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EYE                                                                                           EYE CARE AND
 EYE CARE ANDCARE AND
 QUALITY OF LIFE                                                                              QUALITY OF LIFE
 QUALITY OF LIFE




        Guidelines for Screen Time                             light exposure. The eyes work harder when there are more reflec-
           The American Academy of Pediatrics (AAP) provides recommen-  tions on the screen. The glare settings can be adjusted for comfort-
        dations on screen time limits, some of which include eliminating or   able viewing.
        minimizing media exposure, other than video chatting, for children
        under the age of 18 months. For older preschool-age children, there   Sleep Habits
        are appropriate media limits. Having a strategy and establishing clear   The American Academy of Pediatrics (AAP) recommends that
        guidelines for usage of screen time can reduce eye strain and fatigue   children should not sleep with digital devices such as smartphones,
        and other impacts on health. The AAP recommends families develop   computers and televisions in their bedrooms. The AAP also recom-
        their own personalized media use plans.               mends no devices or screen exposure for one hour before bedtime.

        Screen Position                                       Outdoor Activities
           The screen on your child’s laptop or desktop computer should be   Encouraging outdoor time and activities exposes children to nat-
        positioned slightly below the eye level. This should be in a way that the  ural light, which is helpful for visual development and may help delay
        child looks down on it and not up. Looking up at a screen can lead to  the progression of myopia or nearsightedness.
        dryness as it leads to a wider opening of eyes. Also, children should be   Eye exams should be part of children’s regular healthcare schedules.
        encouraged to work on a larger screen rather than a smaller phone as   Children may not be forthcoming when they have vision issues or blur-
        children’s eyes must work harder to focus on smaller screens and those   riness. At a minimum, annual vision screenings at your pediatrician’s
 Screen Time and the   that are closer. Encourage your children to position the screen at least  office during well checks should be ensured. If any issue or problem is
                                                              detected during these screenings, the child’s pediatrician may refer the
        an arm’s length away. In fact, a 1-2-10 rule should ideally be followed,
        implying the mobile phones to be positioned at one foot away, laptops
                                                              child to a pediatric ophthalmologist.
 Impact on Children’s Eyes  and desktops at two feet and televisions at 10 feet. This also helps in   nities, but their pervasive use has raised concerns about the negative
                                                                 Screens offer great educational value and entertainment opportu-
        reducing neck and shoulder strain.
                                                              health. Fostering a balanced approach by combining the screen time
        Screen Settings and Glare Elimination                 impact on children’s eyes and physical, cognitive, social and emotional
 By Manpreet S. Chhabra, MD  The font can be adjusted, especially on smaller screens, to about   limits with outdoor activities, regular breaks and appropriate screen
        twice as large as the child can read comfortably, and that can help   positioning can help children safely navigate the highly digitalized
        alleviate eye strain. Modifying screen settings, such as brightness  world while mitigating the potential risks and preserving their eye
        and color temperature, also helps in minimizing the effects of blue   health and overall well-being.
 n the current digital age, children are spending more and more of  edness. Limited outdoor time, along with extended stretches of screen
 their time with devices like smartphones, tablets, computers and   usage, can lead to further progression of myopia that can have more
 Itelevisions, whether for school, work, entertainment or exercise.  visual consequences for these kids.
 A study published in 2011 showed that about 47 percent of children
 indulged in more than two hours of screen time for entertainment pur-  Some of the Other Effects on Overall Health Include:   References:
 poses, but that number increased to 98 percent in the United States   Sleep Disturbances  1.  Maniccia DM, Davison KK, Marshall SJ, Manganello JA and   7.  Foreman J, Salim AT, Praveen A, Fonseka D, Ting DSW,
 in 2019. A lot of attention has gathered on the impact of screen time   Sleep patterns are disrupted because of screen exposure before bed-  Dennison BA. A Meta-analysis of Interventions That Target   Guang He M, Bourne RRA, Crowston J, Wong TY, Dirani M.
 on kids.  time. There is suppression of melatonin, a hormone responsible for   Children's Screen Time for Reduction. Pediatrics 128, e193-e210  Association between digital smart device use and myopia: a
 sleep-wake cycle regulation, that disturbs the sleep cycle. Blue light   2.  Madigan, S, Browne, D, Racine, N, Mori, C and Tough, S. Asso-  systematic review and meta-analysis. Lancet Digit Health. 2021
 Some of the Effects on Children’s Eyes Include:  emitted from the screens alters the body’s natural circadian rhythm,   ciation Between Screen Time and Children’s Performance on a   Dec;3(12):e806-e818
 Eye Strain or Fatigue  which makes it more difficult for kids to fall asleep.   Developmental Screening Test. JAMA Pediatrics 173, 244-250  8.  Huang HM, Chang DS, Wu PC. The Association between Near
 Extended use of screen time can lead to symptoms of eye fatigue or   3.  Trott M, Driscoll R, Irlado E, Pardhan S. Changes and correlates   Work Activities and Myopia in Children-A Systematic Review
 asthenopia characterized by discomfort of the eyes, strain and head-  Physical, Social and Emotional Health  of screen time in adults and children during the COVID-19   and Meta-Analysis. PLoS One. 2015 Oct 20;10(10):e0140419
 ache. There can be more strain on the eyes by any glare on the screen.   Prolonged screen time use leads to a sedentary lifestyle that replac-  pandemic: A systematic review and meta-analysis. EClinicalMed-  9.  Harrington SC, Stack J, O'Dwyer V. Risk factors associated with
 If kids are focusing on the screen from close distances, this can further   es physical activities and can result in an increased risk of obesity and   icine. 2022 Jun;48:101452  myopia in schoolchildren in Ireland. Br J Ophthalmol. 2019
 aggravate the fatigue as the eyes need breaks especially when focusing  other health issues. This also leads to lesser social interactions and more   4.  Coles-Brennan C, Sulley A, Young G. Management of digital   Dec;103(12):1803-1809
 up-close for long periods of time.   social isolation, and can interfere with the development of social skills.   eye strain. Clin Exp Optom. 2019;102(1):18–29. 10.1111/
 Excessive screen time can also impact the emotional health of children,   cxo.12798
 Dryness and Eye Irritation  causing anxiety, stress and mood disturbances.   5.  Nyugen P, Le LK, Nyugen D, et al. The effectiveness of sedentary
 Prolonged periods of screen time can lead to dryness of the eyes   behaviour interventions on sitting time and screen time in chil-
 and eye irritation. Based on the studies, we tend to blink much less  Strategies and What Parents Can Do:  dren and adults: An umbrella review of systematic reviews. Int   Manpreet S. Chhabra, MD, is a board-certified ophthalmologist
 when focusing intently on the screen and that leads to eye dryness. The  The 20-20-20 Rule  J Behav Nutr Phys Act. 2020;17(1):117. 10.1186/s12966-020-  with focus on Pediatric Ophthalmology and related conditions.
 eyes need a clear tear film for clear vision.   The eyes need a break since focusing on the near tasks can lead to   01009-3  He did his ophthalmology residency at the University of
 discomfort. Encourage your children to follow the 20-20-20 rule —   6.  Wang J, Li Y, Musch DC, et al. Progression of myopia in school-  Cincinnati in Ohio and pediatric ophthalmology fellowship
 Myopia  take a 20 second break every 20 minutes to look at something 20 feet   aged children after COVID-19 home confinement. JAMA   at the Northwestern University in Chicago. Dr. Chhabra has over two
 There have been several studies that have shown the correlation of   away — and this leads to lesser eye strain. This approach can allow the   Ophthalmol. 2021;139(3):293–300. 10.1001/jamaophthal-  decades of clinical experience in his field. He practices at Alamo Pediatric
 excessive screen time with the development of myopia or near sight-  eyes to reset and refocus, alleviating eye fatigue.  mol.2020.6239   Eye Center, and is a member of the Bexar County Medical Society.

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