Important considerations for managing patients who are gamers
Cory Lappin, OD, recently presented a session at the American Optometric Association’s 5th World Congress of Optometry. He talks with Optometry 360 about the importance of providing eye care treatment and education to gamers, over half of whom are diagnosed with some sort of eye-related issue.
Cory Lappin, OD:
Hi, I’m Dr. Cory Lappin, and I practice at the Dry Eye Center of Ohio in Cincinnati, Ohio. I was really excited to be presenting this lecture on gaming at Optometry’s meetings. It’s “Game On: The Impact of Gaming and Ocular Surface Health.” This is a particular kind of area of passion for me, mainly because I grew up playing video games, many of us have. But it’s something that we really don’t think about, the impact that it actually has on our eyes and our ocular surface, and it’s so common now. Actually two-thirds of Americans regularly play video games, and the majority of Americans actually play video games at least 1 hour per week. It’s actually now become the most dominant form of actually media. There was $57 billion in revenue in 2023 in the U.S. spent on video games. Globally, that number goes up to $200 billion, that is more than movies, music, and TV combined. This is a huge thing.
We all know that screen time is so important now when we’re talking to our patients, because of what it can do to the ocular surface, what it can do to our vision. The AOA actually did a survey and they looked and they found when they talked to gamers specifically, that they spend on average about eight and a half hours a day looking at screens, and four and a half of those hours are spent gaming. Now, this group particularly is one that’s been ignored, but we really shouldn’t, because over half of these groups of gamers already are diagnosed with some sort of eye-related issue. Even though they have that diagnosis though, they asked this issue, how many of them prioritize getting their yearly eye exam? It was less than half. Even less than half of this group talks to their eye doctors routinely about actually their screen use. We’re really seeing this disconnect right now between this group that really has these visual needs, and yet they’re really not being addressed. This is a trend that’s going to grow.
Now, one of the misconceptions often is that gamers are kids, only kids are playing video games. The average age of someone who is gaming [is] 36 years old. Even then they think, “Oh yeah, but then as time goes on, you actually decrease your game playing.” Well, actually, those over 50, about 30% of them play video games. It’s not just sitting on the couch playing your PlayStation or Xbox, you grab your cell phone. That’s what a lot of people are actually doing. The majority of their gaming now is on their cell phone, which they happen to have with them all the time. Games are always with you at this point. Traditionally, it’s thought to be more male dominated, but now it’s actually about 50%, both males and females who identify as gamers.
If we look at this generationally, millennials, 82% are self-described gamers. Then when we move to Gen Z, that goes to 90% and Gen Alpha, it’s up to 94%. It’s just wild at this point. We as optometrists, as eye care providers, need to be addressing eye health when it comes to our gamers, our patients with this. This is where things start to change. We all know that when we look at screens, it’s going to affect how we blink. The reason for that is because screen viewing is near viewing. The way our eyes are set up, our ancestors were hunter-gatherers; 90% of their visual world was off in the distance, so they were looking for predators and prey. They might look at something like berries on the bush or tracks down on the ground. They might look at it for a few minutes.
The thing is now, we are staring at things up close. Our visual world has basically flipped; 90% of our world now is with an arm’s reach. Instead of looking 90% of our world far away, it’s now up close. What that does is it affects the way we blink. We actually blink less. When we’re looking far away, we blink about 15 to 20 times per minute. But when we look up close, it can drop to 4 to 6 times, because anything we’re holding close to our face we’re deeming important information and it’ll be hard to look at it if we’re constantly blinking like this. Our brain is suppressing our blink reflex. But the problem is, we’re not looking at berries on the bush for a minute. We’re staring at screens for 8 hours a day, and that’s just during our work. Then when we come home, we look at our small screen, we look at our TV screen, we look at our consoles, our video games. We’re staring now even in our leisure time.
What we’re doing is we’re now just constantly in this basically near viewing mode, and that’s going to suppress the blink, and that’s tied to the way we actually produce tears. When we blink and we bring our… Basically, our eyelids come together and completely touch, that’s when we secrete the tears. That’s when we get the meibum coming from the meibomian glands. But what we start to do when we’re looking at screens all the time, is we want to blink, but we don’t want to obstruct the vision. We start to do these partial blinks. There’s 2 things going on: 1, we’re not blinking as much, so the eye surface is drying out, and 2, we’re blinking, but we’re not getting that full secretion of the tears. The meibomian glands can get clogged, that can lead to MGD and evaporative dry eye and dry eye in general. Now you’re starting to get in this vicious cycle, and we’re doing this all the time.
Really with our gamers, we need to talk to them about preventative maintenance for this. It’s the old saying that an ounce of prevention is worth a pound of cure. That’s really what we have to talk to them about. We need to talk to them about taking blink breaks. We need to talk to them about proper ocular hygiene, which is another thing we don’t talk about. They can have artificial tears and lubricating drops, but they need to make sure that they’re taking breaks in between their gaming sessions, because the majority of gamers, over 50% say they only take a break of less than 15 minutes from screens. That’s a very small period of time. They need to know, “Hey, between matches, when you’re playing Call of Duty, you’re playing Halo, you’re taking a break, blink, look away from the screen. Blink, refresh your tears.”
Talk to them, “Hey, if you’re still struggling, let me know.” Because gamers have reported that they have headaches, they have eye strain, there’s higher rates of dry eye. This is going to get worse as time goes on. Dry eye patients were traditionally seen as an older demographic, but now we’re seeing it younger and younger, and a lot of that is related to the way we use screens even in our free time. They’ve done studies with children now, with smartphone gaming, their blink rate is changed, and symptoms began within 1 minute of them using a smartphone game, and it persisted through the hour of the study. There was another study of college aged kids that basically showed that when they were gaming for 4 hours, inflammation increased on the surface of the eye.
We need to talk to them and let them know that there are safer, healthy ways for them to continue doing what they love, but if they’re having trouble to talk to us. What I always recommend is you talk to them about the basics. Things like hydration is always great for that, taking their blink breaks, using artificial tears just to lubricate the surface. But if they’re still having trouble, then we can look at prescription dry eye options for them, for those who are really struggling. We want to make sure they have the right basically glasses or contact lens prescription. If you can’t see what you’re doing, you’re going to have eye strain. You might have binocular vision issues.
You want to make sure your visual system is entirely cared for. Then you can even talk to them about screen viewing, finding the proper distance that’s going to be best for you ergonomically. There’s a ton of different things that we can do for our dry eye patients, whether it’s just the basics of dry eye treatment as prevention, or helping those who already have dry eye. Because we know that, hey, gaming is something they love. It’s not going anywhere. We want to make sure they’re doing it in the healthiest way possible.
