Click here to view a PDF of Born Connected.
They are the next up and coming generation—babies, kids, tweens and teens—all under the age of 19. They are known as iGeneration. Homeland Generation. The Plurals. The Founders. Centennials. They are not only digital natives, but social natives as well as device natives, engaging with many, and often. Not tech savvy, but tech innate. This is Generation Z, and they’re growing up fast.

These are the children who are coming of age in the shadows of a post-9/11, post-recession world, witnessing their older siblings and parents struggle and sometimes fail. In school, they’re being taught in classrooms that emphasize diversity and collaboration. Genders are bending.

Ethnicities are blending. Generation Z is global, cooperative, responsible and walking into your practice, multiple devices in hand. As ECPs, what do you need to know in order to keep up? VM spoke with several ODs about the vision needs and eye health challenges facing this newest generation and here’s what they had to say.

Who is Generation Z?

Depending on the source, those defined as “Generation Z” are comprised of a blended makeup of individuals born between 1995 and the present (with some sources starting at 1997, and others with 1998, etc.). For a general understanding, the population group can be loosely defined as anyone aged 0 to 19, with the focus (for marketers, especially) tightening on children, tweens and teens between the ages of 5 and 15.

The U.S. Census Bureau’s most recent estimates released in 2014 (via the 2014 American Community Survey and 2014 Population Estimates Program) report those aged 19 years and under make up roughly 26 percent of the population, totaling 83.3 million. That figure exceeds Millennials by 9 million. According to a 2014 report by media agency Sparks and Honey, there are 361,000 babies being born into the world every day, meaning this generation is growing fast, and so, too, is their influence.

In the report titled “Meet Generation Z: Forget Everything You Know About Millennials,” Sparks and Honey asked moms of Gen Z-ers how much influence they believed their children had over household purchases. The response was striking—according to these mothers, kids are impacting their parents’ buying decisions in every category, from toys (84 percent) to apparel (74 percent) to family vacations (65 percent). Further, for those Gen Z-ers that are able to, they’re researching online, shopping online and making responsible decisions about how to spend their (or their parents’) money.

Andrea Thau, OD, owner of Dr. Andrea P. Thau and Associates in NYC, recommends discussing contact lens options even before a patient is old enough to wear them.
“These are the kids I like to call, ‘too smart for their own age,’” said Justin Bazan, OD, owner of Park Slope Eye, in Brooklyn, N.Y. “They’ve been immersed in a world of information overload.” An age group that has grown up “seeing their parents use Google for everything” has made Generation Z more inquisitive and more resourceful than any young population before them.

“These kids are able to access information and figure things out better than anyone. If I give them information and they want more, they know where to get it,” he said. “They’re very comfortable navigating the internet to find high quality sources.”

This generation is also more diverse than any before it; the Millennials may be multicultural, but Gen Z is multiracial, with children born from parents of mixed races—the fastest growing youth group in the nation, increasing 50 percent since 2000.

“The demographics of this group is quite interesting,” said Carla Adams, OD, owner of Optique EyeCare in Saint Charles, Ill., who is attuned to Gen Z’s unique makeup, as well as their buying habits. “This group is coming of age in a stressful time, since the sting of the recession is still palpable. As a result, they tend to be more conservative in their spending, and are less loyal to particular vendors.”

Compared to Millennials, who were the first generation to be exposed to electronic devices on a large scale, Gen Z is also even more technologically connected, many multi-tasking across as many as five screens per day (including televisions, mobile phones, tablets, laptops and desktop computers).

“Gen Z is the first to be born with exposure to these devices as toddlers or earlier,” said Adams. “They have a near addiction to mobile devices at an early age. This has caused an inordinate amount of stress on their young developing visual systems.”

One of the largest areas of concern among optometrists is that the time “iGeneration” members are spending with technology is taking away from their time outside, where they are able to engage in activities that keep their visual systems active and in shape. “Gen Z-ers change how our vision systems were meant to be used—for example, outdoor and unstructured play is being replaced with sedentary lifestyles and screens.”

Jessi Lee, OD, a vision therapy and pediatrics specialist at LensCrafters in Buffalo, N.Y., also noted this discrepancy between Gen Y and Gen Z patients, even as a Millennial herself. “One of the biggest things we see is that technology use is starting so much younger now,” Lee said. “I consider myself someone who grew up around these things, but it was for school or luxury. Kids are figuring out how to use a smartphone when they’re one year old, so that’s certainly changing the way their visual systems are developing.”

More Myopia, More Problems

This increased screen time from a younger age is something many optometrists are dealing with at their practices, many of whom report increased instances of conditions such as digital eye strain and myopia.

“The myopic epidemic is a worry for the younger generations, and that includes Gen Z. This is the major trend that is being reported worldwide—children are becoming myopic at an earlier age—and myopia is associated with an increase in cataract, glaucoma and macular degeneration,” said Adams, who focuses on preventive care at Optique EyeCare.

“It’s very obvious that this age group is spending a lot of time with digital devices,” said Nathan Bonilla-Warford, owner of Bright Eyes Family Vision Care and Bright Eyes Kids in Tampa, Fla. At Bright Eyes Kids, Bonilla-Warford puts an emphasis on pre-myopia treatment, educating parents and patients about the adverse effects digital devices can have on young eyes, such as digital eye strain and developmental vision problems, and ways to avoid them.

“The types of conditions we used to think of as Computer Vision Syndrome, typical of office workers, has become a real mainstream issue. We’re seeing the exact same things in this younger generation, only we don’t call it Computer Vision Syndrome, because it’s not just adults on computers, it’s kids, and it’s everyday life,” Bonilla-Warford said. “Having six year-olds watching YouTube is not the same as playing tag outside.”

Lee also advocates supplementing tech time and near-vision activities with tasks that require multifocal ranges. “You want an equal amount of time reading and getting outside to do things that help work that distance vision,” she said. She also added another feature to the popular 20/20/20 rule: “Something I recommend a lot is using a slant board for better visual posture,” she said, referring to simple stands that help eliminate neck bending and leaning forward. “It can even be a five-inch binder.”

Testing 1, 2, Z

In addition to simple lifestyle adjustments that can help promote healthy eye movements, optometrists, particularly those specializing in vision therapy, are adamant about full-scope testing.

“School and pediatrician screenings are not comprehensive eye exams,” said Lee, also noting that even optometrist-administered exams are sometimes not enough to catch issues early.

For example, she said, checking near vision and binocular vision, in addition to distance vision, is essential for this generation, since they are spending more time viewing things up close, and less time focusing on longer distances. “That’s not where kids are spending 90 percent of their day anymore,” she said.

Carla Adams, OD, owner of Optique EyeCare in Illinois, administers a vision test with teen patient, Camille Diaz.
Furthermore, children, tweens and teens, as well as their parents, may not recognize when a problem is present, or may not make the connection when an issue is connected to their eye health. Common problems such as headaches, difficulty reading or trouble focusing in school can be improved or even avoided with ample vision screenings.

“It’s important to test those things because kids don’t know what to report. We have to educate parents, too, because there can be something underlying going on [in their children’s eyes],” Lee said.

At Optique EyeCare, Adams also stresses in-depth testing, as well as liberal prescription of specialty lenses. “The most common vision ailments I see in the Generation Z population are binocular vision problems, such as focusing disorders, eye tracking problems and eye teaming problems,” said Adams. “I typically recommend lenses with coating, to reduce exposure to harmful blue light, and lenses to prevent digital eye strain. Specialty products can include multifocal eyeglass lenses, multifocal contact lenses for burgeoning myopes, as well as Ortho-K lenses.”

Andrea Thau, OD, president-elect of the American Optometric Association (AOA) and owner of Dr. Andrea P. Thau and Associates in New York City, recommends discussing contact lens options even before a patient is old enough to wear them. “We discuss contact lenses as an option for all patients who we feel are good candidates, even if they are not ready for that responsibility now,” said Thau. “We plant the seed for the future.”

Who You Calling ‘Four-Eyes’?

Luckily, or at least, on the bright side, increased instances of myopia has made prescribing eyewear to children less of a challenge, several ODs told VM. Put simply: glasses aren’t un-cool anymore.

“The idea of wearing glasses is a lot more popular than it used to be,” said Lee. “I don’t feel like I have a lot of struggle to get kids to wear their glasses. Everybody knows someone who wears them, and glasses are a lot cuter now than they were when I started out.”

This experience is reflected across many optometric practices treating Gen Z patients. “It’s different now than when I was a kid,” said Bonilla-Warford. “Glasses are so popular and trendy and big and bold. Right now, I’m getting more kids who are disappointed they don’t need glasses than those who are upset that they do.”

According to Thau, they’re not only fashion savvy when it comes to frames, but more receptive of eyecare overall than the generations preceding them. “These patients tend to be more serious and responsible than past generations with regard to compliance,” said Thau. “They are more open to trying contact lenses and very interested in the fashion side of eyewear. They love sports goggles even worn as regular ‘dress’ eyewear.”

And further, Thau said, this cohort is the first to have vision care readily available to them. “Thanks to the efforts of the American Optometric Association, the Affordable Care Act’s Essential Pediatric Vision benefit includes an annual comprehensive eye examination and materials.”

In short, Gen Z will be the first generation that has coverage for annual comprehensive eye examinations, which can lead to a lifetime of good eye health, and clear, comfortable binocular vision.

Sports Vision Eyewear

“Dr. Nate with the “Amazing John John,” YouTube personality known for his scientific videos including “How to Get Vision Therapy” and “How to Get Sports Vision Training,” which were filmed at Bright Eyes Kids in Tampa (2015).
Part of Generation Z’s goal-driven mindset is a result of their parents instilling the values of academic and athletic success in them from a young age. This attitude creates a great opportunity for ODs, who might consider educating patients and their families about eyewear that can help their performance, both in the classroom and on the sports field.

“Parents and coaches are often willing to invest time and resources to make sure their child/student is able to compete at the highest level,” said Optique’s Adams.

“This is why sports vision and vision therapy is making a resurgence in many communities. Therefore, an optometrist who provides these services will serve a need that is very important. The rehabilitation of an ailing visual system can be the most rewarding experience imaginable for the optometrist and the patient.”

Tell Me More! (Or I’ll Find Out Myself)

Another facet of Gen Z patients, particularly those in their tweens and teens, is that they are curious in the exam room as well as online on their own—even about visual conditions.

“I find these patients are more interested in hearing about the care we’re providing,” said Park Slope Eye’s Bazan. “My patients love information—the kids crave it. If there’s an eye condition or a disease, they want to know about it. Whereas in the past I would talk to the parents, Gen Z is so smart and able to absorb information that I can present to the kid.”

Brooke Barber, age 10, happy to be receiving a new pair of frames at Park Slope Eye in Brooklyn, May 2016.
Even younger patients are well-equipped to learn, Bazan said, recalling a recent visit from a patient whose parents were interested in Ortho-K treatment. Prior to the appointment, the 12-year-old patient researched Bazan and his practice online, watched several videos about Ortho-K on YouTube, and had garnered a genuine understanding of the topic, Bazan said. “He was able to talk and guide his parents through it. He came really well prepared.”

Of course, access to resources has a significant impact on just how savvy kids are; in Park Slope, for example, patients are typically affluent and equipped with devices and education. Bazan said, “In my neighborhood, the kids have a tendency to be very inquisitive by nature. The level of knowledge and willingness to come forward with it is much greater. And not only are they learning, they’re willing to share almost impulsively.”

Carla Adams, OD, administers a vision test with young patient, Nathan Collier at Optique EyeCare in St. Charles, Ill.
So what’s next for the generation coming after Gen Z? “As a society, we’re coming to grips with how this technology is affecting us for both good and bad,” said Bonilla-Warford. “Having discussions early and giving patients options is very important. Many parents, especially very good parents, just haven’t thought about it or didn’t know their options. It’s all about education,” he said.

Connecting with Gen Z patients and their parents about treatment options starts with conversation, Bonilla-Warford said. “We ask a lot more questions up front, even on our intake form: How much screen time do they get? How much time are they spending outdoors? We start the conversation before they even get in the exam room,” he said. “Even before they’re myopic, if I can see signs, I start educating them. Proactive education is the only hope we have.”

“Gen Z-ers are sure to be a generation in need of specialty optometric care,” said Adams. “The desire to stay connected or play on electronic devices will come with consequences. I always end each visit by stressing the importance of annual, professional care. It is important to emphasize that eyes and vision are under more stress than in previous generations, and preventive care is of the utmost importance.”

—Catherine Wolinski is a N.Y.-based freelance writer and former associate editor of Vision Monday.