Childhood myopia on the rise as screen time soars: AIIMS doc flags warning signs, suggests new formula for parents

That’s why the All India Ophthalmological Society (AIOS) has released new guidelines on preventive strategies, including annual eye examinations, school vision screenings, limiting recreational screen time, maintaining appropriate reading distance, ensuring adequate lighting during study and encouraging children to spend at least two hours outdoors daily. The recommendations also reinforce the widely advocated 20-20-20 rule, which encourages children to take a 20-second break every 20 minutes and focus on an object 20 feet away to reduce eye strain.

Dr Namrata Sharma, Chairperson, Scientific Committee, AIOS, and Professor of Ophthalmology, AIIMS, New Delhi, said, “The prevention and management of childhood myopia require a shift from reactive treatment to proactive prevention. Environmental factors such as prolonged near work (any activity that requires you to focus your eyes on objects within 16–20 inches or 40–50 cm or closer), excessive digital exposure and reduced outdoor time are modifiable risks that demand immediate societal attention. While anti-myopia therapies may slow progression, prevention through lifestyle modification remains the most powerful strategy.” Excerpts:

Are both eyes affected equally in childhood myopia, and what triggers it?

Usually both eyes are affected in progressive childhood myopia, although the severity or rate of progression may not always be exactly the same. One eye may worsen slightly faster than the other, but in most cases both eyes are involved.

The condition is driven by a combination of genetic and environmental factors. Children with one or both myopic parents are naturally at higher risk. However, prolonged near work, increased screen exposure and reduced outdoor activity have emerged as major lifestyle-related triggers. Extended focus on close objects, especially through handheld devices, places sustained strain on the eyes and contributes to progression.

How much outdoor time is recommended?

Most experts recommend that children spend at least two hours outdoors during daylight hours every day. This outdoor time does not have to involve organised sport or intense physical activity. Walking to school, outdoor recess, spending breaks outside or simply avoiding prolonged indoor confinement during daylight can all contribute meaningfully.

The key protective factor appears to be cumulative exposure to natural daylight, which helps regulate healthy eye development.

How much screen time is too much?

Recommendations vary depending on age. For children younger than two years, screen exposure is best avoided as far as possible. For children aged two to five years, exposure should ideally remain below one hour daily and should always be supervised. Among children aged five to ten years, recreational screen use should preferably remain under two hours a day unless additional use is required for academic purposes.

For older children, strict limits become more difficult because of educational demands. However, experts caution that sustained exposure beyond four to six hours daily can place significant strain on developing eyes. More important than the total number of hours is ensuring regular interruptions to near work.

Should reading distance and posture be adjusted?

Yes. Reading distance and posture are among the most important modifiable factors. Desktops and laptops are generally preferable to phones and tablets because they naturally encourage a safer viewing distance. Children using handheld devices often bring screens very close to their face, increasing visual strain.

Sitting upright at a table in a well-lit room, ideally with access to natural light, is considered ideal. Reclining or lying down while using screens often causes poor posture and reduced viewing distance, both of which may contribute to myopia progression.

Should children take breaks during studies?

Absolutely. The 20-20-20 rule remains one of the most effective and practical strategies. After every 20 minutes of near work, children should look at something roughly 20 feet away for at least 20 seconds. Alternatively, short breaks every 30 minutes that involve walking around, looking outdoors or simply shifting focus away from close-up tasks can help relax the eyes.

Myopia progression is often worsened by long hours of uninterrupted near work, excessive digital exposure, poor posture, inadequate breaks and insufficient outdoor activity.

Are regular glasses enough? How often should eye exams be scheduled?

Regular glasses remain the standard method for correcting myopia and restoring clear vision. Contact lenses are another option in suitable cases. However, newer interventions including specialised anti-myopia glasses, certain contact lens designs and medicated eye drops are now available and may help slow progression in selected children.

Routine eye examinations should ideally take place once a year. Earlier review is advised if a child develops headaches, blurred vision, watering of the eyes, difficulty seeing distant objects or begins bringing books and screens unusually close.

What warning signs should parents watch out for?

Parents should remain alert to behavioural clues such as squinting to see distant objects, sitting very close to the television, frequent eye rubbing, complaints of headaches or blurred vision, difficulty copying from the classroom board or consistently moving closer to visual displays. A sudden worsening of these symptoms or rapid changes in visual behaviour should prompt urgent ophthalmic evaluation.

What can families do now to protect long-term eye health?

The most effective long-term strategy is prevention through simple lifestyle measures. Ensuring healthy screen habits, maintaining proper reading posture, encouraging daily outdoor exposure, taking regular visual breaks and scheduling routine eye examinations can make a significant difference. Adequate hydration, balanced nutrition and regular physical activity also support overall eye health.