Welcome to question of the day #116

Welcome to question of the day #116

I have just examined the 4 year son of one of my patients. Both parents are myopic. They were worried because the boy was sitting close to the TV. I found the visual acuity to be 6/6 in each eye and +0.75 DS in each eye. All other tests had unremarkable results. How can I explain why he sits close to the TV.

In my clinical experience about 10% of pre-teen patients that I have examined have presented because one or both parents are worried about the nearness the child sits to the TV. While occasionally some of the 9 to 12 year olds did need spectacles for myopia the younger patients did not have refractive error that could explain the close TV viewing.

A reasonable explanation is that young children enjoy the sensory stimulation of the colour and sound and are drawn to that rather than not being able to see what is happening on the screen. The closer they are to the screen the bigger whatever it is they are looking at and this is a bonus especially if it is a favourite character. Getting close means that the TV screen fills their field of view and removes visual distractions.

Also, the closer they are the louder the activitiy on the screen and this can be useful if there is a lot of extraneous noise perhaps produced by siblings or by the parents shouting to sit further back from the TV. For children, and others, the bigger and louder something is, the better the experience. Getting close means that the TV sound muffles audio distractions.

With this presentation it is important to conduct an examination, but the close promity to the TV is often about magnification, sound and eliminating distractions, rather than a lack of clarity of vision.