Children's Vision: What Parents Need to Know About Gadgets and Eye Health

Vision plays a dominant role in children's growth, development, and overall performance. With approximately 80% of learning acquired through visual processing, it is crucial for parents to be aware of their child's visual health. Dr. Norazah binti Abdul Rahman, a pediatric ophthalmologist at Subang Jaya Medical Centre, frequently encounters concerned parents seeking answers to questions about their child's vision. 

Furthermore, the excessive use of gadgets and digital screens has raised concerns about the potential impact on children's eyes. In this article, we will delve into the signs of vision problems, the correlation between gadgets and myopia, and provide practical tips to safeguard your child's eye health.

Recognizing children’s vision issues

Vision issues in children can affect various age groups, particularly younger children who may struggle to communicate their visual difficulties. It is crucial for parents to be aware of signs and symptoms that may indicate vision problems in their child. Some of these signs include:

Abnormal eye appearance

  • Abnormal eye reflex. When an apparel light is shined into the pupil, the normal reflex expected is the red eye. When a white reflex, or Leucokoria is seen, this may indicate eye diseases that include cataracts, Retinoblastoma or several other causes. 

  • Droopy eyelid covering pupil. Unchecked, this can lead to a condition called Amblyopia. Commonly referred to as Lazy Eye, this condition decreases vision since the underlying causes could stem from eye misalignment, irregularity of the eye shape or power difference between near and far-sighted. 

Photo from Orbis Cybersight at

Significant congenital ptosis of the right upper lid encroaching into the visual axis. Such significant ptosis can lead to amblyopia, and should be repaired.

Photo from

Abnormal visual behaviours

Pay attention to your child's daily activities such as reading, watching TV, or playing. Some behaviors that may indicate vision difficulties include:

  • Frequently looking at an object with the chin raised, head tilted to one side, or turning the head sideways. This may suggest your child is using one eye to see or has an alignment problem.

  • Squinted eyes (strabismus) where the eyes point in different directions or appear to be drifting apart.

  • Partially closing one eye or shutting one eye to see better, which could be a sign of myopia.

  • Chronic eye irritation, including frequent eye rubbing, watery or teary eyes, sensitivity to light, or frequent eye redness.

  • Shaky eye movement (Nystagmus) can be voluntary or involuntary eye movement, acquired in infancy or later in life, may results in limited or reduced vision.

  • Difficulty completing puzzles or playing with building blocks among toddlers, or difficulties recognizing letters or numbers for older children.

  • Delayed normal physical development, such as walking, picking up dropped objects, or lack of response to facial expressions in babies.

  • Abnormal eye movements or roving eye appearance.

  • Having developmental delay resulting from in-born conditions such as Down’s Syndrome or Cerebral Palsy.

  • Children with hearing impairment or those who have a family history of high refractive errors, squint or lazy eyes.

How gadgets and digital screens are harming your child’s eyes

The use of what we call gadgets are so prevalent in this day and age, that you no longer remember the time when pay-phones were the only way to communicate while travelling.

And then there is myopia. Myopia or short-sighted/near-sightedness is a significant global public health concern rising in importance since the last few decades.

Clearly, there must be a correlation between excessive use of gadgets and global increase of myopia cases. No doubt, contact lenses, glasses or surgery can help to correct short-sightedness, but the underlying problem remains that myopia is caused by a slightly elongated eyeball. So, are smartphones and gadgets to blame for this? The short answer to that is yes.

Blurred vision

Viewing digital screens like laptops or smartphones involves an active vision process called accommodation. It is when the eyes adjust focus from distant to near objects by contracting the ciliary muscles, shaping the lens for clear vision on the retina.

However, prolonged focus on nearby objects, like reading from a smartphone or playing games on laptops or tablets, can strain the ciliary muscles. This strain, known as "Accommodation Spasm," makes distant objects appear blurry, causing temporary pseudo-myopia or false short-sightedness. Fortunately, this condition goes away when you stop using digital screens.

Dry Eyes

When using gadgets and looking at screens, the eyes focus on nearby objects, leading to a reduced blink rate from 15 blinks per minute to about 5 blinks per minute.

Children who use gadgets may sit on adult-sized furniture, like a lower chair while using a laptop. This causes them to look upward at the screen, resulting in wider eyelid opening and increased tear evaporation. The combination of reduced blinking and wider eyelid opening can lead to dry spots on the cornea, known as superficial Punctate Epithelial Erosions (PEE). Symptoms of PEE include dry eye sensation, redness, foreign body sensation, sensitivity to light (photophobia), and burning sensation. Proper diagnosis, treatment, and prognosis of PEE require the expertise of an eye care professional. Treatment options may include artificial tears or topical antibiotic eye drops.

PEE lesions on cornea surface seen under fluorescent light

Increased cases of myopia (short-sightedness)

Spending too much time indoors with a gadget will dissuade children from doing any outdoor physical activities. Studies have found that myopic children have lower levels of dopamine compared to children without any vision problem.

Dopamine is a chemical produced in the brain and acts as a neurotransmitter, also famously known as a feel-good hormone as it creates feeling of happiness and satisfaction. It is found that dopamine helps inhibit the elongation of the eyeball, which is the leading cause of myopia.

Low levels of dopamine relate to reduced motivation and decreased enthusiasm for things that would excite most people. Getting enough sunlight, doing adequate exercise and getting adequate amount of sleep has shown to increase the level of dopamine naturally.

Eye nerve damage

Gadgets employ digital screens which produce blue light rays which in the visible light spectrum has the shortest wavelength but the highest energy. Although our cornea and lens are very effective at blocking UV rays from reaching the sensitive retina at the back of the eyeball, virtually all visible blue light passes through the cornea and lens and reaches the retina. Laboratory studies have shown that too much exposure to blue light can damage light-sensitive cells in the retina. This causes changes that resemble those of macular degeneration, which can lead to permanent vision loss.

The ways to protect your children’s eye health

My kids won’t stop using gadgets. So, what can we do to minimize potential damages to our children’s eyes?

20-20-20 Rule

Many kids spend a substantial period of time looking at smartphones and gadgets, which can lead to eye fatigue and neck strain. To prevent such occurrence, practice a 20-20-20 rule. Every 20 minutes, take 20-second break and focus your eyes on something at least 20 feet away. Frequent breaks while using digital devices can also prevent the occurrence of accommodation spasm or pseudo-myopia. Remind your children to blink frequently and fully while using their devices and use moisturising eye drop when their eyes feels dry.

Limit time exposure to digital screens

The American Academy of Paediatrics have provided a recommendation and guideline for media usage in children from birth to adulthood. Among its recommendations are:

  • For children younger than 18 months old, avoid the use of digital screen other than video chatting.

  • For children aged 2 to 5 years, limit digital screen use to 1 hour/day of high quality program.

  • For children aged 6 and older, there should be consistent limit on the time spent using media, and the limit set must ensure adequate time is allocated for sleeping and physical exercise.

Encourage outdoor activities

It is a well-known fact that outdoor activities such as running, swimming, doing sports and camping keep us healthy, tightens bonds between family and most importantly distracts children from using their gadget. However, our busy schedule and our hot tropical climate will make daily exercise difficult. If this sounds familiar, allocate a period during weekends to exercise, or arrange activities that can be done together in a group, such as camping, participating in running events or hiking. Also, exposure to the morning sun encourage our body to produce more serotonin, a hormone that controls sleep/awake cycle and increases the level of dopamine produces by the body.

Correct Usage of Digital Device

If a digital device is an essential part to your children for any reason, ensure that they practice correct posture while using their devices. The height of the chair should be adjusted so that the laptop/tablet screen is at 15 degrees below their eye level. Looking up to the devices while lying down or sitting in a smaller chair will cause their eyelids to open wider which can lead to dry eyes. The digital screen should be at least 30-40cm away from their eyes. The device should be used under proper lighting, preferably natural light from the sun. If the screen glare is too strong, consider getting a blue light screen or filter that can reduce the level of blue light that can get into their eyes.

Annual Eye Examination

The American Optometric Association (AOA) has released a guideline for paediatric eye health. Research has provided evidence that supports the need of children ages 6 to 18 years to receive a comprehensive eye exam before entering school and annually thereafter. The recommended comprehensive eye exam has shifted from a two-year to a one-year frequency due to increased prevalence of eye and vision disorders.

And finally, look out for sign of eye problem in your child such as headaches, dry eyes, neck and shoulder pains, frequently rubbing their eyes, squinting while reading or watching television, or looking at object with chin raised or head tilted. Factors that could contribute to this are poor lighting, bad seating posture, excessive glare from the screen or simply fatigue.