The Balancing Act Between Eye Health and Increasing Technology in Classrooms

The COVID-19 pandemic has had implications for many areas of daily life, including the increased use of virtual learning for children in school. With up to 94% of children’s screen time use coming from virtual classes,¹ it has become more important than ever for educators and eye doctors to consider a balance to avert long-term implications for developing children.

Long-term Effects Start at a Young Age

The use of computers and smart devices in schools at a young age can have significant adverse effects for children in the long term. A systematic review published in The Lancet found that screen time on smart devices and computers was significantly associated with myopia,² and a study published in Ophthalmic Epidemiology found that more than 75% of students sampled in Nanjing, China, experienced symptoms of computer vision syndrome, including dry eyes and itchiness.³

“Prescriptions, in terms of nearsightedness, [are] happening at a higher frequency than [they] used to, and the magnitude of the prescriptions is greater than ever before,” said Noah Tannen, OD, FAAO, FCOVD, an optometrist at EyeCare Professionals in New Jersey. “And researchers have linked that to virtual learning and also just more time spent indoors throughout the pandemic.”

Tannen explained that children having higher prescriptions now means that these children will have to contend with the side effects of the high prescriptions later in life, which can include retinal tears or detachment.

“The risk for retinal detachment goes up considerably with each diopter of prescription and especially over a –6 or –7 is what’s considered pathological, and the risk factors are quite high when you get to that range,” he said.

Early onset is the biggest predictor for how high the prescription will end up, which makes the importance of prevention all the greater in children of a young age. “Luckily, there are things that we can do now to mitigate or counteract the impact that a lot of screen time or the pandemic has been having on vision,” he said.

Technology in the Classroom: A Constant Shift

When children couldn’t get to class in person in March 2020, a shift to online learning occurred across the country and the state.

Sabina Ellis, a data manager in the South Orange/Maplewood, New Jersey, school district and the chairperson of the New Jersey Education Association (NJEA) technology committee, said, “Since the pandemic, screen time did increase, I can say that for sure. Especially in the last 3 years, screen time [increased] when it came to Chromebooks, students using their own laptops, iPhones, Androids, tablets.”

Gabriel Tanglao, associate director of the Human and Civil Rights, Equity, and Governance division of the NJEA, said that the increase in screen time also came from needing to ensure that children were still learning during the pandemic. “Obviously, there’s a dramatic increase in the use of technology.…We needed to ensure that students had access to technology to access learning. There were districts that invested in ensuring that there’s more technology available,” he said.

Ellis added, “And parents love it, the options: ‘Oh, my kid is sick, we can still attend school. We’re not missing out on a lot of instructional time.’”

Both said that the technology also comes with needing a sense of balance. Ellis noted that the use of technology has affected children’s social and mental health, as many children returned to school in person and had a hard time disconnecting from the virtual world and interacting with others in a healthy way. Tanglao said that the brain chemistry of children is something to keep an eye on as technology can be addicting.

The Balancing Act: Avoiding Constant Screen Time

As Tannen explained, constant screen time can have implications on retinal health in the long term for children with strong prescriptions in their early life, so avoiding constant screen time is paramount in developing eye health.

Both Tannen and Tanglao spoke about the need for breaks in the day from screen time. “You’re supposed to have as good practice to look away from a screen every 20 minutes, focus on on an object that’s 20 feet away for at least 20 seconds,” said Tanglao.

Tannen added that 20-minute breaks from the screen can be beneficial for children in classrooms.

Ellis noted that teachers in her school district have started emphasizing writing more in the classroom, as kids have nearly forgotten how to write after 2 years of solely typing.

“Starting in January, teachers started to back away from Chromebooks. They started doing more handouts and writing…So just practicing penmanship, turning off the lights, back[ing] away from the computer,” she explained. “So that’s where they’re trying to step away from technology. It’s good in one aspect, but then when learning that, we’re losing our life skills.”

“We can’t think of this as binary: technology is good/technology is bad, screen time is good/screen time is bad. There’s no going back to non–screen-based learning,” said Steve Baker, director of communications for NJEA. “So it’s really a matter of...how to incorporate it and how to avoid the risks involved with overutilizing technology.”

Moving Forward: Future Plans for Schools

Collaboration between educators and eye doctors to properly account for children’s eye health is key to the continued conversation on eye health in school children.

“I would love to go into schools and talk with teachers and administrators and educate them and increase awareness,” said Tannen. “It’s a delicate balance because kids now do have to be technologically literate.”

He added that incorporating outdoor activities in the school day, like recess or gym, and having outdoor classes when the weather allows can go a long way in preventing eyesight from deteriorating.

Ellis said that in September, children in New Jersey, beginning with pre-K, will start to have mandatory school time dedicated to learning about technology, like learning how to use a computer, and listening to doctors is important when introducing that.

“There has to be a balance. It’s not good to be on a screen, like our parents would tell us,” she said. “That’s across the board on working with students, we have to just step away. It’s okay to step away and take that walk outside; it’s okay to play outside.”

Tanglao said that wellness should always be paramount in making future decisions about technology in the classroom. “I appreciate the framing of keeping wellness at the center of this conversation around tech literacy and the development of it, so just making sure that that’s at the center as we think about the development of young folks and our educators,” he said.

Collaboration between educators and doctors to assess and address the influence that technology in the classroom has on vision and eye health will be critical in achieving a proper balance of teaching children about technology while also maintaining their health.

References

1. Kaur K, Kannusamy V, Gurnani B, Mouttapa F, Balakrishnan L. Knowledge, attitude, and practice patterns related to digital eye strain among parents of children attending online classes in the COVID-19 era: a cross-sectional study. J Pediatr Ophthalmol Strabismus. Published online December 20, 2021. doi:10.3928/01913913-20211019-01
2. Foreman J, Salim AT, Praveen A, et al. Association between digital smart device use and myopia: a systematic review and meta-analysis. Lancet Digit Health. 2021;3(12):E806-E818. doi:10.1016/S2589-7500(21)00135-7
3. Li R, Ying B, Qian Y, et al. Prevalence of self-reported symptoms of computer vision syndrome and associated risk factors among school students in China during the COVID-19 pandemic. Ophthalmic Epidemiol. Published online August 25, 2021. doi:10.1080/09286586.2021.1963786