‘There is not enough evidence to confirm that screen time is in itself harmful to child health at any age,’ said the first ever guidance on children’s screen time published in the UK.
The Royal College of Paediatrics and Child Health (RCHCP) published the ‘Screen Time Guidance’ following a review of evidence by University College London (UCL), which was published in BMJ Open.
It was a slightly surprising statement given the close associations between excessive screen time and poor health – obesity, depressive states and poor diet.
It followed research findings that ‘there is evidence that higher levels of screen time is associated with a variety of health harms for children and young people (CYP), with evidence strongest for obesity, unhealthy diet, depressive symptoms and quality of life’.
However, the RCHCP said: ‘Evidence to guide policy on safe CYP screen time exposure is limited.
‘Although there are negative associations between screen time and poor mental health, sleep and fitness, we cannot be sure that these links are causal, or if other factors are causing both negative health outcomes and higher screen time,’ said Dr Max Davie, officer for health promotion for the RCHCP.
UCL’s ‘systematic review of reviews’ considered 13 reviews to assess the impact of screen time on child health. The reviews covered a diverse range of health areas, from body composition and diet to mental health and cardiovascular risk.
Not one review mentioned eye health. No cause of, or even connection to, poor eye health was discussed in relation to screen time. And this lack of hard and actionable evidence linking screen time and eye health is something that hinders optics. For example, there is not enough concrete evidence concerning the causes of myopia to base policy around and, to make things worse, practitioners are given mixed messages by health authorities.
Mixed messages
Health authorities have been reluctant to suggest causes for eye conditions that may be linked to excessive screen time, such as myopia, given the lack of hard evidence.
‘Although it’s not clear exactly why some people become short-sighted, there are some things that can increase your chances of developing the condition,’ said NHS online advice.
These, it said, included your genes, too little time outdoors and ‘excessive close work’. For its section on close work, the NHS said: ‘Spending a lot of time focusing your eyes on nearby objects, such as reading, writing and possibly using hand-held devices (phones and tablets) and computers can also increase your risk of developing short-sightedness.’
This, however, was somewhat at odds to advice offered by the College of Optometrists.
‘The College has long advocated that the current evidence-base suggests more time spent on near vision tasks does not have a strong influence on myopia development,’ Daniel Hardiman-McCartney, clinical advisor at the College, told Optician.
Hardiman-McCartney also commented on the RCPCH’s guidance. ‘The RCPCH is clear that the evidence of harm is often overstated. It should be noted that the recent review published in the BMJ and advice from the RCPCH did not consider vision or eye health. The College of Optometrists is not aware of evidence to suggest screen use is harmful to eyesight.’
What then, if anything, has caused an increase in concern about prolonged screen time? Research published in the US by The Vision Council in 2018 found 59% of US adults reported ‘experiencing symptoms of digital eye strain’, which it defined as ‘physical discomfort after screen use for longer than two hours at a time’.
It revealed that 32.4% of adults reported experiencing eye strain, 27.2% reported dry eye, 27.7% said they experienced headaches and 27.9% said they had blurred vision as part of digital eye strain. This is the research at the heart of most digital damage claims, although it is yet to be recognised by UK optical bodies, validated on a larger scale and appears to be broadly anecdotal.
However, fears surrounding digital eye strain are not confined to the US.
Awareness is growing
Suppliers of blue light blocking lenses have observed a growth in demand for their products in the UK, fuelled, they say, by growing concern among the population in regard to excessive screen use.
Daniel Nugent, co-founder of Dublin-based Ambr Eyewear, which specialises in blue light blocking glasses, established his company in 2017. ‘Within 18 months, we have achieved online sales in over 60 countries and expect to achieve revenues of $1m in only our second year,’ said Nugent.
He continued: ‘We validated our business idea by looking at Google query volumes and saw that searches for blue light blocking glasses have increased exponentially year on year since 2016.
‘Sales for our product have grown considerably month on month. We launched our website in May 2017 and have seen our website traffic increase by 150% for the same period in 2018.’
He and his partner, Sacha Cahill, have recently launched a retail partnership with Selfridges Group. A growing subculture of people, unconcerned by the lack of scientific endorsement, have been buying into his products. Nugent explained that some customers find out about blue light blocking glasses via ‘their favourite podcast or Instagram personality’.
He cited ‘sleep benefits’ as the main reason for buying the glasses, but also explained how many customers are ‘worried that all this exposure to screens is going to have seriously damaging effects on their long-term visual health’.
Some countries have been less reluctant than the UK to endorse the arguments behind the damaging effects of screen time and have implemented measures to mitigate its potential impacts.
China changes position
By 2020, half the population of China will be myopic – that is around 700 million people. This was the shocking projection that led to a drastic change of position by the Chinese Communist Party (CCP) in regard to how much time its population spends playing video games as part of a burgeoning e-Sports subculture.
e-Sports, a competitive form of gaming, have taken deep root in China. In 2017, 270 million people played e-Sports, constituting 64% of global players, according to Chinese technology giant Tencen.
The Chinese state has had a complicated relationship to e-Sports. A deliberate government push saw e-Sports added to the national curriculum in 2017, with scholarships available to the best students.
Last year, however, China chose to limit the amount of gaming time its children can have, limiting them to one hour a day. Myopia is fast becoming an epidemic that, along with other forms of visual impairment, cost the country $100bn in 2012, according to a 2015 national vision report.
In August last year, CCP President Xi Jinping demanded more national attention to eye health. A week later, an Education Ministry statement sought to justify the new restrictions on screen time as part of a national campaign to mitigate the myopic threat among minors and the subsequent effects on China’s economy.
And the spread of myopia is not confined to the far East. A 2016 Northern Ireland Childhood Errors of Refractions (NICER) study by Ulster University, jointly funded by the College of Optometrists, was the largest longitudinal study into children’s vision in the UK. It showed that ‘myopia is more than twice as prevalent among children in the UK now than in the 1960s’, with nearly one in five UK teens being myopic.
Moreover, children with one or both parents having myopia were three and seven times more likely to develop the condition, respectively. This suggests that as rates of myopia increase there will be a positive feedback loop, meaning increasing cases of myopia across the population.
Given that Chinese intervention was only possible through a state with almost complete control over society, how do practitioners in the UK inform and educate their patients about the potential dangers of prolonged screen time in the face of such mixed messages?
Voices from the high street – Davina Dosanjh
‘For adults and children alike, I recommend a sensible and balanced approach,’ said Davina Dosanjh, optometrist owner of Richard Petrie Optometrists in Derby. ‘I say evidence around the area is still growing. Since the use of screens is now a part of everyday life for us all, we have to try to manage it as avoidance is not an option.’
Dosanjh said she did not have a problem with blue light blocking products. She said: ‘I view it as a choice for me as well my patients. I have specs of my own with Prevencia and Blue Control.
‘The benefits for me come down to less bright white glare from my screen, a little more comfort when driving, even on dull days and this is what I tell my patients. I also tell them their device most likely has a “night mode” which does a similar thing, so they can use this if they choose.
‘At the end of the day, with little hard evidence and guidance, we make our patients aware of the current information and let them decide given our knowledge, experience from research and personal use of these products.’
Voices from the high street – Julian Williams
‘I have long felt the strength of a parent’s stare in the back of my head willing me to tell their child to put the computer devices down because it was doing them harm,’ said Julian Williams, practice manager at CR Williams Opticians in Coventry. ‘But I have always resisted, even though as a parent myself I have been exasperated by the time my son spends on his computers and consoles.’
‘I strongly believe that regular breaks from screens are beneficial from the aspect of tired eyes staring fixedly at one point for too long and tired bodies from a lack of muscular movement leading to headaches and lethargy,’ he explained.
He continued: ‘I tell patients that we can’t escape the genetic factors that would encourage myopia in a child. But if the child does appear to be developing myopia then there is evidence that exposure to daylight reduces the myopic progression, so would encourage outside activities which may consequentially reduce screen time.
‘I can only think of one patient who has had the blue light filter. They actually requested it on the basis of “better to be safe”, even though I said the science is a bit woolly.’