explain it by saying that the shape of the eye is more like a football than a basketball, but it’s really about the curvature of the cornea and the lens… and other factors that can affect that,” she said.

Scarring or abnormalities in the lens can also cause astigmatism, which results in blurry or distorted vision because light refracts differently as it enters the eye, she added.

As Gaffar says, there is such a thing as pathological myopia, which requires correction of 6 diopters or more, but this is not common.

“When we talk about pathologies, we’re talking about the large numbers, those with really long eyes who are more likely to have abnormalities associated with myopia,” she said.

“Retinal detachment is a serious issue,” she said. “And so when kids come in with really high myopia, the eye is so long and you can imagine the retina is stretched a little bit, it can cause thinning of the retina and retinal detachment. So that’s a separate category.”

Most of the myopia cases associated with the increase are not pathological, “because they are not related to the diseases that the child has, or to a familial, congenital inheritance pattern or anything like that,” she said.

Although some ophthalmologists prescribe glasses for young children, Gaffar typically does not.

“I tend to give glasses a little later, and that’s just because a 5- or 6-year-old in kindergarten doesn’t need to see 20/20,” she said. “A lot of their world is still right in front of them. If the teacher is doing something, it’s more like circle time. If she’s reading a book, it’s circle time, so it’s not too far off.”

The exception would be if the child had “very high myopia. I think that could affect their visual development and their ability to learn,” she said.

Gaffar tends to postpone prescribing glasses until a child is about 8, she said, “because then they’re maybe in second grade and they’re doing a lot more remote work. That’s when they’re doing math and stuff on the interactive whiteboard. But if a parent is adamant about getting glasses sooner for whatever reason, then I’ll do that, too.”

Gaffar said she sees a lot more 5- and 6-year-olds wearing glasses than she used to. “I’ve been training for 15 years, but this is a trend that people who trained a lot before me have mentioned.”

Another practice is to prescribe bifocals or even trifocals “to almost reduce what’s called accommodation and see if that reduces progression,” Gaffar said. “And they didn’t find that worked very well. Now some people will swear by it, but it didn’t really show up as a good way to reduce progression of myopia when we did the trials.”

Another finding from the researchers is that myopia is more common in people living in cities than in rural areas, “because they do more work outside the home,” Gaffar said.

“The urban population, we have readers, we have a lot of close-up work,” she said. “So they’re the ones who are becoming a little more myopic. All the signs point to that. … I haven’t seen any studies on this yet about screen time and myopia, but I know it’s got to come.”

Dr. Alan Solinsky, an ophthalmologist at the Eye Surgery Center at Hartford Hospital, believes that increased screen time contributes to higher rates of myopia.

“Myopia and nearsightedness are more common in younger children now that they’re using their iPhones, iPads and other electronic gadgets,” he said. “They’re reading them for a while, six hours a day, instead of going outside and playing ball and looking at things in the distance.”

He said the eye adapts to the range of distances it is accustomed to, “and sooner or later it gets blocked. This has actually been studied and established for many, many years.”

Solinsky said research has shown that cultures where children study many hours a day have greater myopia.

“Basically, the more you look up close, whether it’s at a book or an electronic device, the more myopia you’ll have as a child,” he said.

“The eye is like a camera,” Solinsky said. “The eye has a lens in the front, and that lens, when we’re younger, is very, very malleable. It focuses the eyes. It’s flat when it’s looking far away and very spherical when it’s looking up close.”

If someone is looking up close, “it stays very spherical and doesn’t move as much,” he said. “And then there’s the sclera, which is the coating of the eye and surrounds the whole eye like the outside of a golf ball, the white part that also starts to lengthen when it’s subjected to prolonged up-close tasks.”

Solinsky said the “natural state” of the lens is to look farther and remain flatter.

To slow down myopia, Solinsky and Gaffar proposed the “20-20-20 rule.”

“Every 20 minutes, you should stand up and look away, look 20 feet or more away, and stretch,” Solinsky said. “That’s good for adults and children. They shouldn’t be focusing for hours and hours.” – Hartford Courant/Tribune News Service