I seem to discuss eLearning multiple times a day. Most of us are involved in it as either parent, teacher or care provider to a student involved in the process. It is challenging for everyone: students, parents, teachers, administrators, and everyone who knows any of these people. Every child's case is unique and they need to do what is best for them. I will admit that as a parent I am brand new at it. We have our oldest in kindergarten right now.

E-learning can be the most visually stressful type of education because it is a set schedule of screen use for a large portion of the day, every day. In a classroom setting, there is a lot moving around and looking up at the board and at friends to provide visual novelty. In a Virtual School and homeschool setting, the schedule can be much more flexible to allow for visual breaks. Teachers are working as hard as they can right now, but they are not children's vision experts.

Based on my knowledge of children's vision, research and personal experience, I list some helpful guidelines below to ensure that your children can get the most out of E-learning this fall.

Why is this important?

For many years, Optometrists have helped office workers who suffered from Computer Vision Syndrome (CVS), a collection of eye and vision problems related to excessive computer use. It was originally thought that CVS was an adult problem, but now research has shown that children can (and do!) experience this problem, too. This can be compounded by the increased screen time and the general stress of e-learning during the COVID-19 pandemic.

Common symptoms from long-term computer use are:

Eyestrain.
Headaches.
Blurred vision.
Dry eyes.
Neck and shoulder pain.

It is not hard to imagine how any or all of these can make learning difficult for a child who has to be in front of a computer or laptop most of the week.

What can you do?

1. Have The Right Set up

We have our workstation in our son’s room. As a parent of a 2 year old and 1 year old there is just too much chaos in the public parts of the house.

Selecting a screen - Bigger is better! The larger the screen the easier it is to focus on details. Currently we have no choice in the matter the school provided us with a chrome book which is driving me crazy.
Position the screen - Position the center of the screen straight ahead so the head doesn't need to tilt back or to the side. Position screen further back on the desk. Allow for at least “knuckle to elbow distance” from the eyes to screen. Imagine each child has his or her own ruler for ideal working distance that ruler is the distance between his middle knuckle to his elbow; we call it the “Harmon distance” named after the PhD Darrell Boyd Harmon.
Chairs - for our son we used a balance ball chair since he is so young. This may lead to more movement which isn’t necessarily a bad thing.
Foot rest - If the child's feet can't touch the ground, a foot rest can stabilize them.
Lighting - You don't want it to be too dark or too bright. Being near a window is great for natural light, as long as the direct sun is not shining in the child's eyes or directly on the screen.

2. Posture

We all know that it can be difficult to get kids to maintain any particular position, specifically if they are little. However, showing them the proper posture and reminding them often can go a long way to helping them stay comfortable during work.

Here are recommendations for efficient posture for kids at the computer.

The chair seat should not compress behind the knees and cut off circulation.
Their feet should rest firmly on a floor or footrest (no dangling)
The head should be balanced on neck (not tilted back or too far forwards)
The upper arms close to body and relaxed
The elbow should angle >90° (forearm below horizontal)
The wrist should be neutral (not flexed)

Here is an illustration from the American Optometric Association:

3. Do Children Need Computer Glasses?

For many adults after forty we need glasses to see small print up close. Children, however, have more visual focusing ability so they don't usually complain of not being able to see the screen. However, many children do have functional issues and benefit from wearing glasses at the computer.

Some of these conditions are:

Refractive problems - Conditions such as farsightedness (hyperopia) and astigmatism can make it more difficult to see the screen.
Focusing problems - If children's eyes do not focus accurately on the screen, glasses can help make it easier. Having glasses can make the difference between working comfortably and headaches and blurry vision.
Rapid Fatigue - Some children can see the screen clearly for the first 15 or 20 minutes then start to lose interest because they can't sustain focus on it.
Convergence problems - Some children have issues where their eyes either tend to over-converge (tend to turn in) or under-converge (don't turn in enough). In both instances having the right glasses helps keep the image of the screen clear and single and makes reading easier.
Specialized prescriptions - Some children have unique vision problems and require alternate prescriptions such as prism or bifocals, these should definitely be taken into account.

3. What About Blue Light?!?

Blue light is a very popular topic in 2020. We need more scientific study in this area about which frequencies of light matter, how much filtering is needed, and what are the effects. But after following the research for years with my own clinical experiences I feel comfortable saying these things:

There is more and more evidence suggesting that light from computers and devices is not likely going to cause permanent eye disease. (UV light from the sun is a much, much greater concern and that is why we recommend UV-blocking sunglasses for all ages.)
There absolutely is evidence that blue light exposure from screen can interfere with circadian rhythm and sleep cycles. Your best bet is no screen use a couple of hours before bedtime. But if that is not possible, then blue light protection in glasses as well as night-mode device settings can help.
Many patients have less eye strain and fatigue by limiting the scatter of blue light. This is especially important if the patient has had a concussion or other traumatic brain injury.

If your child appears to be having screen-related fatigue see your optometrist first and discuss it, there may be bigger problems. Many people benefit from lenses for the computer and devices to reduce fatigue and eye-strain. If your child is already getting glasses for computer use, it makes sense to get the blue light protection, because there is basically no downside other than extra cost.

4. Taking Breaks.

If using digital devices is the problem, then stopping using them is part of the solution. However, looking away from the computer only to check message on a phone doesn't really count as a visual break! The important thing to remember is that breaking up long sessions into shorter sessions helps a lot to release tension in the eyes. There are two rules of thumb that are helpful.

20/20/20 Rule - Every twenty minutes, look 20 feet away for 20 seconds This lets the focus of the eyes relax.
1/5 Rule - Every hour take at least a 5 minute break and move around. This wakes these eyes, body, and brain up, especially if they go outside.

I know that you do not have perfect control of your children's schedule, but by setting reminders you can try to develop these habits.

5. Getting Outdoors!

What is even better than looking out a window? Actually getting outside and moving around. Children's brains (and mood!) function better with some good old physical activity. Even if they can't exercise, just being outdoors is great for them. The change of scenery will help break up the routine.

Even if it's just a short walk of the dog, or just standing in the yard or back porch, there are big visual benefits. First, the eyes get to fully relax when they look very far away. Instead of the space of just 5 or 10 feet in the room, outside we can 100 or 1000 feet away. Second, the natural light contains the full spectrum of light frequencies. Also, we tend to blink a lot more when we are outside moving around than we are just looking at a screen "in the zone" of e-learning. This keeps the eyes moist and comfortable. And there is a lot of research that shows that taking young children outside is one of the best ways to reduce the chances of them becoming myopic (nearsighted).

Of course, if you are outside in the sun, wear sunglasses to protect the eyes from UV light!

6. When To Check With Your Children's Eye Doctor.

Extensive computer use is more difficult for all patients, but some children are at greater risk. Here are some situations when you should schedule an eye and vision evaluation for your child who is e-learning:

Pre-existing visual problems - If your child has on-going visual dysfunction, definitely have an evaluation and discuss all the options to limit the visual stress of e-learning.
Symptoms - Any symptoms of fatigue or eyestrain should be evaluated.
Overdue - Many patients are overdue for visits due to offices being closed in the spring. Children's vision can change extremely rapidly, so we recommend annual exams for children in school. This is especially true if they are e-learning.

I want to highlight one specific symptom - blurry vision when looking far away. This can happen for several reasons but there are 2 important reasons to consider:

eyestrain up close causing a focusing spasm (a red flag)
newly developed myopia (AKA nearsightedness).

Both of these are on the rise around the world generally due to increased screen time and decreased outdoor time. Both of them have management options that can reduce future problems, including good habits, glasses, and vision therapy. Make sure you discuss this with your child's eye doctor at their appointment.

And that's it. I know it was kind of long, but it is important. As different as it is from classroom education, e-learning can be very effective. And it certainly is beneficial in social distancing and keeping everyone safe from COVID-19. With the information above you can help make sure that e-learning does not cause vision problems as well.

Good luck this year! If we can help in any way, please reach out at www.familyvisionandtherapy.com or 630-969-2807

Vision and eLearning