 Hi, I'm Meredith Maher at the University of Maryland Medical Center. Today we're discussing how increased screen time can affect children's eye health with Dr. Ronnie Levin, an assistant professor of ophthalmology and pediatrics at the University of Maryland School of Medicine. Thanks for being here today, Dr. Levin. Thank you, Meredith, for inviting me. And thanks to all of you for watching. We invite you to leave your questions for Dr. Levin in the comments section below, and be sure to like this video to let us know your tuning in. Dr. Levin, what are some of the associated risks with increased screen time among children? That's a great question, Meredith. So as a mother and as a pediatric ophthalmologist, I do have concerns about increased screen time in children. There are three things that we're concerned about. So some studies have actually shown that there is a link to increased attention related disorders like ADHD with increased screen time. Other studies have actually shown that there's an increase in obesity. So children that spend a lot of time in front of a computer screen or in front of a television spend less time on healthier activities like exercise and spending time outdoors. And then finally, the third concern that we have is related to digital eye strain and increased rate of nearsightedness. So there is some evidence that increased screen time can lead to increasing myopia or nearsightedness, which is treatable with glasses, and also with digital eye strain. What exactly is digital eye strain? So digital eye strain is something that we've been seeing more and more during this digital age when individuals are concentrating and focusing on a computer screen for long periods of time. We tend to blink less. So the normal human blink rate is about 15 to 20 times per minute. But when we're staring at a screen, we tend to blink half as much. So if you think about it, like driving in the rain with your windshield wipers off, your vision starts to become blurry and cloudy. When the windshield wipers clean off the windshield, you can see better. So the same thing with blinking. Every time you blink, you refresh the surface of the cornea. That's the clear window or sort of like the windshield of the eye. And so when we're staring at screens, we blink less and our eyes can become blurred, tired. We can develop trouble focusing and difficulty reading. And this is digital eye strain. What are some things parents can do to help prevent or reduce the digital eye strain that their child may experience? Three things that you can do. So the first is called the 2020-20 rule. So every 20 minutes of screen time, you want to take a 20-second break and look 20 feet away. This is a great chance to grab a glass of water. Make sure that your child is staying hydrated. You can literally set a timer on your phone for every 20 minutes and take a break. All of that near work that you're doing, staring at the computer, can strain the eyes. The second thing that you can do is make sure that you're paying attention to your blinking. Now it sounds kind of funny to train your brain to blink, but at the end of every punctuation, at the end of every period, blink your eyes. Encourage your child to blink more and that will become more of a habit. And the third thing is using artificial tears. So if your eyes get tired and dry, you can use artificial tears or rewetting drops. Make sure you don't use any medication that says get the red out. You want to use just lubricating artificial tears and this can refresh the surface of your eye and help reduce eye strain. Do you have any advice related to posture, screen height, even the light that's in the room or behind their child? There's a few things that parents can do to make virtual learning more comfortable. So you want the screen to be at eye level so that the child isn't straining or bending or flexing their head and neck. You also want the screen to be at arm's length away. So for this reason, I prefer using a laptop or a desktop versus something like an iPad, which kids tend to hold closer to their face. And you also want the room, the ambient light in the room to match the brightness of the screen. So you don't want to have your child sit in a dark room. You want to be in a room that's brightly lit and you can also reduce the brightness of the screen to decrease glare. What is the maximum number of recommended hours that a child spends on screen time, whether that's consecutively on the screen or even throughout the day? So the American Academy of Pediatrics actually has a position statement on this and they do recommend less than two hours of screen time a day. Now this is virtually impossible now because the risks of COVID-19 and the risks of public health and safety are far more important than reducing that screen time. So this is going to be virtually impossible. So kids are going to spend time in front of the screen doing virtual school and virtual learning. So what I would recommend is that when we're not doing essential things like maybe doing Zoom meetings with grandparents or virtual school, that kids really spend time outdoors. So take breaks from those screens when you're not using it for essential purposes. Play outside. There's also good science and evidence to suggest that natural light and sun exposure and outdoor play actually reduce the progression of nearsightedness and may help prevent kids from needing nearsighted glasses. So make sure that you take breaks and go outside. And then what are some of the symptoms that a parent should look out for for when they know that it's time to take their child to see a pediatric ophthalmologist? So our pediatricians are fantastic. They screen the kids in their office and they'll refer children that they feel need an eye exam but parents can play an important role in this too. So if there's a family history of eye disease, whether it be strobe business, cross-dyed, lazy eye, or parents needed glasses very early in life, sometimes this can be genetic. So if a parent suspects an eye problem in a child or if a child is really complaining of blurred vision, we always encourage them to bring them in to have an eye exam. Is a family history alone enough to warrant a visit to a pediatric ophthalmologist or even just see their pediatrician or should they be presenting with some sort of symptom? So both are good indications for bringing a child in. We do see history of need for glasses spreading in the family. Another thing that I commonly see is cross-dyed and lazy eye. There is a genetic component to that as well. So I always encourage families to bring children and if there is a history of this and you can always consult with the pediatrician first and see if a child needs further evaluation by a specialist. There's been a lot of articles and headlines and trending over blue glasses lately. Can you tell us what blue glasses are exactly and if they're effective at all? That's a great question Meredith. I get this question literally every day from parents and pediatricians alike. So what blue light is, it's a low wavelength of part of the visible light spectrum. There is actually no good scientific evidence that blue light is harmful to the eye. In fact, there is far more blue light in just ambient outdoor sunlight than there is coming from screens. Most of the blue light is actually filtered by parts of the eye, the cornea and the lens and parts of the retina can actually filter most of the blue light. There is evidence, however, that blue light can affect circadian rhythms and sleep. So blue lights actually beneficial during daytime hours. It can boost your attention and your mood, but it can be disruptive at night. So reducing the blue light component in your screens or maybe avoiding screens all together before your child goes to sleep is a good idea just to help you relax. There's certainly not harmful to the eyes. And if you feel that you want to use them go ahead, but there isn't great scientific evidence in terms of blue light and learning or blue light and eye strain reduction. Is there any other advice you could offer to parents related to their children's eye health, any topics we didn't cover or just anything you like to, I guess, expand on that we did discuss? So that's a great question. Another thing that I've actually been seeing during this COVID-19 pandemic is a lot more patients, children and adults are coming in with symptoms of dry eye. And we've actually found that the masks that we're using are blowing air onto the surface of the cornea and increasing dry eye. It can cause evaporation of tears. And so I do recommend, you know, continue to wear your mask, wash your hands, stay safe in social distance, but when you do wear those masks, try to make sure that they have a good seal. So you want the mask to seal well on your nose so that you're not blowing that air into your eye. And you can also consider blinking more and using those artificial tears to reduce dry eye related eye strain for mask use. For viewers who still have concerns about children's eye health or are interested in scheduling an appointment with you, what do you suggest next? Completely. Our pediatric ophthalmology team is here and available to meet your needs. We see patients in Columbia, Owings Mills, and downtown Baltimore. And so if you have any questions, you can feel free to schedule an appointment or visit our website for more information. Great. That's all the time we have today. Thank you, Dr. LeVen, again, for being here with us. And thanks to all of you for watching. You can continue to leave your questions in the comments section below, and we'll get back to you within 48 hours. If you're interested in learning more, you can visit umm.edu-i or call 667-214-1111 to schedule an appointment. Thank you. Thank you. And please remember to stay safe and healthy. Wash your hands, wear your mask, and social distance.