Maryland eye doctors see more complaints about eye pain from kids due to virtual learning

Dr. M. Roni Levin, pediatric ophthalmologist and assistant professor of ophthalmology and pediatrics at the University of Maryland School of Medicine, offers tips to help children avoid eye strain with increased screen time due to virtual learning.

Heather Webb, a Baltimore County mother of two and a senior administrator at Johns Hopkins Hospital, knew from the early stages of the coronavirus pandemic that having her kids home during the school day would pose logistical problems for her family.

But Webb, tasked with keeping the hospital running, said the brunt of the burden has largely fallen on her 8-year-old son, Paul.


“Paul is a hyperactive kid and wants to know everything about different things,” she said. “It’s very difficult to sit someone like him in front of the computer all day.”

Paul has increasingly complained about headaches since he started virtual learning, Webb said, and she has taken him to see his pediatrician and given him pain relievers every week. She blames the newfound discomfort on the surge in time Paul now spends in front of screens.


“This digital learning is almost like 24/7 hell, for lack of a better phrase,” she said.

In anticipation of this untraditional fall term — where thousands upon thousands of students have not yet returned to schoolhouses as COVID-19 remains virulent — the American Academy of Ophthalmology said in August that parents and children should anticipate the unintended consequences of digital learning and the effects it can have on the body.

“I was a digital eye strain naysayer prior to recent events,” said Dr. Stephen Lipsky, a pediatric ophthalmologist and clinical spokesperson for the academy, in a statement. “But in my practice, I really have seen a marked increase in kids suffering from eye strain because of increased screen time.”

That sentiment has been echoed by eye doctors in Maryland, who say they have fielded more questions and concerns about digital eye strain than usual from families as most school systems take the school year online.

“This problem has been coming up more and more since the springtime,” said Dr. M. Roni Levin, an assistant professor of ophthalmology at the University of Maryland School of Medicine.

Levin answered some of the most frequently asked questions in a Facebook Live video posted by the University of Maryland Medical Center last week. Already, it has nearly 50,000 views.

Levin said three main concerns stem from the new, virtual normal.

Some studies show that children who spend more than two hours per day in front of screens are nearly eight times more likely to have inattention problems; there could be a link between screen time and obesity, and long-term eye strain could cause permanent nearsightedness, she said.


But two equitable and easy remedies could help offset these unintended consequences: Blinking more and spending more time offline.

Levin recommends using what she calls the “20, 20, 20 rule,” or spending 20 seconds looking 20 feet away for every 20 minutes spent looking at the computer or the tablet.

She also encourages remote learners and workers to blink more often than they think they should. To do this, set timers, take breaks and bookmark stopping points in books and work packets.

She compared blinking to using windshield wipers when it rains; without doing so, visibility worsens.

When people concentrate on screens, they blink less, she said, and that precipitates blurry vision or dry eyes. Lubricating eye drops can help — but regular and frequent blinking can, too.

Adults and kids who spend much of their day on digital platforms also should try to limit their nonessential screen time, she added. More time spent playing outdoors and exercising could lessen the threats associated with weight gain as well as digital eye strain.


“We are all adjusting to virtual learning, and obviously we have to weigh the risks and benefits,” Levin said. “Considering the public health issues, it’s important to stay socially distant. So, encouraging the blinking and spending more time outdoors are practical, and you can do both without spending lots of money.”

There’s also the posture problem. Both Levin and the American Academy of Ophthalmology recommend positioning the computer screen about an arm’s length away from students and at eye level to prevent neck discomfort. The screen should be dimmed to reduce strain on the eyes, and the room should be well lit with light coming from behind the computer to reduce glare.

As for those trendy glasses that claim to filter blue light, Levin said they are not proven to prevent eye strain or discomfort. They might help people sleep better, she said, but can be an expensive fix for a problem with free and simple solutions.

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Tonya Sweat, the vice president of advocacy for Maryland PTA, said while the group supports distance learning for now, the board has concerns about some of the wellness problems that students and educators could experience, especially as the pandemic drags on.

“The health of our children is our No. 1 priority,” said Sweat, adding that her organization had prior concerns about the digital divide, nutrition and mental health among students who do not have the ready resources of the school system at their disposal. “This is just another issue, and it may be something that parents don’t even have awareness of yet."

For Webb, the Hopkins administrator, virtual learning’s limited reach for children like Paul who benefit from specialized attention provides further evidence that students should go back to the classroom. But other parents said they prefer to handle virtual learning and its associated problems at home to help keep kids, teachers and other essential school personnel safe.


Elisa Alonso, a Towson mother of four children between ages 1 and 10, said she wants to keep them home for now, but acknowledged it’s causing some issues.

“We were not a huge screen-time family before this, so I find that being on screen all day means that the kids are very wired at the end of the day,” she said. “Their heads hurt, they’re tired, they’re not learning as much — there’s no good solution.”

Alonso said she has been taking her kids for short walks around the block when she can, but as a working parent, she finds it isn’t always easy to find the time in her schedule. But she would rather have the kids at home and frustrated than back at school with hundreds of other students — at least for now.

“I just hope they keep giving us the option to do things online, and I hope they offer teachers flexibility,” Alonso said. “I don’t plan to send my kids back to school until the case count is really low.”