Screen Time and Myopia: What Every Parent Needs to Know

Welcome to Where Parents Talk. My name is Leanne Castellino.

Our guest today is an award winning optometrist. Dr. Meenal Agrawal specializes in nearsightedness in children, contact lens fittings and laser vision correction. She's the owner of a trio of eye health clinics in the greater Toronto area and hosts a podcast. Dr. Agrawal is also a mother of three kids under the age of nine. She joins us today from Toronto. Thank you so much for taking the time. Thank you for having me today.

It is a very popular topic these days because we are surrounded by screens virtually everywhere. So as a starting point, I wonder if you could paint a picture of the current state as it relates to, you know, eye health and our exposure to screens. What does that currently look like? Yeah, so, I mean, you know, with kids and learning being online, we are, our kids are on screens all day and so, so are most of us, you know, sitting at home now, working from home.

So screens have become a big part of our life and it's affecting us, you know, in all aspects, whether it's socially, cognitively and eye health wise as well. And I think the stat is somewhere around like ages 8 to 12, kids are exposed to screens four to six hours a day. And I think as teenagers, it goes up to almost nine hours a day, which is ridiculous. But that's the stat out there.

I think that the biggest thing for eye health is the proximity of the screens is causing or increasing our rate of nearsightedness, which is myopia. So many of us are, many of our children are getting into glasses at ages that are much younger than expected. Sometimes I'll see a child for an eye exam one year and they have no prescription, and then the next year they're shocking me with a significant prescription. We never had that when I first started practicing 16 years ago.

So it's the proximity. So whether it's a laptop, whether it's an iPad or whether it's a phone, it's the same thing. Your muscles are working to look at things up close and it's causing that nearsightedness.

So certainly cause for concern when you talk about younger kids coming to see you with myopia, which has been called by many people a global epidemic, by the way. But I wonder, like from and within that group of kids that you are seeing, what concerns you about how they're presenting to you. Yeah, I think, I think a lot of parents are in denial as well.

I think there's a whole denial part to it where they're not Bringing their children in until there is significant changes in their myopia, such that they are, you know, having to bring things very, very close. Before, we used to get children just coming in for their regular routine annual eye exams where we would catch it at very early stages. The problem with that is under correction or not being corrected is a stimulus to myopia progression.

So when they're not coming in for these eye exams and we're waiting till they have to be right up to the TV or right up to their books, we're already at a, you know, minus two minus stage and there's already that myopia increase. And the problem is with increased nearsightedness comes increased risk of eye diseases. And that's why we're worried. You know, you know, as a mom and, or a parent and as a clinician, there's, there's two aspects to it. As a parent, I worry about numbers.

Numbers matter to me. Whether my child's a minus one or my child's a minus two, that matters. But as a clinician, what matters to me is not the minus 1 or 2. What matters to me is that jump from minus 1 to minus 2 has just must increase that child's risk of myopic maculopathy, retinal detachments or retinal diseases, cataracts, glaucoma, all diseases of the eyes.

So for us as clinicians, it's the myopia matters because of the rate of disease that these child, children are going to be exposed to as they get older. Such an important point. And I think that really begs the question, like, what does it need to look like optimally? What age do kids need to go in and see an eye specialist as opposed to a pediatrician who's doing that quick sort of eye exam. Obviously a big difference between those two types of exams. So what should that look like?

Yeah, so I mean, a great first step is, you know, a school vision screening or a pediatrician, you know, that's at least some sort of flagging of an issue. But I encourage parents to take their children in for annual eye exams starting at the age of 6 months. I know that sounds odd because most parents are like, well, my six month old can't read letters or can't tell you pictures. That's not what we're looking at. So we are able to detect mild prescriptions without them reading us letters.

Reading us letters or pictures is just a bonus for us. But we are able to tell if they have prescriptions and obviously check their ocular health. There are two Parts to a child or an adult eye exam. One is the vision component. Vision component includes the prescription, includes eye alignment, depth perception, color vision, and then there's the ocular health check, which includes the retinal health, the ocular surface health check, and possibly even the pressure check for some children.

So there's two parts to it, and that's what we call a comprehensive eye exam. So, you know, I really urge parents to take their children in annually, so starting at 6 months of age and then annually after that. And, you know, I always say we will. We're quick to visit the dentist or, you know, the family doctor every year, but we forget about our eyes. And for me, obviously, it's the most important sense that we have. And without vision, you know, it's a struggle at school for children.

It's an interesting point, right, Because I don't know where I health ranks in terms of the average parent when you're talking about physical health and mental health and emotional health and all of these things. What needs to change to get that message out there to your point, And I think a lot of parents would be quite surprised to hear you say, starting at six months, to change the narrative on eye health care. You know what I think? Stats, you know, the stats don't lie, right?

So right now in Ontario, I think I recently saw a stat by the Canadian National Institute for the blind. There was 2% of, you know, Ontario children are going in for their regular eye exams. I was actually shocked by that. I thought it would be much higher. But that's scary, right? Whether it's lack of access to care or lack of awareness. But like you mentioned, right now 30% of the world is nearsighted and it is projected that that stat goes up to 50% by the year 2050.

I believe a big, big part of it is the, is the device. But that's scary. 50% of our children will be into glasses and will be at high risk of these eye health diseases. So, you know, I'm urging parents not to be scared of going into the eye doctor to find out that their child needs glasses. I mean, we all are. My daughter, actually just recently I found out she needs glasses, you know, and I was nervous as a parent too, right?

I'm like, you know, I don't want my child into glasses, especially as an eye doctor. I'm like, no, she doesn't need it, but. But I would rather her get into it now. And, you know, we can try to control. There are myopia control methods that a lot of optometrists are performing and it's a therapy that's so effective. So if you can catch it early, then we are able to control it early.

But if we're going to wait till that child's a minus three, minus four, we missed, you know, a big section there, a big chunk there that we could have controlled. So in what other ways then along those very lines can a parent, in addition to, let's say, taking their child in for an eye appointment annually and starting at six months, are there any other ways that parents can be proactive about their child's eye health? Yeah, so I mean, a couple of things.

Well, first, you know, I think parents need to talk to their children as well and, you know, find out are they seeing. Well, a lot of us aren't asking our children those questions when they're coming home from school. You know, can you see the board? Just something basic like that will help. Help. You'd be surprised how many, you know, 10, 11, 12 year olds will come into my room and just say, oh yeah, I can't see from one eye. And I'm like, oh, did you mention that to your parents?

You know, and it's been a while and they just assumed it was normal. So a conversation is important to have with your children. A basic home test is also great, like just covering one eye and making sure they're relatively equal. Checking the pupils of your, of your children is so important. So you know, you can see the black holes inside the colored part of the eye.

Making sure they're relatively equal is important too, because that, that can flag signs of eye health issues or neurological issues, but also just device usage. Right. We have this 20, 20, 20 rule which is every 20 minutes for 20 seconds, look 20ft or just far away. Most of us don't follow that, but that's a recommended, you know, sort of time period where we can take breaks. And a break does not mean going from, you know, my kids will go from the laptop straight to the phone, right?

That's, it should be a break from near work. And I say anything, every, everything is near that you can touch. So if you can touch it, it's considered near work where your muscles are straining up close. So I would rather you even go from a laptop to a TV than go from a laptop to an iPhone, you know, so those are ways that parents can, can really help their child. And just getting good lighting, that's another big one. So studying smarter.

I want to say when you are, you know, you have your child's desk set up have it set up near a. So there's natural light. Artificial light can sometimes be a little bit harsh or strenuous on the eyes, but natural light is always the best. Or having overall room lighting versus just a desk lamp that's always better and helps to our muscles to relax. And the other, you know, and a big proven fact that I want to stress is outdoor time. So outdoor.

Increased outdoor time has been proven to slow the onset of nearsightedness or myopia down. So an extra 15 to 20 minutes has even been shown to be very effective. So I know they get recess at school, but, you know, even after school, they're out in the backyard for 15, 20 minutes. That's great. So increasing that outdoor time will also help with their eye health or nearsightedness.

I want to follow up on something you mentioned there, which has to do with, you know, going for an eye test and maybe seeing potential eye diseases that can result from that test. Are there any other things that an eye test, a comprehensive eye test can reveal about a child? Yeah. So, I mean, obviously eye health issues and there. And there's so many of them. But, you know, I'm going to say that the eyes are like the window to the body. Right.

So that was a statement that used to be talked about a lot, but it's actually true. So, you know, for certain children, I mean, it's not as common in children as it is in adults, but like hypertension, diabetes, cholesterol plaques, for children, we will see more neurological tics or their pupils are varying size. And sometimes that can be an indication of a neurological issue. Signs of cancer or masses in the eyes can be signs of, you know, malignancy in the body.

There's so many things that we can see in our eyes that are indicative of medication that our children on. You know, I saw a child recently, recently who was on a steroid, and the steroid has caused, you know, cataracts. It's caused a prescription shift, you know, so we are obviously collaborating with her nephrologist to help decrease that medication or change the medication. But. And your eyes are really the windows to your body.

So why do you think then, Dr. Agarwal, that, you know, eye health still seems to take a back seat to other parts of the body and other, you know, emotional, mental, as we mentioned, other things to worry about as it concerns our health. I think it's always been almost like a stigma or a thought process that your eye doctor only checks your prescription. And it was almost like we were laughed at, at the beginning that, oh, your eye doctor just does one or two better, right?

But people are missing the whole second part of it. And I think it's us as optometrists as well, or I hear eye care professionals to advocate and explain to our patients what's happening every step of the way. So, for example, when I'm checking a patient's prescription, I tell them that when I'm checking their eye pressure, I tell them why I'm checking their eye pressure or I'm, you know, dilating their eyes or checking their renal health, I tell them why. And I think that's important.

And, and that's on us to maybe start increasing awareness and advocating early preventive care. So let's say you're a parent who is, has got tweens, teens, young adults in the family. That's a different conversation. It's, you know, it's a different communication, certainly. And let's say you haven't been as diligent about their eye health. Now you've heard this interview, now you're all over it.

What kind of compelling argument can you make to a young person in that age group to get them to be advocates for their own eye health? I think a lot of children and parents are scared of glasses. So I think once they end up going to the eye doctor and discovering, you know, they have a mild prescription or hearing it from their eye doctor, that you might develop a prescription.

So I will tell parents if I can detect a very small amount of a prescription that we don't even prescribe at that point, but I will plant that seed so that they start decreasing their device usage or they start making those proactive sort of efforts towards decreasing progression. And sometimes we can scope the eye and just see that they might become near sightedness or they're nearsighted, or they're not following on trend as they should be as a child. We're able to see trends.

And I think sort of planting that seed to these children or parents sometimes will make them more fearful of it and actually take that proactive step to, you know, whether it's decreasing your device usage or getting more outdoor time. But, you know, 80% of learning is visual. That's a very scary, unknown stat. I have seen children that are on individualized Education plans, or IEP as we call it here, and they come to see us for an eye exam saying we're their last resort.

They're on these plans and they're still struggling at school and they're minus threes. It's as simple as they need glasses or they're plus fours where they're farsighted and their muscles are not able to sustain doing work. It's as simple as a pair of glasses that can transform their life.

I urge parents that have children who are struggling learning to read or just on IEPs, have your child's eye tested because you have no idea how many things can, you know, a plus 0.5 can make wonders and do wonders. And I've seen it. So that's really the take home from that. Definitely. And during back to school season, lots of this stuff may be on our radar more than other times of the year. Right.

So what would you say to a parent in terms of what they could be looking out for as kids get back to school and into the routine, you know, into the books and computers and all the rest of it, to be on top of potential eye issues? Yeah. So I think some of the warning signs, I guess that your child might need an eye exam ASAP might be we see a lot of head tilts. We'll see the preferring of one eye where they'll, you know, want to only prefer one eye versus the other.

We'll see excessive blinking, you know, squinting, misalignment of the eyes where you find at times, you know, when of the eyes turns in or both turn in or out. So misalignment is a big one as well. And then the obvious, which is going closer to the tv, which we get a lot of, or going closer to the board, or, you know, if you have your work up close, coming really up close to it. So those are kind of the quick warning signs that, you know, you should visit your optometrist asap.

What about a child who maybe is trying to hide some of those elements from their parents and now the parents are in the dark, but maybe it's more pronounced when they're at school. Like, is there anything else that, you know, parents need to be mindful of to sort of detect that case? I think for me, like, I'm just thinking about my kids and if they were at school and they were hiding it from me, I think the, the biggest telltale sign would be their performance at school.

So if they're not doing well, you know, parent teacher interviews, report cards, not up to, to speed or on par with grade level. That's a classic question I ask every child's parent entering. Is the child on par with grade level and you know, with reading, learning, math, you know, everything.

And another big one actually I shouldn't have mentioned was the lack of Attention so that a lot of children that are not able to focus and, you know, we say, oh, they're just not attentive or they're rambunctious. Sometimes it's vision, and so they can't concentrate, their muscles can't, you know, get coordinated. So they just start, you know, daydreaming and being silly. And a lot of times that's vision.

So if you're not sure, I would obviously talk to your teacher and see how they're doing at school. But regardless, I would take them in for a visit at the end of the day.

Let's talk a little bit about your lived experience. Now, you were diagnosed with glaucoma at the age of 11. Could you take us through what kind of impact that had on you at such a young age and how that sort of influenced your life from there on? Yeah, so, I mean, that's actually when I wanted to be an optometrist. So I decided at 11, you know, I was kind of scared because for me it was the type of glaucoma where the eye pressure was high.

And so when I was told that, you know, it was a lot of stress on the family because when you Google it or you looked it up, it was all about blindness, you know, and obviously having that at a younger age is always more impactful. And so it was a lot of visits, a lot of visits to the hospital, my optometrist, a lot of care. I had four types of drops that I was doing 11 times a day to help control my eye pressure. And we have much better treatments now.

This was years ago, so now it's down to one or two drops a day. But back then we didn't have that. But I think it was living in fear that was very stressful. I was a minus 10 prescription. So it kind of added up, you know, the high prescription, probably have glaucoma, you know, or could have glaucoma. So I lived in fear for. For my whole life, but I was well controlled, and I'm well controlled on drops and, you know, so I truly believe in catching it early.

But the interesting thing is I had been seeing an optometrist, you know, since I was young because I was a minus 10 prescription. So I was getting new glasses every year. And it was only when I moved optometrist or changed because we moved at the age 11 that I was detected with glaucoma. So it is really important that doctors and parents know that eye diseases are not only for the elderly or 40, 50 plus. Right. Eye diseases can happen in children. It's not as common, but it can happen.

And that's very important for us to know that you're not just going into the optometrist because you want to get the vision checked. You're going in because you need to ensure that there's no disease. And if there is, we need to start preventive care now.

Now, along those same lines, having lived that yourself and now being the mother of three young children, I wonder how that has influenced, not to mention your, your professional path, how all of that has influenced how you manage eye health in your own home with your own children. Yeah, so I'm crazy. I'm very proactive with that. So, you know, obviously we have, for me, a big part of it was the myopia. Right.

And I truly believe that that was a significant risk factor for me having a disease and for everything. So I really want to control the nearsightedness. I mean, I know some of it is genetic and I can't, but as much as I can. So my kids have a lot of outdoor time. I mean, it's the moment they're home, they're thrown in the backyard, right. And the screen. So we have a lot of screen free times or periods where I say there are no screens, whether, you know, it's an iPhone, iPad, whatever, it.

So we have those screen free times. They are taking breaks. I never, like if I can catch them, I'm like, no, off, everything goes off. And another big one is dryness. So a lot of kids are blinking a lot because they're getting dry because they're on a lot of devices which requires staring. So we're not blinking enough. And therefore when we're off the device, we blink more trying to gain those tears.

So I proactively put artificial tears, non preserved artificial tears, as they're more safer in my kids regular. And I always compare it to lotion. It's like, you know, we'll always put cream on our face, but we'll never do anything for our eyes. Or we're floss our teeth and brush our teeth, but we don't do anything for our eyes. So, you know, if your child can take it, it's not harmful to put drops and it's very good. And it soothes the eyes and helps coat that surface.

So that's another one I'm a big advocate of. And then obviously eating is a big component to eye health. It's a big component to everything. So eating healthy, you know, vegetables, fruits, antioxidants from The Berry family, all great for your eye health as well.

Are there any other misconceptions that you have heard from your patients, the parents that you see of the children that come to see you, that parents make misconceptions by parents around eye health that you think really need to be addressed?

I think the biggest one around eye health is the fact that your children cannot have diseases. A lot of parents think they can't have them as children, children. So that. That's a big misconception. The other one I find is the glasses component to it, that if they don't or they shouldn't wear glasses because if they wear them, they'll become dependent on them and therefore their vision will get worse. So that's a big misconception. And so many studies have thrown that misconception out.

There's hundreds of studies on the net about that, that not correcting your child is actually or can be a stimulus to progression. So, you know, I want to really debunk that myth that please do not feel that glasses are going to make things worse or make. Of course your child's going to get dependent on it because they're going to feel good.

Either they're going to see better, or in a farsighted child's case, their muscles are going to be relaxed, so they're going to be able to do their work better. So of course they're going to get dependent on it. They're going to like it, and that's a good thing. And I compare that to, you know, when you're on a treadmill and, you know, for adults, I'll compare it to, as we're getting older, we'll. We won't run on a treadmill.

We're going to wear a knee brace to help us, and then, you know, we might walk on the treadmill to help protect our knees. It's the same idea. So glasses are your crutch. It's what's going to help your muscles relax so things possibly don't get worse, but also so you can see better, process that information. As children, you want to be able to see and process the information that the school is giving you faster and better.

Do you feel like we've reached some kind of critical point where we're at? You know, you mentioned some pretty stark statistics off the top there and projecting forward, like, where do we go from here if younger kids at a younger age are developing nearsightedness or myopia and maybe going undiagnosed in terms of other kids, like, what needs to happen in terms of really addressing this issue among parents and families actively. I think awareness really needs to increase.

And I think that's, you know, thankful to, thankful to you to, you know, have this episode in order to raise that awareness because we're really trying. There's a lot of groups that are upcoming. You know, there's myopia awareness months now out there, you know, where we are really trying as a profession to increase that awareness. So parents are aware that this is really going to be a big thing by the year 2050. And we're, we're almost there. We're at 30% like that. That's significant.

And for us, it's again, it's about the eye health. It's not about the numbers. So, you know, I hope that parents listen to this and really proactively take their children in, but also take those proactive steps at home so you can save your child's eye health. Dr. Minal Aggarwal, optometrist podcast host and mother of three, thank you so much for your time and your insight today. Thank you so much for having me.