Myopia: It's Not the Tablet

Last week I had a young Asian family come in with their 10 year old daughter. This was the daughter's very first eye exam. Both parents were high myopes, I later learned: father -10.00 mother -8.00. The exam revealed that the child needed vision correction and was myopic. When I broke the news, the parents were distraught. The father especially couldn't believe it. "We never even let her use the tablet!", he exclaimed. I had to explain to them about axial myopia and genetics. Listen people, I know it's all over the internet that blue light is evil and near point stress causes refractive error, but it really doesn't. It is almost all genetics. When both parents are high myopes, the children are likely to be myopic. No amount of restricting access to the iPad is going to stop it. Axial myopia is from having an eye that is too large. Well if both parents have large eyes...guess what? Their children are more likely to have large eyes. If both parents had large ears, would you be surprised if the child had large ears? Apparently some parents are. They shouldn't be. Restricting use of headphones will not lessen the likelihood of the child's ears being big. They're just gonna be big because...genetics. Yesterday I saw a young mother who brought me her 3rd child...both older siblings had high astigmatism. Guess what? Younger brother also had high astigmatism. She asked me "why"? It's genetics. It's inherited. It's not from reading too much or reading in low light or too much gaming or rubbing their eyes or using the tablet too much or standing too close to the TV or not eating enough carrots or playing the Nintendo 3DS too much...literally NONE OF THAT. Refractive error is almost all genetic. I will admit that environmental factors (time spent outside, near point stress, etc) *can sometimes* play a *slight* role in myopia progression, but in my professional opinion it is not the root cause. The root cause is genetics. I feel like all patients and even some medical professionals GREATLY OVERSTATE the role of environmental factors in the development and progression of refractive error. So while it's not good parenting to hand your child a tablet and just let them spend all day on it, it's not going to "ruin their eyes". If they're going to be myopic (or astigmatic, or hyperopic, or strabismic, etc etc), they're probably just destined to be that way no matter how much you restrict their access to the iPad. Some of these eye myths (like carrots being good for your eyes, crossing your eyes makes them stick that way, standing too close to the tv ruins your eyes, looking at a tablet too much or too close causes nearsightedness, etc etc ) are so ingrained in popular culture that people FIRMLY BELIEVE them, so much so that even when a medical professional explains them away, they're still skeptical.