As a father of five I can worry a lot about my children – especially the amount of time they spend on their phones and screens.
My particular concern is their eyesight – that we’re raising a generation who can swipe before they can walk and, if we’re not careful, as a result some could go blind before they grow up.
Sounds overly dramatic? Look at the numbers and you’ll realise this isn’t a scare story – it’s a slow-burn public health disaster.
A study published at the end of last year in the British Journal of Ophthalmology which examined global rates of myopia (short-sightedness) in children and adolescents from 1990 onwards found that these tripled between 1990 and 2023, with 36 per cent of teenagers across the world now short-sighted.
Why? The paper makes it crystal clear: although genes are important in determining if you are short-sighted, the real driver of this rising incidence is the way we’re bringing up our kids.
Children today spend far less time outdoors and far more time staring at smart phones and tablets.
This ‘near work’ overload, combined with a lack of daylight, is quite literally reshaping their eyeballs – their eyes are growing too long, and that structural change sets them up for serious problems down the line.
The reason exposure to natural light matters is that it helps control the steady growth of the eyeball. It’s thought that bright outdoor light triggers the release of dopamine in the eye, which stops it becoming too elongated – the cause of myopia.
Professor Alex Day says we need to start taking children’s eye health more seriously as cases of myopia rise among younger generations
This concern about rising rates of myopia in children is not new. It’s been floated by various small studies for some time. But it’s now been proven beyond doubt by groundbreaking research published by Jama Network Open last month.
When researchers from Seoul National University College of Medicine analysed data from 45 studies encompassing over 335,000 participants (average age of 9.3 years) they found that for each additional hour of daily screen time, the child had a 21 per cent increased risk of developing myopia.
Notably, the risk jumps after just one hour of exposure per day, suggesting that limiting screen time to less than an hour daily is what we as parents should be doing.
And the reason all this matters isn’t simply because these kids will need glasses, but because of the serious complications associated with abnormally shaped eyeballs – such as retinal detachment, glaucoma and macular degeneration (when the part of the eye that sees sharp, straight-ahead vision is damaged with age), which are all major causes of blindness.
The problem is that as the eyeball elongates, the back part of the eye called the retina – which ‘sees’ the images and sends them to the brain – stretches and thins, making it more fragile and vulnerable to tears, which can cause the retina to detach.
If the macula is damaged it causes a type of macular degeneration called myopic maculopathy. Meanwhile, the optic nerve which sends the images to the brain is compressed, making the eye much more vulnerable to damage from a build-up of the fluid inside the eyeball – the hallmark of glaucoma. As a dad, I’ll admit that I often end up giving my toddler my phone to placate him when I’m trying to get ready in the morning. Until I read this study.
So what’s the answer? Well, clearly I’ve had to try and stop giving my toddler my phone.
But getting your kids outside more is also key.
A report from the Education Committee published in 2024 found the amount of time 5–15-year-olds spent online rose from an average of 9 hours per week in 2009, to 15 hours per week in 2018
Research published in the British Journal of Ophthalmology in 2022 found that the more time children spent outside, the lower the rates of myopia.
Similarly, when confronted by rising rates of myopia in school children – up to 50 per cent – some schools in Taiwan introduced mandatory outdoor time (80 minutes a day) which has halved short-sightedness rates. Yet in the UK, many schools are pushing screens as part of digital learning rather than getting them outside exercising.
Though if they are inside, mimicking the outdoors may help. Research from Central South University in China showed that children taught in classrooms decorated with detailed, nature-themed images slowed their short-sightedness over a year. This is because when we look at detailed, high-contrast scenes (such as trees, grass or a cloudy sky) it tells the eye: ‘You’re seeing the world clearly – no need to stretch or grow longer.’
At home, as well as getting kids playing outdoors more, we need to limit screen time, and build habits, such as the 20-20-20 rule: every 20 minutes of screen time, get them to look at something 20 feet away for at least 20 seconds.
But there is some good news if your child or grandchild is already short-sighted, with a breakthrough treatment that many parents and many health professionals – myself included, until I researched this column – don’t yet know about.
A few weeks ago, The Cochrane Review, an authoritative body that assess evidence for treatments, published a report on kids’ short-sightedness after examining 64 trials across 11 different countries, involving over 11,000 children.
The therapy that actually works? Low-dose atropine eye drops.
The drops don’t reverse myopia, but they hit the brakes on it. Eye growth is driven by signals in the retina and the sclera (the white outer wall of the eye) activating particular receptors called muscarinic receptors. Atropine is a drug that blocks muscarinic receptors, controlling the growth of the eyeball.
More studies are needed, and it’s not yet available on the NHS, but many parents are turning to private providers.
For adults, there are, of course, laser treatments and replacement lenses. Nothing can change the shape of your eyeball but laser eye surgery, such as Lasik (laser-assisted in situ keratomileusis) can reshape the clear layer at the front of the eye called the cornea. Or you can have new lenses inserted to change how light rays are directed on to the back of your eye.
I did this seven years ago after I went swimming with my then-three-year-old and my glasses came off in the pool. Being effectively blind without my glasses I couldn’t see my little boy and embarrassingly needed the help of a lifeguard.
But I was scared about the risks of the procedure. In my job I need to be able to see very clearly to suture wounds and I was anxious that, if anything went wrong, I would not be able to do my job.
My anxieties were calmed by talking to Professor Alex Day, one of Europe’s leading laser eye and cataract surgeons working out of the world-leading Moorfields Eye Hospital in London.
One eye was shaped to see things in the distance and one eye for near reading, so I didn’t need reading glasses as I aged.
Last week, I spoke to Professor Day about the rise in myopia. ‘We’re increasingly seeing younger children coming in with significant myopia,’ he told me. ‘It’s a growing problem that will get worse and worse until society starts to truly value children’s eye health.’
As with most things, when it comes to eye health, prevention is better than cure. But fortunately if prevention fails there are techniques to help you see as clearly as you did when you were a child.
