Gamer Eyecare? Proactive Eyecare Solutions for a Rapidly Growing Market

Video games have been around for a decent span of time, and they have come quite a long way from their humble 1-bit origins. The audience of those who enjoy video games has also grown dramatically, especially as game developers find new and innovative ways of marketing games to new generations of potential players. While there may still be a lingering idea of a stereotype gamer, today's true gamer population is incredibly diverse and includes individuals from all walks of life. Due to the ever-expanding range of games and new platforms on which to play them, you might find anyone from a grade-schooler to a geriatric enjoying video games.

One of the common misconceptions around gaming is that it has to involve a console system. Many of us think of a Playstation or a Super Nintendo system plugged into a television set, and a stack of cartridges or discs that comprise a library of games. While many still play on consoles and there is still a huge demand for these systems (simply look at the recent Playstation 5 or Nintendo Switch release, if you have any doubts), one would be remiss to forget about handheld systems, PC games, and mobile games that are available on tablets and cell phones.

On computer platforms, popular services such as Steam, Epic Games, and XBox Game Pass allow users to play thousands of games on their PC, including games that were originally released on console systems only. On these services, you can find games ranging from retro classics to cutting edge new releases, from puzzle games to mystery quests to first-person shooters to survival and crafting games, there is truly something for every taste. A quick spin through the Apple or Android App stores reveals a plethora of mobile games, including puzzle games like Candy Crush and sudoku, as well as battle royales like PUBG and Call of Duty. It’s no surprise, then, that video games have stealthily made their way into our lives.

Spending time playing video games, whether it is on a television, computer, phone, or tablet, all takes an effect on our eyes. Studies have shown that when we concentrate on screens, we tend to blink less, which can cause our eyes to dry out faster and experience symptoms of eye strain. When we are looking at screens within arm’s length, such as computers or phones, we also have to hold a posture of convergence with our eyes, which for long periods can become exhausting. 

When I explain this to my patients, I start by stating that our eyes were initially developed to help us see far away, in order to identify potential threats or to hunt food, and thus our eye muscles are optimized to focus on distance targets. When we look at things up close, our eyes have to converge in order to focus. It doesn’t take much effort to do this, but over time it can become straining.

I often use the analogy of holding two 2-pound weights in your hands and holding your arms out straight to the side: at first, the weight feels like hardly anything, but if you try to hold your arms out like that for several hours, you’ll feel pretty worn out. The same thing happens to our eyes when we spend hours upon hours focusing on a screen close to us. For this reason, many optometrists advocate for some variant of the 20/20/20 rule: for every 20 minutes you are on a screen, pause to look at something 20 feet away for 20 seconds. This gives your eyes a chance to relax, as well as blink. When we shift focus from a near to distant target, or vice versa, our eyes naturally blink, so this also helps prevent the eyes from drying out.

Staring at screens for long periods also means increased ocular exposure to blue light. All modern LED and LCD screens emit a notable amount of the higher energy wavelength blue-spectrum light that has been shown to be potentially harmful to our eyes, as well as disrupt our sleep cycle. Whether you are looking at a television, a computer, a tablet, or a phone, you are exposing your eyes to higher amounts of blue light. Because of this, those who play video games often feel the consequences of eyestrain and eye fatigue that has been correlated to increased screen use.

In addition, there is projected to be a significant increase in the rates of myopia, in part due to our increased dependence upon near-work and screens. According to research, by 2050 nearly 4758 million people will have myopia, which is 49.8% of the world’s population. In addition, nearly 10% of the world population will have high myopia. Some recent predictions have estimated that by 2050,  30% of those who are visually impaired will be due to myopia.

While these increased rates of myopia aren’t entirely due to the increased prevalence of gaming, gaming certainly plays a role in the shifting trend due to the demands it places upon the ocular system.

Two organizations have recently recognized the public health challenges and market opportunities faced by the gaming community’s unaddressed eye care needs and have decided to team up. 

Alcon-Complexity Gaming Collaboration

The eyecare company Alcon paired up with Complexity Gaming, one of the top Esports organizations, to help emphasize the relationship between gaming and a patient’s eye health. Alcon’s brand Systane, an artificial tear, is the first to officially partner up with the organization. Both Alcon and Complexity Gaming share a mutual aim: to give special attention to the eye care of gamers and keep gamers comfortable and healthy. They realize that gamers have different habits than non-gamers, and as such their eye problems can be approached slightly differently. There is much to learn from the Alcon and Complexity gaming collaboration, and their alliance will hopefully help bring attention to the growing need for addressing the effects of digital device use on ocular health. This partnership highlights a unique approach eye care companies can take in the interest of their patients’ ocular health.

We hope this collaboration will provide new insight into the usage patterns of the gaming community and give us more ways to communicate, educate, and help the gamer patient population. Since most gamers do not realize the long-term impact of gaming on their eyes, this requires special collaboration between eye care companies, the gaming industry, and eye care professionals to intercede on the current reinforcing loop between gaming and digital eye strain. 

Special Care for Gamer Patients

Extended use of digital devices by gamers causes eye fatigue and dryness, which can cause stinging, burning, and headaches, as well as other symptoms of digital eye strain. These symptoms also impact the gaming experience as eye irritation can potentially deter focus. Eyes that feel irritated or gritty can deter from the immersive experience many games offer. In addition, some fast-paced competitive games require hyperfocus and lighting reflexes, and having to struggle with irritated eyes might cause a gamer to lose more matches than they would prefer.

While gaming, just as with all digital screen use, we don’t blink as often as our eyes require. This can result in eye dryness and irritation. The prolonged demand on convergence can have more alarming consequences, such as focus problems, especially in children. As reported by the American Optometric Association, screen time exceeding 10 hours can have negative long-term effects on the eyes, both in children and adults.

Gamers, because of their high ocular demands and chronic eye strain from digital screens, require personalized attention. Our practices need to bulk up on our gaming understanding and lingo. Eye care specialists can inquire about the gaming routines of their patients and suggest changes accordingly. You don’t necessarily need to be spending every weekend sinking hours into the latest video game in order to understand the needs of those who game. However, having a general working knowledge of how patients might be playing games these days and the way it can affect the eyes can help you address the unique needs of your patients.

A patient's eye health can also notably improve if they integrate the right eye care products into their routine. Some patients may benefit from using the occasional artificial tear to lubricate their eyes, especially if they are logging a significant amount of hours on a screen.

Since gaming has the potential to be addicting, it is very common for patients to lose track of time. It’s not uncommon to spend several hours staring at a screen in uninterrupted gameplay. Patients can benefit from taking breaks every 20 to 45 minutes and allowing their eyes to adjust their focus. We need solid treatment protocols and behavior modification programs to instill healthful vision habits, and as an eye care provider, we are in a great position to educate patients about ways to help protect their eyes and reduce eyestrain.

As an eyecare provider who also spends a significant amount of her spare time playing video games, I often find it fairly easy to relate to my gamer patients. When I describe the 20/20/20 rule, I admit that I often have difficulty abiding by the 20-minute suggestion. When gaming, it is easy to sink hours into a game without even realizing how long you have spent playing. While some game developers, such as Nintendo, have started putting reminders into their games to pop up and suggest players take a break after playing for a certain amount of time, these reminders are often after several hours of play and are rarely heeded.

I suggest gamers try to establish their own system to remind them to take breaks. For example, in many online multiplayer games, there are loading screens while connecting to servers and finding opponents. During these loading screens, I recommend gamers take a break and look away from the screen and choose a distance target to look at. Or establish a routine that after every match, you look at a distant target in the room for 30 seconds. If the game is a single-player continuous game, every time the player reaches a save point they can consider taking a 30-second break and/or putting in a lubricating artificial tear. 

When all else fails, I remind players that they can set an alarm on their phone or watch to go off every half hour to remind them to look away from the screen and blink a few times. Even though the official rule states we should take a break every 20 minutes, I find that patients are more willing to abide if you make it around half-hour suggestion.

We have to embrace our role as optometric physicians and teach our patients to listen to their bodies and not ignore the sensations that they feel. If their eyes feel heavy after continuous gaming, it means that they need rest. Staying awake at bedtime to play games can not only cause eye fatigue but also disrupt the body’s biological clock, especially since the blue light from digital screens has also been shown to influence our circadian rhythm. This impacts both our physical and mental health because, without adequate rest, the body and its organs do not get the opportunity to regulate themselves.

A patient's eye health can also notably improve if they integrate the right eye care products into their routine. Some patients may benefit from using the occasional artificial tear to lubricate their eyes, especially if they are logging a significant amount of hours on a screen. 

In addition, I have found anecdotally that blue-light blocking anti-reflective coatings and materials can help reduce glare and increase comfort for anyone spending an extended amount of time on a screen, whether for gaming or for work. Some gamer-targeted companies have even started marketing “gamer glasses,” which are usually plano lenses with some form of blue-light blocking in the lenses. This represents a potential market that eye care practices can easily cater to simply by knowing how to bring the topic up in conversation.

Occasionally, I have seen yellow-tinted glasses being advertised to gamers to help reduce eye strain and increase performance while gaming. Just like a competitive marksman or hunter might use yellow or amber-tinted lenses to improve their contrast perception and identify a target faster, some gamers feel that a yellow lens helps them react quicker in games and feel less eye strain. The yellow tint essentially blocks out all blue wavelengths, thus dramatically reducing the digital strain that comes with increased blue-light exposure. These lenses may be a great fit for the gamer who doesn’t want to sacrifice any screen time, but also is having trouble regulating their sleep cycle and is suffering from digital eye strain. 

However, keep in mind that tinted lenses will naturally distort color perception, and thus may take too much away from an immersive gaming experience. In addition, the scientific evidence supporting tinted lenses has wavered back and forth over the years, and I find that people respond very differently to tints. I like to have some cheap, fit-over frames with a range of yellow to amber tints for patients to try before they decide to have a permanently tinted pair made. There is often no way to predict whether a patient will feel any subjective benefit from a tinted lens until they simply try it for themselves.

We have to face the reality that gaming is only going to get bigger and bigger. We need to find ways to address this human health concern now. It is unrealistic to expect patients to quit gaming for the sake of their eyes, just like we can’t expect offices to stop requiring computer use and for people to stop looking up memes on their phones. We should focus our attention on what we can control. We can teach patients ways to adjust habits to improve ocular health and offer products and solutions to mitigate the potential damage caused from extended digital screen time. By recognizing that gaming is no longer limited to an isolated audience, ECPs and eyecare companies should become proactive and take the gamer eye care challenge head-on.