Visual Stress And What It’s Doing To Our Children: The Little Known Side-Effects Of Online Learning

April 18, 2020

An entire generation of children has been kept home from school, and many for who knows how long? In many instances, they’ve been given ‘online learning’ for their education, but that’s come at great cost. Some of the highest cost, however, is on their eyes and visual processing, and it’s important we take steps to minimize injury.

At the end of last year, my husband and I took our son to a Vision Therapist Optometrist at the suggestion of our son’s occupational therapist. When he was younger, my son was diagnosed with dyspraxia, and last summer, with dysgraphia, and the new OT we were seeing felt strongly that there were issues going on with his vision and visual processing that were really impacting his progress and holding him back from doing even better than he already was.

I explained to her that I *had* taken my son to the ‘best pediatric eye doctor’ not only in Florida, where we’d previously lived, but here in Maryland where we live now.

And that’s when everything I thought I’d ever *known* about vision and visual processing changed.

What Is The Difference Between Sight and Vision?

Being told by several incredible pediatric ophthalmologists that my son had superior sight, I didn’t really know what to expect when we first met with Dr. Bryce Applebaum of Applebaum Vision in Bethesda, Maryland. We filled out a lot of paperwork about my son, and many of the questions were ones I would expect if I was having my son evaluated for ADHD or a learning disorder.

My son is a straight-A student, never a behavior issue and is a wise old soul. He’d be the last person anyone would consider ADHD in behavior, and even with dysgraphia, because we’ve taken him to OT for many years, he still did well and even excelled. He never fit the ‘mold’ of a child with vision problems…or so I thought.

In just the first half-hour of the exam, I noticed how my son’s attitude and behavior changed. He went from a sweet, rational little boy to a very short-tempered, emotional being in front of our eyes. It was almost a Jekyll/Hyde event. Even his face changed, as he looked battle-worn and the bags under his eyes were very noticeable.

When we met with Dr. Bryce about a quarter of the way through the 2-hour evaluation, I learned why.

My son was suffering from visual stress. The tasks required in the evaluation were taxing, and they were not allowing my son to use any of the ‘modifications’ he typically used (leaning to one side, covering his eyes some, squinting, etc). His brain was overloaded, despite his ‘superior sight’ because superior sight does not mean one has superior visual perception. Sight is what you see and how well you can see it. It’s your ability to see and how clearly. Vision is different, it’s how you comprehend and process and perceive what your sight feeds your brain, and it’s different. Visual perception is how you are able to interpret the environment around you using light and objects, and how your brain processes all that information? Well, that’s a whole bunch of neural connections that really blow my mind.

The visual stress my son was experiencing was in large part due to his convergence insufficiency and intermittent exotropia. But visual stress, and particularly excessive visual stress, can come from any experience/situation that taxes your eyes and your brain’s processing.

The visual stress our children as a whole are now facing as a result of COVID-19? Scary, and we absolutely have to learn about it and learn how to minimize the damages.

Dr. Applebaum says he’s worried about our children in general, as so many are learning exclusively through screens, technology and tangible demonstrations. Now, though, as schools across the world are canceled and ‘distance’ or ‘online learning’ is now a new norm? The visual demands that we are putting upon our children are coming at great cost.

Dr. Bryce tells us that the majority of functional vision problems come as a result of our children not having developed the appropriate visual skills and abilities they need to meet the visual demands we place on them. When our visual systems are asked to operate under less than ideal conditions, we start to see problems and maladaptations like headaches, visual fatigue, eye strain and general behavior changes.

In a few words, as we demand they use screens MORE in an effort to continue their education, we’re tasking them visually to the point that we see physical and behavioral ramifications.

According to Dr. Applebaum, while many feel that most vision disorders are either naturally occurring or hereditary, there’s a large body of evidence that many non-pathological (disease) vision disorders are actually related to how we use our eyes and the ergonomics involved. Simply put, we can damage our eyes if we are not sitting appropriately and stare at computer screens at inappropriate distances and for inappropriate times. Dr. Bryce told me that some common eye conditions like nearsightedness (can’t see far away) and astigmatism could develop from doing near work (like reading/writing, etc.) excessively, as well as having poor posture while reading or working from a desk or with a computer. As he told me, I immediately thought about the many, many nights I’d read by flashlight or my nightlight well past my bedtime as a little girl, and how myopic (nearsighted) I’ve been since childhood.

Additionally, Dr. Bryce told me that some other functional vision disorders, though less known, were a breakdown in visual efficiency skills due to prolonged visual stress and poor posture. Some of these involve eye teaming (fusion), focusing (accommodation) and eye-tracking (saccadic).

The thing is, some visual conditions have very obvious symptoms. When your child tells you things are blurry or they see double, you immediately think you have to get them to the eye doctor.

But Dr. Bryce says that the diagnosis of ‘perfect sight,’ doesn’t always guarantee that critical visual skills are functioning efficiently and intact. In fact, some of the lesser-known symptoms of visual stress and visual overload are actually some of the most prominent symptoms you find in children with ADHD/ADD and dyslexia! Behavior issues, muscle tension, irritability, prolonged avoidance of work…all of those symptoms and more could (and often are) be indicators of visual stress. Think your kids are off the hook because the world has broken and their entire routines are out of whack? Probably so.

Just trust that all the extra visual stimulus they’re most likely getting in the form of screens for online learning or just to occupy the time are not helping, despite what you may read about from those who will say now is not the time to worry about screen limits.

Now is when we have to worry about it the most

Computer Vision Syndrome: A Tragic Side-Effect of COVID-19?

Computer Vision Syndrome (CVS) existed well before the self-isolation and distance learning lives we now lead due to COVID-19. CVS has been around as long as computers have been around because in a nutshell? It is the result of too much time spent on the computer. Computer Vision Syndrome can cause blurry vision, double vision, sore eyes, headaches, fatigue, and even environmentally created myopia (nearsightedness). When your child is no longer watching his teacher in the classroom, and instead watching a screen, she is no longer able to effectively explore the space around her as her focus is solely on a screen with blue-lights. She is no longer figuring out how to process what she takes in visually with the information she also takes in with her other ambient senses, and is forcing her visual sensory system to work in ways it wasn’t really designed to at the level we’re asking them, particularly now with online schooling.

Related: I Don’t Use My Child’s Distance Learning Plan During COVID-19

Computers are a part of our daily life, and now so more than ever. They’ve become part of our children’s lives too, as about 85-90% of school-aged children either have a computer or use them in schools. About 20-30% of college students today will tell you that they started using computers before they were 9-years-old, and in 2015, The Vision Council found that approximately 1 in 4 children spend over three hours a day using digital devices. This goes against (what we believe are still too high) the standards the American Academy of Pediatrics puts out with their recommendation of two hours per day max.

And while many may believe that glasses are just a part of life for some–your mother and her mother and her mother’s mother may have worn them too–some eye doctors specializing in children’s vision like Dr. Applebaum believe sustained computer use may put kids at higher risks for developing childhood myopia. A University of California at Berkley School of Optometry study found that there was a strong correlation between the development of nearsightedness in 253 children, and the amount of time they spent on the computer.

What Is It About Screens That Make Them So Dangerous For Kids’ Eyes?

Many people believe the danger of too much screen-time exists in the content your kids are watching. We wouldn’t serve them a plate of rotten food to fuel their bodies, and no, we shouldn’t be okay with rotten content fueling their brains and their development.

But it’s not just the danger of content in screen-time consumption that we need to worry about and manage. When children are sitting in front of a screen or a tablet or a device for hours on end, they’re stressing their eyes because the computer makes their vision system strain and focus a lot more than most any other task we ask of them. Using a computer or tablet stresses your eyes more than reading a print magazine or book because it’s harder for us to focus on computer-generated images than it is for us to focus on printed images. For children, whose visual system is ever-developing, it can be especially taxing.

And then, there’s the concern about long-term effects of blue light exposure. Blue light is known as high-energy visible, or HEV, and it penetrates our eyes even deeper than ultraviolet light does. Excessive exposure to blue light from tablets and devices is even more dangerous for our kids, according to the American Optometric Association. This is because children have little understanding of what they see as being normal or not simply because they’re younger and their life experience is less developed. They’re smaller than adults, and so they will often sit too close to a screen or sit in weird positions that strain their neck, eyes and shoulders in ways they’re not meant to be. And, research suggests that children’s retinas are at risk for more blue light damage than an adult since their lenses absorbed less short-wavelength light than an adult lens would. This means that more blue light gets to a child’s retina than it does an adult’s and they’re especially vulnerable for risk.

This is why it’s imperative that when your kids ARE using screens for schoolwork or anything else? They need to use blue-light blocking glasses like these.

In no uncertain terms, distance learning through computers, tablets and devices carries significant potential for eye and visual system damage.

How To Prevent Visual Stress Damage

So what are you to do? Your kids may have to use screens to do school right now, and for the unforeseeable future. How can you minimize risk and damage to your child’s eyes in this time of screen-dependence like we’ve never seen?

Dr. Applebaum has a few suggestions:

Make sure your children are sitting on chairs that let their feet sit flat on the floor and their legs at a 90-degree angle. Too often, this means your kitchen table is too high, ergonomically speaking, so use stools/boxes/whatever you can to try to achieve this positioning.
If your kids are reading, writing or watching a screen, try to have them do so at a distance that is equal to the length of their arm from elbow to middle knuckle. This is known as Harmon distance, and will have them strain less.
Make sure that they’re not tilting their heads when they’re watching a screen. This means that you don’t want them to use a computer or tablet if they’re lying on their back or their stomach, and yes…we know this may be tough to enforce, but it’s super important.
Make sure your monitor/device screen is bright enough. Don’t let them strain any more than they already may be.
Make their work periods shorter. Yes, we know this may mean less productivity for you, but we promise, it’s for their good. Have them take frequent breaks if they’re using the computer or tablet extensively, and make sure they’re following the 20-20-20 rule. This means for every 20 minutes of screen time, ensure they’re looking away at something at least 20 feet away and for at least 20 seconds.
If you can enlarge the font on your screens, do so. Try to have font no less than 14-point for less straining.
Take out conflicting peripheral stimuli. This means to remove materials or input that’s not related to the task. So, no, no music while doing their math online. The less they have to process, the better their sensory system is for it.
Dr. Bryce stresses balanced and adequate lighting in the room and at the desk as pivotal. If there is reduced lighting or glare in the room, there is an effect of decreasing peripheral vision sensitivity.
Use as large a monitor as possible. We know for many of us thrown into distance/online learning, it means your phone. Try to use as infrequently as possible.
Don’t let your children sit closer than 6-8 feet from the television.
Make sure that time OUTDOORS equals (or ideally, according to Dr. Bryce, exceeds) time spent on screens. If outdoors is not possible, at least encourage screen-free activities that encourage good habits, motor development and executive functioning skill-building.

We’ve put together a list of some of our favorite activities, games and puzzles that are screen-free and which offer lots of screen-free fun and engagement. Many of these help teach your children tons of important skills–critical thinking and reasoning, problem-solving, logic, fine and gross-motor skills and more. The most important thing is that they’re screen-free, and engaging, which means your child will want to choose THEM over screens when they have the choice. Considering many of our children have to use screens for school? We want to have lots of screen-free options to help them fill the rest of their quarantine time.

Screen-Free Fun For the Whole Family

Cinemood Projector: Okay, okay…so if you MUST do screens, there are safer ways to do it! The Cinemood will let your family explore national parks, the galaxy and more, and yes…there is NO SCREEN. Cinemood is a projector that comes preloaded with fun interactive games, content and the ability to watch NetFlix/YouTube with the family in a much smarter way. Because it’s a projector, there’s no screen, no blue light and no worries about having to choose online school or family movie night to protect your family’s eyes.

Hand2Mind Magnets : Hand2Mind makes tons of educational and fun resources for schools, homeschoolers and now quaran-schoolers, and we love this magnet set. There are 9 experiments and 20 real lab tools that will encourage your kids to be scientists. And we love that Hand2ind has launched their Learning At Home Platform, filled with real-time content created by on-staff educators. They provide math and literacy content that’s great for our at-home learners.
Puzzles. Okay, okay, so you can’t go to Paris right now, but with Ravensburger puzzles, you can go a lot of places! Puzzles are GREAT ways for your family to strengthen visual processing skills, together, and have fun in the process.
Marble Runs. Marble runs like these from Gravitrax are SUPER cool (and screen-free) ways to have a blast and build critical-thinking and problem-solving skills. Every time your child plays, they can create new paths, and that means there’s endless (and screen-less) fun for a while.
Minecraft Builders and Biomes: Want your Minecraft fans to get their fix without the screens? Here you go! Minecraft Builders and Biomes is a great way to enjoy Minecraft screen-free, and it builds all kinds of awesome skills while your kids play.

Ninja Slackers Outdoor Play: Okay, who does NOT want to play on their very own obstacle course? If you have the trees and the space, this offers ENDLESS outside play opportunity that your kids will run to all day long.
Dog Crimes: This single-player logic game is loads of fun for kids, and each game is a new challenge! Screen-free entertainment that they can play independently with, and seriously. We can’t get enough of poor old Beans!
Brio Builder Record and Play Set: This incredible building set from beloved Brio is a great way for siblings to work together, screen-free, for loads of fun. They’ll put this amazing little bot together and then wait for the giggles as they’re recording themselves.
iPlay, iLearn Bowling Set: A great way to develop fine-motor, gross-motor and basic math and coordination skills!
Frogs Games Kit: This is a fun game that has come whacky rules and consequences, and we love that they’re made responsibly and sustainably. They also have a lifetime guarantee.
Oh My Gourd: This is fun for the whole family and takes just 15 minutes or so to play. A great way to build bonding and offer a break for screen-time.
Wise Alec Family Trivia Game: Another fun game for the whole family; it’s family trivia that has two levels of trivia so young and older can play together.

Obviously, these are just a few of our favorite ways to spend time without needing to resort to screens, and there are tons more on the market.

The most important thing is that you realize the potential for damage to your children’s eyes and you continue to err on the side of caution when it comes to excessive screen time.

We wish we could be one of those publications that says “Desperate times call for desperate measures,” (and we are, sometimes!), but when it comes to your children’s eyes and their visual processing and sensory systems? We want you to know the truth.

When we know better, we can do better, and mamas, we understand you have to do what you have to do. But when you have the option for your kids to be screen-free, especially during a world pandemic? Please, please take it.

If you have any questions about your child’s eyes/vision systems or more, contact a developmental optometrist who is certified in Vision Therapy and Rehabilitation like Dr. Applebaum is. If you’d like to read and learn more, you can find the information at Vision Help, COVD and the Vision and Learning Project.

Photo: Sam Wordley/Shutterstock

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