Thursday, August 1, 2019

Letter to the Maryland Department of Health
Dated: July 19, 2019
Re: Failure to provide adequate state medical consultation

This letter was sent to the Maryland Department of Health (MDH) leadership and copied to Governor Hogan's staff on July 19. No response has been received regarding the Department's failure to provide reliable medical consultation in the State's development of health and safety best practices for the schools' digital devices, as required by law.

It now seems evident that the Joint Audit Committee should look into this matter, since the unanimous vote of the General Assembly to ensure classroom protections for students statewide has been inadequately addressed - in fact, it has largely been ignored - while the process itself was compromised by ed tech special interests whose influence cannot be overlooked.

Nothing prevents the Maryland Department of Health from updating and revising its direction to the Maryland State Department of Education. It's imperative that clear guidelines are presented to local school districts, or our children will continue to remain at risk from serious, known hazards.

July 19, 2019

Dear Mr. Ye,

The medical consultation from MDH required by HB1110/Ch244 should have served as evidenced-based guidance for local school district leadership, administrators, parents and students to mitigate the health risks posed by statewide demands for students to use hazardous school equipment.

Instead, MDH has partnered in the production of lukewarm suggestions that will likely put children at greater risk, since a false sense of 'protection' will result. Schools will be able to claim they are following your expert direction.

Students are required to put their own health at risk when they are required to use the schools' admittedly hazardous digital devices. Many will be put in serious peril because MDH, within the context of this law, didn't accurately or appropriately identify (or offer resources about) the serious health issues facing Maryland students. This lackluster approach adds to the false sense of protection - implying there are no real concerns.

Since the Maryland Health Department didn't mention it, it must not be that important, for instance, to properly evaluate students' health before requiring screen use. Pre-existing myopia, dry eye disease or other childhood health issues such as obesity, sleeplessness or scoliosis will only be exacerbated by unsafe practices in the use of digital devices at school every day and night. Medical experts know that any of these conditions could lead to crippling outcomes if not properly identified, treated and mitigated.

Yet, comprehensive evaluations of each child's health as it relates to the schools' screen use was simply ignored.

Pediatric optometrists and ophthalmologists who specialize in dry eye disease are now seeing permanently damaged corneas in ever younger patients, because the blink rate of device users is only 67% or less of what it normally should be.

And the myopia epidemic remains unbridled. It is a progressive eye condition that cannot be reversed. Severe myopia can lead to catastrophic eye conditions later in life: glaucoma, cataracts and detached retinas. Less recess and more device use is the one-two combination that is fueling this epidemic. Even the teachers' union is now recognizing the need for more outdoor play to mitigate myopia and obesity.

Why didn't MDH take these issues seriously, research this professionally, and advise school boards, administrators, teachers and parents appropriately?

Burgeoning research has been consistently shared on my website for years - it's time MDH became committed, and dig into its own resources to address this growing public health issue. Blue light hazards go far beyond melatonin suppression (see the University of Toledo work from last summer, and Review of Optometry's blue light research to better understand retinal cell death and the role of blue light as it relates to accommodation in refractive errors.)

And while the mention of blue light's relationship to sleep is important - it falls pathetically short.  Your department missed a key component: the schools send digital devices home at night for studying and homework. Where is the 'best practice' that would put an end to that? Online homework and studying are literally destroying the impossibly important health aspect of children's sleep, which of course, is directly related to obesity, anxiety and depression, with associated comorbidities: heart disease and diabetes.

Last June, I specifically noted the false underpinnings of the so-called "20-20-20 rule," warning against this type of bumper-sticker advice.  It has no scientific merit whatsoever, as revealed by Optometry Times. The 'rule' was originally posited within the context of ergonomics, not eye health.

I have shared this kind of research with the Maryland Department of Health for several years now. Even though your department was made well aware of the misleading nature of this 'rule,' you still released this graphic - making claims that lack any medical evidence.

Of course, any break is a good break. And of course, the encouragement of frequent blinking is imperative -- but at every turn, where the Department could have provided reliable research and reference, only AAP documentation is provided.

Please note; the American Academy of Pediatrics has yet to provide any research or documentation on the use of classroom devices, so even those references are not applicable within a school setting.


And your ergonomic image is simply wrong. By all accounts, including this one from "Let comfort be your guide" on HP's Safety and Comfort Guide, the top of the monitor should be just below eye level, and the elbow should form a right angle.

One glance at the suggestions you had in hand, and the research with which MDH has been presented for several years now, it's clear that this was an uncommitted exercise on the part of the state's medical experts who were supposed to care about protecting our kids, and who were required by law to provide medically-sound input.

That simply didn't happen.


Please consider updating, revising and supplementing the medical research that should be shared with school districts statewide. It can't be underscored enough: the use of this equipment poses serious health risks to Maryland children that will threaten their proper bone development, vision, eye health, weight, sleep and mental health for a lifetime.

Schools literally do not know what they're doing to the health of Maryland children. We were counting on you to fill them in, not whitewash this situation.

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Cindy Eckard
@screensandkids