The Effects of Too Much Screen Time on Children’s Vision

By Dr. Rahul Bhola, pediatric ophthalmologist at CHOC Children’s

Technology has become an integral part of our daily lives. As we become increasingly more reliant on and absorbed in technology, many children are exposed to smart devices at less than 5 years of age. These devices have also become an integral teaching tool in classrooms—more than half of teachers in the United States use smart devices in elementary school. According to the U.S. Department of Education, 97 percent of classrooms in the U.S. have at least one computer. School screen time coupled with at-home smart device usage can on an average expose a student aged 8-18 years to media for more than ten hours a day.

As children’s exposure to screen time rises, many parents wonder how harmful excessive exposure to electronic media can be. While on one hand, an early exposure to technology might prepare children for future careers in technology-related fields, or jobs that require mastery of technology as a fundamental key to success. On the other hand, children overly immersed in this technology and not otherwise challenged can become socially stunted and ridden with health-related issues due to decreased physical activity.

Dr. Rahul Bhola
Dr. Rahul Bhola, pediatric ophthalmologist at CHOC Children’s.

One of the biggest health issues related to smart devices are vision related. A recent study by the National Eye Institute found that the frequency of myopia, also known as near-sightedness, has jumped exponentially in Americans over the last few decades. Two clear reasons for this spike in myopia are an increased amount of time spent looking at things up close and also a lack of outdoor activities. Focusing on things too close to the eyes for a prolonged period puts excessive strain on the eyes and has been found to hasten the progression of myopia. Although genetic risks of myopia cannot be modified, limiting the amount of strain on eyes by avoiding excessive time spent looking at things up close can minimize environmental risk factors. It is imperative to prevent prolonged exposure of up-close work (such as reading) in children by allowing small breaks (during prolonged reading sessions, for example).

The American Academy of Pediatrics (AAP) recently revised the recommendations for screen time in childhood.

  • 18 months and younger: no screen time is still best. The exception is live video chat with family and friends.
  • 18 months to 2 years: limit screen time and avoid solo use. Choose high-quality programming, and watch with kids to ensure understanding.
  • 2 to 5 years: limit screen time to an hour a day. Parents should watch as well to ensure understanding and application to their world.
  • 6 or older: place consistent limits on the time spent and types of media. Don’t let screen time affect sleep, exercise or other behaviors.
screen time
The American Academy of Pediatrics released new guidelines on how much screen time is appropriate for children.

A separate study recently found that excessive screen time usage in adolescents was associated with development of acute onset esotropia, or crossing of the eyes, and that limiting usage of these gadgets decreased the degree of eye crossing in these patients. A portion of the patients in this study had to undergo surgery to correct esotropia.

Excessive screen time can also lead to “Computer Vision Syndrome” which is a combination of headaches, eye strain, fatigue, blurry vision for distance, and excessive dry eyes. There’s a number of things you can do to help avoid these symptoms:

  • Check the ergonomics of the workstation. Placing the screens 20 to 28 inches away from the child’s eyes and aligning the top of the screen at eye level so that the children look down at the screen while they work.
  • Restrict entertainment-related screen time to two hours or less a day
  • Practice the 20-20-20 rule: After every 20 minutes of screen time, take a 20-second break and look 20 feet away.
  • Remind children to blink regularly to avoid excessive dry eyes.

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Meet Dr. Rahul Bhola

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Rahul Bhola, an internationally recognized expert in pediatric ophthalmology.

Dr. Bhola comes from a family of physicians. His parents practiced internal medicine for more than 40 years in India, and the empathetic and holistic care they provided to their patients inspired him to pursue a career in medicine.

“Very early on in medical school, I developed a special interest in pediatrics, and the surgical finesse of ophthalmology later cemented my passion for pediatric ophthalmology. A gift of vision is the most important sense a child can have,” Dr. Bhola says. “Giving a ray of light to those who struggle with vision is very gratifying to me. Treating children is important to me because they have their entire lives ahead of them and improving their vision positively impacts their entire family.”

Dr. Bhola attended medical school and completed an internship at University College of Medical Sciences in Delhi, India. He completed two residencies in ophthalmology at Maulana Azad Medical College in New Delhi, India and the University of Louisville, Kentucky. He pursued fellowships in pediatric ophthalmology at the University of California Los Angeles and University of Iowa.

“The biggest reason I was inspired to join CHOC was the mission of the hospital. I feel that CHOC’s mission to nurture, advance and protect the health and well-being of children is in close alignment with my personal goals as a physician,” Bhola says. “I seek to nurture the healthcare of children by delivering state-of-the-art ophthalmology care to our fabulous community. CHOC has the resources, reputation and experience to provide great care.”

At CHOC, Dr. Bhola will provide comprehensive eye care, treating patients with a variety of eye disease and disorders. In addition to treating refractive errors (the need for glasses), Dr. Bhola will provide more specialized care for diseases like amblyopia (lazy eyes), pediatric and adult strabismus (crossing or drifting of eyes), blocked tear duct, diplopia (double vision), pediatric cataracts, pediatric glaucoma, tearing eyes, retinopathy of prematurity, ptosis (droopy eyelids), traumatic eye injuries and uveitis.

Dr. Rahul Bhola
Meet Dr. Rahul Bhola, pediatric ophthalmologist at CHOC Children’s.

The Need for Regular Eye Screenings

Dr. Bhola is passionate about providing education on the need for regular eye screenings. For example, kids complaining of headaches may be taken to a neurologist. However, eye problems like refractive errors (the need for glasses), convergence insufficiency and strabismus can result in headache from excessive straining of the eyes, which may affect school performance and even social withdrawal in some children. These conditions are likely to be identified at regular vision screenings.

Unique Approach To Treating Pediatric Glaucoma

Dr. Bhola is among the very few surgeons nationally skilled in treating pediatric glaucoma surgically using the illuminated microcatheter. This highly-specialized, minimally-invasive approach of canaloplasty has been used for treating pediatric glaucoma only within the last five years. The onset of juvenile glaucoma often occurs between the ages of 10 and 20. It can be secondary to genetics, or traumatic.

“Even though childhood glaucoma is an uncommon disorder, it often goes undetected and can eventually result in blindness, underscoring the importance of regular eye screenings,” says Dr. Bhola.

As a Level II pediatric trauma center, and the only one in Orange County dedicated exclusively for kids, CHOC’s trauma team treats a variety of critically injured from across the region. This includes children who have sustained sports injuries, during which damage to the structure of the eye can cause glaucoma.

Patient-Centered Care

Dr. Bhola’s philosophy of care is to treat his patients as if they were his own children.

“My main philosophy is to provide patient-centered care, delivered with compassion and excellence. I remember their life events, and celebrate their achievements with them. It’s important that a patient remembers and trusts you completely with their care. I love when my patients send me holiday cards and copies of their school photos and let me know how they are doing. They became part of my family. I always treat every patient of mine like they are my own child,” Dr. Bhola says.

He also focuses on treating the whole person rather than the disease, and involving patients in their care.

“I don’t treat the disease, I treat the individual. Healing is more than treating the disease. I want to be at their level so I always talk to them directly and not only talk to their parents. I involve their entire group during treatment,” he says.

At CHOC, Dr. Bhola is eager to provide holistic eye care for his patients.

“My practice will offer complete comprehensive vision care to all patients, which includes both medical as well as surgical care. Our patients come to us for glasses, contacts, regular vision screenings, and we also provide more specialized care like glaucoma, cataract and strabismus surgeries,” Bhola says. “Systemic disorders such as diabetes, sickle cell anemia, juvenile rheumatic disease and lupus, have coexisting eye issues that may go undetected if children aren’t seen for regular eye screenings. CHOC patients with systemic disorders such as diabetes now have better access to holistic care.”

As division chief for CHOC Children’s Specialists ophthalmology, Dr. Bhola is passionate about providing state-of-the-art care to patients and training the next generation of pediatric ophthalmologists.

“My main goal is to build a state-of-the-art ophthalmology division, not only delivering excellent patient care but also engaging in vital research and disseminating education to the next generation of ophthalmologists and referring providers,” Bhola says.

When not treating patients, Dr. Bhola enjoys cooking, practicing yoga and meditation and spending time with his wife and two daughters.

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