BLOG: How to raise a non-myopic kid in a world of screens
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John Wilmot once said, “Before I got married, I had six theories about raising children; now, I have six children and no theories.”
To be sure, raising my three kids (now aged 20, 17 and 13 years) has challenged every skill my wife and I have ever learned. The world is filled with distractions, making it nearly impossible for them to be disciplined on matters that affect their long-term well-being, like taking care of their bodies. The allure of unhealthy foods, video games and addictive social media, and the sedentary lifestyle that accompanies all three, can cause real long-term damage, even in early childhood.
Progressive myopia is another danger that comes with a life of screens, and it brings along the risk for retinal detachment, maculopathy, and the need for corrective lenses or surgery. Mounting evidence suggests, though, that we can combat myopia if we start at an early age. At least four approaches are worth considering.
1. Unstructured outdoor play time is first and maybe most important of all. Having children spend time outdoors not only exposes them to sunlight that combats the development of myopia, according to a 2018 study of almost 700 children in Taiwan, but it also teaches them habits and problem-solving skills they can’t learn on a screen. Richard Louv’s brilliant book Last Child in the Woods outlines the development of and treatment for a condition he calls “nature deficit disorder.” Several studies have shown that kids who spend more time outside are more resilient and have greater persistence in overcoming challenges, both physical and intellectual. When kids do spend time on screens, doing so outdoors — when possible — makes a ton of sense. It also eases the enforcement of the next rule.
2. Obey the 20-20-20 rule. Simply put, every 20 minutes on a screen should be interrupted by 20 seconds looking at objects at least 20 feet away. Relaxing accommodation in this way is thought to break the cycle of muscular contraction that drives axial elongation of the eye and myopia. When you are reading outside, there are more natural distractions than indoors, making it easier to stop, look up and relax accommodation.
3. Limit screen time. iOS, Android and Windows systems all offer robust parental controls that can limit screen time and restrict content. Unfortunately, about half of parents do not use these features to help their children, according to the Pew Research Center. Setting reasonable limits for screen time, which can be configured differently on weekdays vs. weekends, makes effortless and blameless the art of controlling screen access. Controlling the content itself to that which is age appropriate is also underutilized by parents, leading to all kinds of social problems for kids, but that is a subject for a different column.
4. Cycloplegic drops. As discussed in the cover story of this issue of Healio/Ocular Surgery News, atropine in doses from 0.01% to 0.05% has demonstrated slowing of myopia progression without causing photophobia or meaningful loss of accommodation in youngsters. Although no FDA-approved formulations are yet available, both Sydnexis, with its phase 3 STAR study, and Eyenovia, with its phase 3 CHAPERONE study involving an intriguing Optejet dispenser that may one day replace eye drops, are nearing availability. Meanwhile, compounded preparations are widely available, if only parents will administer them. Interestingly, the CooperVision MiSight daily disposable contact lens has also demonstrated slowing of myopia progression in children aged 8 to 12 years and may be useful for those who can wear contact lenses.
Success in parenting is hard to define and even harder to achieve, but my wife and I have mostly focused on teaching self-regulation, relaxing restrictions as our kids have demonstrated they can balance their own lives. The approach has mostly paid off. Despite my wife’s myopia history, only 1 D of myopia has appeared in one eye of one of our kids (sounds like future monovision to me). Active effort to curb myopia is certainly worthwhile. But the most important advice I have embraced on child raising came from a patient of mine who was a pediatric psychologist. As a new parent, I asked her, “How can I avoid screwing up my kids.” Her answer? “You’re going to make a lot of mistakes as parents, but your kids will probably turn out fine if they know every day that you love them.”
References:
Part 4: The role of parents in digital safekeeping and advice-giving. https://www.pewresearch.org/internet/2011/11/09/part-4-the-role-of- parents-in-digital-safekeeping-and-advice-giving/. Published Nov. 9, 2011. Accessed May 31, 2023.
Wu PC, et al. Ophthalmology. 2018;doi:10.1016/j.ophtha.2017.12.011.
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