Anna Kirillova, OD, MS, FAAO
Doctor of Optometry, Boston Children’s Hospital
Instructor in Ophthalmology, Harvard Medical School
What do you do at Boston Children’s?
I am a clinician specializing in myopia control and functional vision exams, particularly for patients with special behavioral and developmental needs. In my practice, I use advanced treatment methods to slow down the progression of myopia (nearsightedness) and help prevent related complications in the future. I have a special interest in working with patients with various psychological needs, such as anxiety, trauma, autism spectrum disorder, as well as developmental disorders, to help them have a positive experience, a successful eye examination, and a better treatment plan.
What does a typical day look like for you?
I have clinical and administrative days. On clinical days, I examine patients or supervise ophthalmology residents. Before seeing patients, I review their previous exam notes, referrals, testing, and any relevant information to prepare for their visits. This includes checking health information as well as any specific preferences that could make the exam go smoother, such as support plans, likes and dislikes, past issues, or potential triggers. When precepting residents, we review patient charts together before seeing the patients. After examining the patients, we discuss the cases and answer any questions. On administrative days, I discuss treatment and management plans with families, triage patients, work on writing papers and articles, and complete additional training.
What led you to the work you do?
I always enjoyed working with children and young adults, but I really fell in love with helping patients with special needs during my internship at Perkins School for the Blind. That experience showed me how much a practitioner who cares about their patients can do for them, and how those practitioners can give a voice to those who cannot advocate for themselves.
What would you say are the greatest opportunities you see for kids growing up in a digitally saturated world?
As a part of the generation that grew up with the development of the internet, I can compare the life before and after the internet became widely available. When I was in elementary school, I could gather information from three main sources: my family, my teachers, and the library. Learning more about a certain subject required going an extra mile — curiosity, effort, and patience. Sometimes I had to wait a week for a book to arrive from another library.
Technology changed everything. Children can find any piece of information in a matter of seconds, with the ability to access digital and audiobooks, free classes and certificates from top universities (including the Ivy League), and even take a virtual tour at the Louvre. If someone is curious about a certain topic, they can become proficient in it by watching YouTube. They can learn to make balloon animals, repair drywall, learn CPR, and play guitar without having to leave home. Regardless of what subject we’re interested in, we can find a group of people with similar interests and learn from them or create content for them from anywhere in the world. There is no reason to be bored anymore because we have instant access to endless entertainment and learning sources on any topic. This is something we could not imagine 30 years ago.
What are the greatest challenges you see for kids growing up in a digitally saturated world?
Time is one of our most valuable assets, and the main challenge is investing it correctly. When one is young, it seems that time is infinite, and it’s easy to spend hours scrolling through Instagram and Facebook and watching TikTok. However, these platforms are designed to be highly addictive, which triggers dopamine release like gambling, so the brain is constantly stimulated.
The paradox is that we have unlimited access to extensive digital resources and can spend our time watching free courses from Harvard or MIT or learning a new skill. Still, many choose to spend their time on those addictive platforms. On average, people spend about 2 hours and 23 minutes on social media daily with teenagers spending almost 3 hours a day on different social media platforms. Just imagine if this time would be used to enrich our knowledge or to address important social or environmental issues.
We all know the importance of exercise. Through years of research, we learned the importance of balanced training, recovery, and nutrition to improve physical fitness. We have to recover well to achieve athletic gains. The same is true for our mental health and eyesight. Studies show that environmental factors are primarily responsible for nearsightedness (myopia). In families that have a history of glasses wear, limiting screen time and spending time outside is even more important. I recommend that my patients spend at least 1.5 to 2 hours a day outdoors and limit their screen time to no more than 2 hours a day between all screens. We now have interventions, along with lifestyle changes, which can slow down or even prevent the development of myopia and reduce the risks of visual impairment and eye health problems throughout life.
Children’s brains are still developing, and their personalities are forming. Providing our children with age-appropriate content is only half the battle. What is more important is establishing healthy technology habits and limiting screen time to ensure balanced development.
How would you change or redesign technology and or media to be healthier for kids across the developmental span?
The genie is already out of the bottle; we cannot reverse it to 20 years ago. There are different tools to limit screen time and access to inappropriate content: programs that shut down access automatically, internet settings that alert parents based on preset phrases, apps that block notifications to promote learning, and age-appropriate TV channels and programs. However, we cannot control what our children do in their friends’ homes or what happens when they connect to other networks. We cannot be with them 24/7 to protect them.
What we can do is teach kids that the internet and media are tools for the world, but are not the world itself. If most of a child’s learning and entertainment comes from screens, they can become even more focused on the digital world and even less interested in real-life activities. This is detrimental to their emotional wellbeing, their eyesight, and their mindset. For example, Steve Jobs, the co-founder of Apple, did not allow his children to use iPads because he recognized the addictive potential of technology.
As parents, educators, and members of society, it is our responsibility to model healthy technology habits and encourage a balanced approach. We can choose at what age to give our kids a phone or whether they should have a tablet. Children learn from their environment, so if they see their parents being on their phones, they are more likely to do the same.
Instead, we should encourage activities that do not involve screens, such as playing music, building with LEGOS, playing with friends, hiking, camping, biking, and visiting museums. We need to stimulate their natural curiosity and promote real-life connections to help develop a balanced approach to technology.
We also need to teach kids how to use technology responsibly, to separate reliable information from the “noise,” and to understand that technology is a tool to enhance our lives, not something that defines our identity.
What guidance or advice do you have for parents and other caregivers to help kids build and maintain healthy behaviors around digital media and technology?
Watching TV and digital content with our children can not only help us better understand our children’s interests and make sure they view age-appropriate content but also promote good technology habits. After watching a movie, TV show, music concert, or documentary together, a good practice would be discussing what we just watched and asking thought-provoking questions to give children the tools to make better choices so they can consume content thoughtfully. For example, did you watch it for fun, or did you learn something from it? How did it make you feel? In this video, they made a specific point — how do you know it is true? How can you verify if it is true? Would you like to learn more? Can we use this knowledge to make the world around us a better place? It is important to help children develop critical thinking skills so they can make informed choices about the content they watch. It is a common practice when we read books in class or in a reading group. Why not do the same with digital content? This practice can help children learn to analyze what they watch and assess whether it is worth their time.
However, even if we choose proper content, we still need to limit screen time to ensure children spend enough time outdoors and away from screens. The digital world can give us a lot, but not everything. Widespread use of electronic devices and increased focus on early education often cause children to spend significantly more time indoors, negatively impacting their eyesight and general and mental health. Running outside, even on a rainy day, is better than spending another hour on a tablet.
And since “no man is an island” and we live in a society, children need to be exposed to real-life social situations to learn how to interact with other kids and adults who are not their classmates or family.
Kids need to experience the world outside the screen. Activities like playing outdoors with friends, hiking, camping with their families, and playing sports are important for a balanced development. For example, being involved in scouting teaches invaluable life lessons of camaraderie and leadership, something that is hard to learn online. Climbing teaches about gravity, our body and muscles, and planning the next step. Do you remember the feeling of almost falling but saving yourself at the last second with your own dexterity? One cannot experience this intense emotion by watching videos on social media, or even playing a game.
As parents and educators, our role is to teach our children how to invest their time right, even if we are not right next to them. We have to encourage our children’s natural curiosity so they can develop their interests and later choose their own path in life.
Is there anything else you’d like to share?
Ultimately, I think the right approach to technology is to focus less on restrictions and more on promoting critical thinking and healthy habits. Educational TV programs, apps, and virtual tours can complement children’s learning and spark interest in new activities.
We need to keep an open conversation between parents, children, teachers, and medical professionals. We have to talk about the value that technology provides to children’s lives and responsible internet use so our children can make informed decisions and feel supported. School and community initiatives, non-profits, and medical care providers can help promote healthy technology habits and provide resources for families.
Here at the Lab, we welcome different viewpoints and perspectives. However, the opinions and ideas expressed here do not necessarily represent the views, research, or recommendations of the Digital Wellness Lab, Boston Children’s Hospital, or affiliates.