The Eyes Have It

We’ve all been there. It’s late at night. We should have gone to bed hours ago. And yet, we know that it wont take very long to play just one more level…followed by many more levels, and then just a few more after that. There is nothing wrong with having a fun night playing the games we love, especially now when videogames can offer an escape from an overly harsh reality.

The problem is that while our brain wants us to keep playing, our eyes would rather take a break and kick off for a few hours. We ask an awful lot of our eyes. In addition to helping us play videogames, they are also essential for things like working on the computer, interacting with our smartphones and doing things like answering email. All of those activities involve screen time, and that can be a strain for our overworked eyes before we even get around to gaming.

Unfortunately, eye strain can be a real problem, especially for gamers. It can lead to headaches and fatigue as well as temporary or even permanent damage to our eyes. But all is not lost. With a few healthy practices, we can ensure that our eyes will continue to help us conquer “just one more level” for many years to come.

We spoke with Dr. Graham Erickson, OD, FAAO, FCOVD at EyePromise about the importance of eye heath, and how we as gamers can give our sight a fighting chance in a world full of strain.

GiN: Hello Doctor Erickson. Welcome to Can you tell us a little bit about yourself and your background in eyecare?

Dr. Erickson: I completed a residency in pediatric eye care where the emphasis was on treating neurological disorders that affect vision. That specialized training applied principles of vision therapy to assist in recovering vision and visual performance. My lifelong passion for sports stimulated me to explore how the same principles could be applied to strong healthy visual systems in athletes in order to make visual performance even better. Over the past 30 years, I have had the opportunity to work with athletes at all levels and a wide variety of sports to help them optimize vision. The rapidly emerging gaming and e-sports community offers another challenge to identify the visual performance barriers and opportunities for optimal performance.

GiN: I am just curious since we are talking about gaming and eye care. Are you a gamer yourself? What kinds of games do you like to play, and how often?

Dr. Erickson: I am not a gamer myself, but my 21-year-old son is an avid gamer.  He started playing Minecraft with his friends, and mainly plays Valorant, Garry’s Mod and Crusader Kings 2 now. He keeps me aware of the emerging trends in gaming.

GiN: Do you field a lot of questions from gamers and those who play games a lot about the effects it has on their eye health?

Dr. Erickson: I do get questions from gamers about how to improve visual comfort, with some concerns about the long term effects of gaming. These questions typically involve common symptoms from extended computer use, such as eye strain, fatigue, eye irritation/burning, redness and blurred or double vision. Symptoms of eye irritation/burning, redness and blurred vision can be the result of dry eyes.

During prolonged gaming, it is common to blink less frequently which can cause the eyes to become dry and irritated. There are glands in the eyelids that help to keep the eyes moist when we blink, and there are many people who also have glands that do not function optimally. For gamers, a combination of extended gaming and poor gland function can produce significant discomfort and also blurry vision.

GiN: Do you find that more people are playing now because of the COVID-19 pandemic, and has this led to more eye strain treatments and questions?

Dr. Erickson: I have certainly heard from some patients that they have been spending considerably more time gaming during the COVID-19 restrictions than they were previously. Many of these patients report that they have noticed more eye strain symptoms. These avid gamers have sought more aggressive steps to treat these symptoms, and are often using multiple options to manage the causes of dry eyes.

Some of the symptoms are the result of underlying conditions that affect focusing and eye teaming control. These neuromuscular conditions are exacerbated by increasing demands on the visual system, and extended gaming can provoke symptoms of eye strain, fatigue, blurred vision, double vision, headaches, and difficulty concentrating.

GiN: What are some of the negative consequences that can happen if people play games too much? Are these permanent injuries?

Dr. Erickson: At this time, we don’t know what the long term effects of gaming may be. There are speculations about the effects of prolonged exposure to the type of light emitted by monitors, which is predominantly shifted toward the blue end of the light spectrum. This type of light can cause inflammation of the sensitive tissues of the eye, particularly in the retina. We know that with prolonged inflammation, there can be a process of structural tissue damage in the body. Treatment steps to reduce the inflammation response would logically help to reduce long term damage. This also applies to dry eye symptoms, where effective treatments can reduce the damaging effects of the condition.

In general, the type of eye strain symptoms experienced from extended computer use is temporary, and is relieved by stopping the activity and getting rest. There are no known long term effects from general eye strain due to overuse.

GiN: How much does it take to get into dangerous territory in terms of eye health and playing games?

Dr. Erickson: There are still no definitive answers to this question. I use the logic that if you are experiencing symptoms, you have triggered a physiological response to gaming. The signals from your brain of eye strain, fatigue, eye irritation/burning, redness and blurred or double vision are indications that tissue changes have occurred. The longer you play, and the more often you experience these symptoms, the more likely that there may be long term consequences.

GiN: Are there any technologies like blue filter lenses and monitors which can help reduce eye strain or damage?

Dr. Erickson: Blue light filtering glasses and monitor-based apps can be effective methods for reducing the amount of potentially damaging light from entering the eyes. These steps can help to reduce the eye strain symptoms experienced from extended gaming. These filters also help to reduce the effects on the body’s melatonin production that is responsible for difficulties with sleep. I suggest finding glasses or monitor-based apps that filter at least 50% of the blue light.

GiN: What other things can gamers do to reduce eye strain? Does taking short breaks away from the screen help?

Dr. Erickson: Short breaks from gaming are an excellent way to reduce symptoms and allow you to play for longer. The American Optometric Association suggests a 20/20/20 rule to help remember the frequency, duration and type of breaks that can be most helpful. The suggestion is to take a break every 20 minutes, and to look at something at least 20 feet away from you for 20 seconds. While this can be challenging to adhere to in the gaming environment, remembering to look far away for at least 20 seconds as often as the game allows is an effective method for minimizing eye strain. Of course, I always recommend a comprehensive eye exam as the best starting point for determining possible causes of eye strain, so that the recommendations match the individual needs of the gamer.

GiN: Are there any special diets or vitamins that can help promote eye health for gamers?

Dr. Erickson: Nutrition plays a significant role in eye and brain function because certain nutrients accumulate in the tissues of the eye and visual pathway in a manner similar to other tissues in the body. There are several nutrients that are beneficial for eye health and function, and may be beneficial for gamers. Nutrients containing omega-3 fatty acids, especially from natural fish sources, can significantly reduce dry eye effects, and provide a natural way to optimize protective gland function in the eyes.

Zeaxanthin, lutein and beta carotene are nutrients that help to protect the retina from light damage, but also provide performance benefits. There is a growing body of research that shows that increasing the intake of zeaxanthin and lutein increases the type of pigment in the retina that can improve contrast judgment, glare disability and discomfort, and photo-stress recovery (recovery from bright lights). The visual skills are important in many sports, and may also be useful for performance in some gaming applications. These are all naturally occurring nutrients that can be found in the certain foods.

While the presence of zeaxanthin and lutein in the eye is well recognized, these nutrients also concentrate in the brain. Studies with young healthy subjects have shown that these nutrient levels are related to functions such as cognition, reaction time, and visual processing speed. Supplementation with these nutrients has been shown to increase brain processing and visual motor reaction speed by an average of 10% to 20%. These

The challenge of increasing dietary intake is identifying the sources and quantity of these nutrients, and determining whether it is reasonable to increase intake through dietary modification alone. Accurate assessment of nutrient intake can be difficult to measure, and can vary based on traditional diets. Study findings suggest that supplementation with purified zeaxanthin and lutein may provide performance benefits in young healthy people who have difficulty ingesting enough of these nutrients through a regular diet. Recent studies have used 20 mg of dietary zeaxanthin in the supplements for those that are young and healthy, compared to lower concentrations for the aging population.

The protective effects of zeaxanthin and lutein are fairly immediate, but the visual and neural benefits will take longer for the nutrients to accumulate. As a general guide, the visual benefits will take one to two months, and the neural benefits will need three to four months to become noticeable.

GiN: If someone really wants to play games, especially now that they are socially distant and isolated from many social and outdoor activities, can that still be done safely? What would you recommend?

Dr. Erickson: I recommend engaging in the activities that you enjoy, but to take frequent breaks to allow your eyes to recover from the effort. Use the 20/20/20 guideline to remind yourself how frequently to take breaks, and the best type of rest for your eyes. If you are experiencing symptoms regularly, schedule an eye exam to determine the cause of the symptoms.

Gamers may experience similar symptoms for different reasons, and effective treatment begins with an accurate diagnosis. Finally, consider nutritional supplementation for the potential visual performance enhancement and long term health benefits.

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