How To Combat Eye Fatigue While Gaming

While gaming can have some negative effects on your eyes, there are things you can do about it!

In part 1 of this double take on “gaming’s effects on our eyes”, I kicked-off with a sarcastic take of how the media used to demonize gaming as being bad for your eyes and brain. Well, although I then continued through ALL of part 1 (read it here!) to highlight the benefits of gaming for our vision, I have to admit that there is some truth to those exaggerated statements from old school media outlets. Let’s dive into what is true about it, and how you can do something about the negative effects of gaming on your eyesight!

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The Basics

A basic understanding here that is necessary, is the fact that pretty much everything that is on the positive side (and detailed in the part 1 ;)), is more related to changes to your brain. Even a fully comprehensive, scoping and leading scientific review states that “Cognitive gains do not correlate with loss of functionality in the vision sensory organ, which is the eye.” (1). Simply said: your eye is kind of an extension of your brain (of great significance for us humans!) - but, it is still an organ by itself, with its own structures, tissues and jaw dropping functionality of making “pictures” for us out of light waves. Like with indisputably everything about our human body, balance is the key - after a certain amount of “eye load” there are increases in risks for your precious vision organ.

For starters I want to highlight that most of what we assume to know about gaming and eyesight, does not truly come from that combination of areas. A lot of (if not most of it) falls under the umbrella terms of “digital eye strain” (a rather new term) (2), or “computer vision syndrome” (3,4), sometimes also called “asthenopia”. The symptoms across all three are somewhat similar (2,4):

• Obviously, dry and/or tired eyes
• Feeling like there is something in our eyes
• Blurry vision
• Watering
• Burning sensation
• Head aches
• Stiff neck and shoulders

Like the terms indicate, these symptoms are related to the general increase in usage of various screens throughout the recent decade. For us average university and adult age computer users the occurrence of these problems ranges from 16.4% to 89.9% (5–8). Furthermore, the significant increase of remote and online teaching for students across all ages during peak COVID times has somewhat “normalized” the constant usage of smartphones among young children. Not to say there was not already an increased usage of smart devices amongst young age groups, but one study focusing on digital eye strain and the COVID pandemic peaks highlights that usage of digital devices amongst teenagers has increased from 1.4% to at least 36.9% (or 61% for smartphones!). Therefore, at any age (68% of English children use computers, and 54% are online after the age of 3 years (9)), you are likely to have eye related problems anyway because of continuous screen usage - whether you play games or not. So any device with modern screen technology (i.e. blue light driven LEDs) has potential to increase the risk of at least having symptoms of eye strain? 

Yes, the TLDR here is simple: you use a screen for a couple of hours a day, and you will get some sort of symptom of eye strain.

Is Eye Strain dangerous?

Ok, our eyes get tired and tell us about it - one way or the other. But is that dangerous over time? Can this cause actual damage? Aye, like everything that can be too much in a chronic fashion - good old balance! Some called it the “shadow pandemic” (10), because of how much greater our daily exposure now is to screens, but also because it can lead to major eye damage. Everything from impaired vision, myopia, photochemical damage to the eye itself, retinal cell destruction, macular degeneration etc. and many more serious sounding eye problems can occur with chronic overexposure (8,10). And we are definitely chronically looking way too much at screens! These sound all scary, because they can truly be quite serious and lasting damage to your eyes, but generally all start with some sort of ocular motility (how your eyes move together) problems, which can already be triggered after only 60 minutes looking at a screen (11).

Yet, what are the specific effects of gaming, after all an activity that (as per my first part article on vision) is apparently one of the greatest cognitive loads a human can currently experience, on our eyesight? Does it make it even worse? Does it matter that it is gaming rather than passive consumption of social media, streaming or similar?

Unfortunately, problems with eyesight, eye fatigue or eye strain symptoms that could specifically relate to gaming are rare. Studies rarely assess what type of screen activity was done by the participants, plus pre-existing vision problems will just add to the complications of figuring out what caused what, and finally, but most shockingly, only one 4 hour session of continuous gaming caused a plethora of negative mechanisms in the eye (12). But there is a bit of work done on the comparison of gaming versus other screen activities.

When I write a bit, I mean, very little. When 3 to 10 year olds were compared for those who play games for less than 30 min per day and not every day against those who do every day for more than 30 min, all symptoms were much worse for the gamers and the persisted for far longer (13). Ironically, the other study was done over 30 years ago, and showed that gamers have much faster eye movements (duh), and thus may have a higher potential for causing issues (14). No surprise here, higher load equals higher risk!

In summary, from all of this several independent (but extra “bad” combo vibes if they occur together) risk factors that have been identified (1,10):

• > 14 years old
• Being male
• Additional smartphone usage
• Device usage > 5 hours per day
• Mobile games > 1 hour per day
• Low ambient light during device usage
• Small font to screen size ratio

How to fix it?

So what can we all do about it? There is no point in me telling you here that “clearly, less screen time is the fix!”. If we are using digital devices for everything from work to hourly (or more!) phone check-ins for distraction, as well as for leisure and entertainment, then we won’t suddenly be able to drop that under 2 hours a day (or at least reduce for 4 weeks, because you know, it of course works (15)). Yet, for younger gamers (e.g. <10 years), I would see if there is a way of building gaming and social media time budgets in a collaborative way with the children (if they build the rules with you together, and they count for us adults as well, they are much more likely to play along with it as well).

Otherwise, if you are looking after the wellbeing of your people at your business, students at your university team, or children in your computer classes, then I think these steps are almost the “minimal best practice” you should do:

• Do some sort of assessment (keep in mind: it is fun to play games, so any problems occurring from are likely to be underreported (16,17)):
• A simple questionnaire asking about computer vision related symptoms (4,18,19)  Computer Vision Syndrome Questionnaire & Rasch-based Computer-Vision Symptom Scale
• The Vestibular Ocular Motor Screen, which is technically for concussions, but a position statement by expert scientist recommends it for gaming and esports participants (20)
• Set the monitor position right (21) (potentially get an ergonomics expert in as well for seating and desk positions):
• Monitor 5 to 6 inches below the straight vision line
• Monitor at 20 to 28 inches away
• Limit glare on the screen can help optimize performance (yes, this means matte displays are heaps better)
• Blue light filter software & lenses can slightly help with some symptoms, but won’t fix the underlying issue, and the disruption of your sleep patterns will still persist Wing-Leung et al.
• It seems like omega-3 fatty acid consumption can somewhat reduce the symptoms from occurring over a period of 3 months (but that does not mean much in terms of potentially damaging mechanisms!) (22)
• If you can somehow reduce total daily screen time under 4 hours (including smartphones!) (23)

I am aware that it is going to be hard and complicated to do any of these. But if you reflect upon everything highlighted here, it just makes sense to put extra investment into the “extension of our brain” which is the eye - particularly if it is such a core element for individuals who need it a lot like esports athletes. Amongst those, at least at university level, 59% reported eye problems (the highest issue out of everything btw.), but only 2% sought medical help about it (24). If you truly care about the people you are working with, then I would recommend following the whole history and physical examination protocol in the “AOASM Position Statement on Esports, Active Video Gaming, and the Role of the Sports Medicine Physician” (20). Why? Eyes are hard to fix, and I still want to play games when I am old and scrappy owning noobs in CS5, Rocket League VR Deluxe or whatever will be hip in 50 years.

References:

1. Mylona I, Deres ES, Dere GDS, Tsinopoulos I, Glynatsis M. The Impact of Internet and Videogaming Addiction on Adolescent Vision: A Review of the Literature. Front Public Health. 2020;8:63.

2. Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol. 2018;3(1):e000146.

3. Portello JK, Rosenfield M, Bababekova Y, Estrada JM, Leon A. Computer-related visual symptoms in office workers. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt Optom. 2012 Sep;32(5):375–82.

4. Reddy SC, Low CK, Lim YP, Low LL, Mardina F, Nursaleha MP. Computer vision syndrome: a study of knowledge and practices in university students. Nepal J Ophthalmol Biannu Peer-Rev Acad J Nepal Ophthalmic Soc NEPJOPH. 2013;5(2):161–8.

5. Mocci F, Serra A, Corrias GA. Psychological factors and visual fatigue in working with video display terminals. Occup Environ Med. 2001 Apr;58(4):267–71.

6. Bhanderi DJ, Choudhary S, Doshi VG. A community-based study of asthenopia in computer operators. Indian J Ophthalmol. 2008;56(1):51–5.

7. Sánchez-Román FR, Pérez-Lucio C, Juárez-Ruíz C, Vélez-Zamora NM, Jiménez-Villarruel M. [Risk factors for asthenopia among computer terminal operators]. Salud Publica Mex. 1996;38(3):189–96.

8. Mutti DO, Zadnik K. Is computer use a risk factor for myopia? J Am Optom Assoc. 1996 Sep;67(9):521–30.

9. Palaiologou I. Children under five and digital technologies: implications for early years pedagogy. Eur Early Child Educ Res J. 2016 Jan 2;24(1):5–24.

10. Bhattacharya S, Heidler P, Saleem SM, Marzo RR. Let There Be Light-Digital Eye Strain (DES) in Children as a Shadow Pandemic in the Era of COVID-19: A Mini Review. Front Public Health. 2022;10:945082.

11. Chi CF, Lin FT. A comparison of seven visual fatigue assessment techniques in three data-acquisition VDT tasks. Hum Factors. 1998 Dec;40(4):577–90.

12. Lee JW, Cho HG, Moon BY, Kim SY, Yu DS. Effects of prolonged continuous computer gaming on physical and ocular symptoms and binocular vision functions in young healthy individuals. PeerJ. 2019;7:e7050.

13. Rechichi C, De Mojà G, Aragona P. Video Game Vision Syndrome: A New Clinical Picture in Children? J Pediatr Ophthalmol Strabismus. 2017 Nov 1;54(6):346–55.

14. Misawa T, Shigeta S, Nojima S. [Effects of video games on visual function in children]. Nihon Eiseigaku Zasshi Jpn J Hyg. 1991 Feb;45(6):1029–34.

15. Moon JH, Kim KW, Moon NJ. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study. BMC Ophthalmol. 2016 Oct 28;16(1):188.

16. Straker L, Pollock C, Maslen B. Principles for the wise use of computers by children. Ergonomics. 2009 Nov 1;52(11):1386–401.

17. Hu L, Yan Z, Ye T, Lu F, Xu P, Chen H. Differences in children and adolescents’ ability of reporting two CVS-related visual problems. Ergonomics. 2013;56(10):1546–57.

18. Seguí M del M, Cabrero-García J, Crespo A, Verdú J, Ronda E. A reliable and valid questionnaire was developed to measure computer vision syndrome at the workplace. J Clin Epidemiol. 2015 Jun;68(6):662–73.

19. Mohan A, Sen P, Shah C, Jain E, Jain S. Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID-19 pandemic: Digital eye strain among kids (DESK study-1). Indian J Ophthalmol. 2021 Jan;69(1):140–4.

20. Franks RR, King D, Bodine W, Chisari E, Heller A, Jamal F, et al. AOASM Position Statement on Esports, Active Video Gaming, and the Role of the Sports Medicine Physician. Clin J Sport Med Off J Can Acad Sport Med. 2022 May 1;32(3):e221–9.

21. Canadian Paediatric Society, Digital Health Task Force, Ottawa, Ontario. Screen time and young children: Promoting health and development in a digital world. Paediatr Child Health. 2017 Nov;22(8):461–77.

22. Bhargava R, Kumar P, Phogat H, Kaur A, Kumar M. Oral omega-3 fatty acids treatment in computer vision syndrome related dry eye. Contact Lens Anterior Eye J Br Contact Lens Assoc. 2015 Jun;38(3):206–10.

23. Ichhpujani P, Singh RB, Foulsham W, Thakur S, Lamba AS. Visual implications of digital device usage in school children: a cross-sectional study. BMC Ophthalmol. 2019 Mar 12;19(1):76.

24. DiFrancisco-Donoghue J, Balentine J, Schmidt G, Zwibel H. Managing the health of the eSport athlete: an integrated health management model. BMJ Open Sport Exerc Med. 2019 Jan 1;5(1):e000467.

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