The Link Between Screen Time and Eye Symptoms in Kids

Priyanka Kumar, MD


June 08, 2018

Editorial Collaboration

Medscape &

Good morning. My name is Priyanka Kumar. I am an attending ophthalmologist at the Children's Hospital of Philadelphia and an assistant professor of ophthalmology at the Perelman School of Medicine at University of Pennsylvania. I am here today to talk to you about screen time and the recommendations for screen time in children.

The guidelines from the American Academy of Pediatrics and the American Academy of Ophthalmology are based on consensus statements.[1,2,3] We recommend that children under 18 months of age avoid all digital screen time, with the exception of video chatting with apps such as FaceTime, Skype, WhatsApp, and similar types of programs. This is to make sure that we are stimulating them with natural visual stimuli in order to support visual development.

For children aged 18-24 months of age, it is recommended that parents and families slowly introduce digital screen time to their children. Parents should be actively involved with what is being watched, monitoring what is being seen, and educating their children about the program and the content.

For children who are 2-5 years of age, we recommend limiting screen time to about an hour a day. It is important to remember that this includes TV, computer, iPad, tablets, iPhones, and other types of electronic programming, with the exception of video chatting. It is really important to try to make sure that parents are showing their children high-quality programming and are still actively involved in terms of what is being watched and teaching their children about what is being seen.

For kids age 6 years and over, the limits are a little less clear. We understand that it can be very difficult to limit screen time based on the amount of homework that is being prescribed and the time that children need to spend on the computer to successfully accomplish their schoolwork. With that being said, it is important to really encourage children to do other things with their time. We still recommend limiting screen time in general to 1-2 hours a day, if possible.

This is important because we know that adults develop symptoms associated with a computer vision syndrome when they spend excess time on the computer or screens of any kind.[4] These symptoms include headaches, fatigue, and asthenopia. We would assume that children are at risk of developing these same symptoms. That is why these limits are in place.

Interestingly enough, these [recommended] limits and [expectation of types of symptoms that may occur] are not based on any hard and fast science. However, more and more research is being done that tells us there is probably a correlation between these symptoms and screen time. A paper published in 2017[5] found that children with more than 3 hours a day of total screen time are at a higher risk of developing asthenopia, headaches, motor tics, and potentially even refractive error.

This study was retrospective and observational, with a small cohort, and thus highlights the fact that we need more research in this area. We would really like to understand this a little better.

The flip side is that more work is being done examining the role of video games and dichoptic computer games to treat amblyopia which, for decades, has been treated with patching, eye drops, and glasses. I think this is an interesting area of research because children would much prefer to play a video game to having to wear a patch on their eye.

The research is showing us that all of these modalities used together potentially could treat amblyopia equally as effectively and improve compliance. Look out for the results from the next papers about these types of studies. Hopefully, we will have more information about this topic in general. Thank you for your attention.

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