Can iPad use contribute to the development of myopia (nearsightedness) in children?

Can iPad Use Cause Myopia in Children?

While excessive near work including screen time was historically believed to cause myopia, recent high-quality evidence from the American Academy of Ophthalmology demonstrates that lack of outdoor time—not screen time itself—is the primary controllable factor driving myopia development and progression in children. 1

The Evidence on Screen Time vs. Outdoor Time

The 2023 American Academy of Ophthalmology Refractive Errors Preferred Practice Pattern explicitly states: "Despite the belief that excessive near work (e.g., reading, screen time) is a causative factor in the myopia epidemic, recent evidence suggests that it is time outdoors that is the controlling factor." 1

What the Research Shows:

• Outdoor time is protective: Children with more than 200 minutes of outdoor time at school showed significantly less myopic shift over 3 years 1
• The effect is substantial: More than 1 hour of outdoor activity was protective against myopia progression in high school students 1
• Screen time evidence is mixed: A 2020 systematic review of 15 studies (49,789 children) found inconsistent associations between screen time and myopia, with a pooled analysis showing no significant association (OR 1.02,95% CI: 0.96-1.08) 2

The Real Mechanism

The critical issue is not what children are looking at, but rather what they're NOT doing—spending time outdoors. 1

• Children with little daylight exposure have a 5-fold increased risk of developing myopia 3
• This risk can rise to 16-fold when lack of outdoor time is combined with extensive close-up work 3
• The protective effect appears related to violet light exposure and other outdoor environmental factors 1

Practical Clinical Recommendations

For Prevention:

• Encourage at least 1-2 hours of outdoor time daily to reduce myopia development and progression 4
• This is more important than restricting iPad or screen use per se 1

For Children Already Developing Myopia:

• First-line interventions include multifocal contact lenses (FDA-approved MiSight for ages 8-12) or low-dose atropine 0.01-0.05% 4
• Combination therapy with low-dose atropine plus multifocal contact lenses provides maximum benefit 4
• Orthokeratology is effective but carries microbial keratitis risk similar to other overnight contact lens wear 4

Important Caveats

• The association between near work (including screens) and myopia is "generally weak and inconsistent" according to the International Myopia Institute 1
• More years of formal education show stronger associations with myopia than screen time itself 1
• Undercorrecting myopia is harmful and actually promotes progression—always provide appropriate optical correction 1

Bottom Line for Parents

Rather than restricting iPad use specifically, focus on ensuring children spend adequate time outdoors daily. The iPad itself is not the primary culprit—it's the indoor, sedentary lifestyle pattern that often accompanies screen use that matters most. 1, 3