The perils of extended screen time: why decent guidelines are needed

When research published by Dr Alex Müntz at the School of Ophthalmology revealed that young people using screens for long hours were showing signs of an eye condition usually seen in the elderly, alarm bells rang.

“But we should be wary of adding to the anxiety we’re already having in this pandemic,” says Alex.

“It’s more important to think of our daily habits long term, not necessarily now while we need to be online for work and learning.”

The research that attracted attention came from a study of more than 450 young attendees at a 2019 Auckland gaming convention. It showed that, on average, they had around 43 hours of screentime a week across all devices, which aligns with OECD data on children in New Zealand.

Research has consistently shown that extended screen use is linked to dry eye disease in adults, but it’s also becoming common in younger people.

“Some of our older patients have such bad dry eye they can’t open their eyes for several hours or leave the house, which can lead to depression,” says Alex. “It’s an invisible condition that’s like sandpaper on your eyes and can also affect vision. We don’t want children going down that path.”

He says the problem with handheld devices is that the content is interactive, and people scroll and engage.

“That affects blinking because when you’re focusing up close, you blink less.”

Dry eye is complex and other factors play a part, including water intake, diet, sleep, alcohol and caffeine. The non-modifiable factors are age, gender and ethnicity.

“Your risk increases if you are Asian, female or post-menopause,” says Alex. “Preliminary work shows Māori may also be at higher risk. We’re investigating if that’s to do with the anatomy of the eye or other factors.”

In terms of screen use, there are ways to ameliorate risk, such as do less online. International guidelines say children under two shouldn’t have any close screentime and from around two, up to an hour a day. While there are apps for babies, they’re not recommended or needed.

“If you’ve had a tough day or you’re on an aeroplane, there’s no harm in a child using a screen for a limited time every now and then. The issue is with daily unlimited use from an early age.”

What causes dry eye in people using screens all day is that they don’t blink enough. However, forcing yourself to blink can be an effective remedy. Alex and his team have undertaken studies that get people with dry eye to do blinking exercises.

“Every 20 minutes you do this sequence: gently shut your eyes, open, shut, squeeze and open. It’s a bit of an investment, but after a month of doing it, people reported much better symptoms and we saw better clinical signs.”

He says artificial tears can help, but shouldn’t be the first line of defence.

“It won’t circumvent the fact you’re doing 16 hours of screen time each day. You’re better off training yourself to blink more, and reduce screen use. If needed, eye drops must be good quality and non-preserved. Get advice from an optometrist or someone specialising in dry eye.”

Alex says voices in neonatal care have singled out screentime from an early age as the biggest threat to neonatal development in New Zealand.

“We have among the highest digital screen use in education in the world. Yet we have a limited understanding of the risks involved with high screen use in children and how it affects many areas of health, not just eyes. Research is now emerging, so we need to develop and implement guidelines for safe screen use in a child’s early years.”

Heavy screen use isn’t just associated with dry eye, but also myopia (short-sightedness).

“Screens, especially smartphones, mean a close working distance for many hours a day and a lack of natural sunlight. This drives the growth of the eye, which results in myopia. Excessive growth leads to high myopia, which dramatically increases the risk of blinding diseases. Wearing glasses does not solve or prevent that,” says Alex.

“While some schools in New Zealand are going full digital immersion, in parts of Asia, where up to 99 percent of teenagers have myopia, screen use is being reduced in the face of emerging evidence.”

Parts of the US and Australia have already started adopting policies to reduce screen use in schools – and don’t allow phones at all.

Alex realises the world has changed and we need to bear that in mind. “But there are tablet holders for cots now! What happens if a young child spends ten hours a day on screen?”

Alex is part of a multidisciplinary group of clinicians, scientists and educators collaborating to support the development of evidence-based guidelines relating to screen use in children. He says teachers and caregivers need New Zealand information based on research.

“Colleagues in clinics are seeing children who have been gaming for up to 16 hours a day – forgoing sleep, food and school. Some stay up all night to engage with the North American market because they see becoming a professional gamer as a viable career option.”

As well as eye issues, some develop serious health problems relating to posture and weight, and mental health due to social isolation.

“Covid-19 has exacerbated screen use in children and youth with the adoption of online learning, so it’s time for the potential health impacts to be taken seriously and for pragmatic health guidelines to be made available in New Zealand.”

He says adults do have alternatives. “You can pick up a book, or phone rather than Zoom.”

Alex makes a conscious effort to be off-screen as much as he can, even at work, and pen and paper remain trusted tools. He loves reading actual books and playing in the real world, be it the guitar, cycling, skateboarding or on his new motorbike.

Born and raised in Transylvania in Romania, Alex has been here for four years. At 18, he went to Germany for his optometry training. He then studied in Canada for seven years, completing his PhD in the university town of Waterloo.

His toddler son is yet to meet his overseas family. But if they do make the long plane trip, Alex says his son will certainly be allowed lots of screentime.

“I do have one emergency app when there’s no other way. It’s uncanny, you hand over the iPad and it’s quiet. When you take it away all hell breaks loose, but you may be ready to deal with it by then!”

He says information is power when it comes to safe amounts of screentime.

“As a society, I’m hoping we are at the peak of a phase where we’re just enamoured with technology and can’t see the alternatives. We will eventually find more awareness and the balance that’s needed.

"You can’t be in bed at 3am scrolling through TikTok. That’s just not viable.”

Denise Montgomery