The eyes of a screen generation: Myopia and dry eyes on the rise among Kenyan children
About 86,000 school-going children in Kenya struggle every day with uncorrected refractive errors, a clinical condition that directly impairs learning, according to a report by the International Agency for the Prevention of Blindness and Seva Foundation.
What you need to know:
- Experts share the critical warning signs every parent and teacher must watch for; from headaches and squinting at the blackboard to copying a friend’s notes.
Jemimah Ndung’u took her son’s eye problem seriously when they got stuck in traffic late last year. The 10-year-old’s eyes had been itching for a while, but they did not think much of it. One day, on the way home from a school pick-up, Jemimah asked him to read an inscription on a car a few metres ahead of them.
“My son was in the back seat, and we were just chatting as we waited for traffic to open up. Then I saw an inscription, ‘old guys rule’, on a car a few metres ahead. To keep our conversation going and to casually remind him that ‘we old people’ rule, I told him to read it. But he couldn’t. He squinted, leaned forward and blinked hard, but still he couldn’t read. I asked him to cross over to the co-driver’s seat. He did, but still he couldn’t read the words, yet I could from the same distance,” she reminisces.
Two weeks later, at an eye clinic in Loresho, Nairobi, where Jemimah took the boy for a check-up, the doctor wrote -3.00 in both eyes. This indicated myopia, otherwise known as short-sightedness. The condition was still progressing, and the prescription was a pair of glasses.
“He is in Grade Five, and here I thought glasses were for old people,” she sighs. “He has had a phone since he was six, though I do not know for a fact whether it is directly related to his eyesight problems because, genetically, we do not have eye problems. I bought him the phone since all his peers have gadgets and also because it keeps him busy when I am working,” she admits.
David Musyoka’s 16-year-old daughter, Baraka Mutanu, started wearing glasses two years after moving to an international school.
“While we have a genetic eye problem in our family, I believe Baraka’s condition was exacerbated by the use of computers and screens in their school. Before joining the school, she hardly ever complained of blurry vision or short-sightedness. But she gradually started complaining of not seeing the projections on the projector from her seat and was moved to the front row of her class. It is actually her class teacher who advised me to take her for an eye check-up, and she was diagnosed with eye dryness,” David shares.
Dr Victor Opiyo, an optometrist who specialises in myopia control in toddlers and teenagers, and also the secretary-general of the African Council of Optometry,
These are not isolated cases. You have seen such children in your estate, in the mall or in your own house. Head down, screen glowing on their faces, shoulders hunched, occasional smiles or grunts, and hours passing without a single look up. There was a time when parents worried about children not eating vegetables. Now short-sightedness and dry eyes have entered the matrix.
About 86,000 school-going children in Kenya struggle every day with uncorrected refractive errors, a clinical condition that directly impairs learning, according to a report by the International Agency for the Prevention of Blindness and Seva Foundation, released ahead of World Sight Day last year. Collectively, those 86,000 children lose the equivalent of 25,000 full school years every year, repeating classes, missing lessons or sitting in class unable to learn because they simply cannot see the blackboard.
Free screenings
A 2024 study published in the African Journal of Empirical Research found myopia prevalence was 15.6 per cent in urban Nairobi, compared to 1.7 per cent in rural Makueni.
In Kakamega, a screening of 3,343 school children found 1.45 per cent already myopic. In rural Kajiado, it was three per cent. In an older Nairobi study, 10.2 per cent had significant refractive errors, and 92 per cent of those were myopia.
Lions Clubs, which do free screenings in public schools, say 17 per cent of pupils have a vision problem they did not know about. Globally, 36 per cent of the population is myopic today, and scientists warn that if we do nothing, this could rise to 50 per cent by 2050.
Healthy Nation spoke with two specialists who see it every day, from two different sides. Dr Hellen Kirubi is a paediatric ophthalmologist, and she acknowledges the rise in eye problems among children.
“Definitely there is a spike,” she starts. “If you compare now and, say, 10 years ago, especially pre-Covid times, we are getting a lot more cases of children with sensitivity to light and eye fatigue, most of which are symptoms connected to prolonged screen use. We are also seeing a lot more cases of children who are short-sighted.
Dr Hellen Kirubi, a paediatric ophthalmologist. She acknowledges the rise in eye problems among children.
“There are recent studies done worldwide, as recent as last year, that looked at different studies and compared them together and came up with the conclusion that there is a relationship between the development of short-sightedness and screen use,” she offers.
Dr Victor Opiyo, an optometrist who specialises in myopia control in toddlers and teenagers and is the Secretary General of the African Council of Optometry, explains why there is a correlation and why more children in urban areas are affected.
“There is indeed an increase in the number of children we see around urban and peri-urban areas. Most of the time, children in towns spend most of their time indoors. And when they are indoors, they are not getting natural light, which helps the eyes develop. Number two, urban children are constantly on e-devices. We are glad they are not disturbing us as adults, but that approach alone contributes to short-sightedness,” he says.
To understand how, he takes us back to the beginning of life: a window called the plastic stage, which is basically zero to eight years. “During that period, the eye is learning how long it should be. Most children are born a little long-sighted, and that is normal. They like close things: your face when you are breastfeeding, toys near them. Then, through a process called emmetropisation, the eye grows into perfect focus, and light is the fertiliser,” Dr Opiyo explains.
Vision impairment
“If there is something making light not reach the back of the eye, it can contribute to vision impairment later. When a child spends hours doing near work, such as scrolling, gaming or watching cartoons an inch from the face, the brain misreads the signal. The brain analyses the signals as the eye being short. So when the eye is short, the brain sends more hormones to elongate the eyes more,” he shares.
“The more the eyes elongate, the more the rays of light will not be able to reach the retina. They will converge before reaching the retina. That is how myopia happens at an early stage. In simple language: you tell your eye the world is only 20 centimetres away, so it grows to be good at 20cm. And it becomes bad at everything beyond that. When children play outside, sunlight triggers hormones at the back of the eye, dopamine and others, which stop that elongation. Two hours outside a day can literally keep the eye from growing too long.”
This is why the data is unevenly distributed as you move from urban to peri-urban to rural. Those in rural areas are outside, probably farming or caring for animals.
“It is also important to note that girls, especially in teenhood, are more likely to develop myopia as compared to their male counterparts. This is because girls tend to be indoors more than boys. Girls also tend to reach early maturation, plus early hormonal factors,” he intimates.
“Culturally, we keep girls inside to help and to be safe, while boys are encouraged to go and play outside. That cultural decision, plus screens, is now showing up in their prescriptions.”
Then there is the other complaint parents bring that sounds too adult for a child: dry eyes.
“Remember, an eye is a moving part, and any moving part needs to be greased for it to move freely, like door hinges. If there is no grease, there is no oil; it cannot move.
So what happens is that when we are viewing the screen, we rarely blink, and when you don’t blink, it means you are not washing your eyes. Normal blinking is about 15 times a minute. On a screen, it drops to six or seven blinks a minute. From this, tears evaporate, and the quantity is no longer sufficient. The eye, like a dry hinge, starts to creak,” he says.
Dr Kirubi sees the same in children who now need lubricating drops. “Prolonged screen time makes the children get dry eyes. The reason is when they are on the screens, they tend to stare a lot, and this staring makes their tears evaporate faster than normal because they are not blinking as often as they need to,” she says. “This does not automatically present as a problem, but you may hear the child complaining of a burning sensation in the eyes, or saying light hurts their eyes or the eyes are just tired,” she notes. “That is why we have the 20-20 rule. For every 20 minutes anyone, including a child, is on a screen, they should look away for 20 seconds at something 20 feet away (about six metres). That blink resets the tears. Most parents miss it because children do not know blurry is not normal,” Dr Kirubi notes.
On the tell-tale signs that parents need to look out for to know if their children’s vision needs a check, she says they may rub their eyes a lot, squint, complain of strong light or move very close to the TV while watching. In class, the teacher notices they are not learning for themselves; rather, they are copying from their friends, not the blackboard. They copy correctly from a book but make mistakes when copying from the blackboard.
So what is safe for children? Both doctors give almost the same rules, and they are stricter than what most Kenyan middle-class homes allow. For children less than two years, no screen time whatsoever. Not even background TV while parents or any other members of the household are watching.
“At that time also, what the brain sees is dependent on what they are seeing physically. When you make them look at things that are very bright and pass their eyes very fast, it makes their eyes tired very fast. And then there is also the social aspect. They start becoming irritable. They get used to seeing things happening fast. So even later on, children just have some behavioural problems,” Dr Kirubi says.
“Between two and five years, at most one hour per day, educational, and not one hour at once, but segmented into small, reasonable minutes added up through the day. From five to 12, the safest threshold is one hour per day. Beyond that, each additional hour adds about 20 per cent risk of developing short-sightedness. It keeps rising until more than four hours, where risk is 40 to 50 per cent higher.
“The distance also matters. Phones and tablets are the worst, because they are close. A desktop monitor or a TV set at arm’s length is safer. Homework should never be done on a phone if you can avoid it. If school sends homework on WhatsApp, let them use a laptop or desktop. There should also be no screen at least one hour before bed because the blue light from gadgets affects melatonin, causing sleep delays by one to two hours,” cautions Dr Kirubi.
Back pain
Dr Opiyo adds practical advice: as a parent or guardian, either reduce screen time or reduce the screen contrast. It is also important to look at the lighting in your environment and proper ergonomics, because screen time also comes with back pain, neck pain and dull headaches, sometimes even nausea. Sometimes even a pair of glasses with a blue cut or blue block can help, even though a lot has not been done in that area. That is an honest answer on blue-light glasses. They may help with comfort, but they are not a vaccine against myopia. The vaccine is outside. Victor is blunter on prevention. “We need to avoid e-devices completely at the plastic stage and encourage at least a two-hour break outside daily.”
He also wants to kill one myth that keeps children blind longer.
“Sometimes guardians come to us, and they tell us that their kids are too young to wear glasses. ‘I hear that when you wear glasses, your eyes go inside.’ And I keep telling them, does wearing a cape or wearing shoes change the shape of your head or your feet? A pair of spectacles is a medical tool. So when the doctor tells you that it needs to be corrected, the earlier the better. There is no age too young for glasses. You can have a baby after one week; we tell you this one needs glasses. We have seen cases where babies within two weeks, three weeks are given glasses. Some are even born with cataracts. We do surgery, and we dispense glasses,” he says.
Is your child’s vision okay? Look out for these signs:
1. They rub their eyes constantly. Not sleepy rubbing, but hard rubbing, especially after screen time. This is often dry eye and eye fatigue.
2. They squint or close one eye to see. Dr Kirubi says children naturally make the eye opening small to focus better when they are myopic.
3. They move too close for better visibility. Close to the TV, the book held too close to the face, the phone almost touching the nose. They are bringing the world to where their eyes can see it.
4.They copy from friends, not the blackboard. Teachers are your best early detectors. A child who copies correctly from a book but makes mistakes from the blackboard cannot see distance.
5. Light bothers them, and their eyes look tired. They may complain of a burning sensation, want to close their eyes, or have headaches or eyes not looking straight.
Pro tip: For every 20 minutes on a screen, look away for 20 seconds at something 20 feet away. The blink that comes automatically re-wets the eye. Two hours outside daily is recommended because outdoor light is medicine.
