Gaming: Navigating the Challenges of Eye Fatigue, Dry Eye, and Blue Light

Published: 15 November, 2023 | 8'

The professional field of the so-called e-sports or gaming is growing exponentially every day, and a recent survey reveals that Asia is leading this sport, with 47% of players in China. In Europe, the highest number of players is found in Spain (17%) and Italy (13%). According to surveys, only 7% are female gamers⁹.

The average use of electronic devices per player is 15 hours/day, which generates intensity of effort at the musculoskeletal, cognitive, and visual levels, affecting sleep quality or quantity, as well as nutritional aspects.

The importance of good vision in the world of e-sports

The evaluation of physical and mental conditions for participation in gaming or e-sports has been developed by the American Osteopathic Academy of Sports Medicine (AOASM).

Vision is a critical area, as stimulation by light waves activates the areas of the brain that process space, motion perception, amplitude, and recreation of manual movements, skills required to perform this sport.

What visual skills does gaming require?

Some of the visual skills determined by the AOASM during gaming practice are:

• Visual acuity and field of vision.
• Eye position, alignment, and ocular movements.
• The integrity and moisture of the eyelids, the sclera and conjunctiva of each eye, the cornea, iris, and lens, and how the pupils react to light.
• Convergence of the visual field, as well as the accommodation of our natural lenses (cornea, iris, lens, vitreous and aqueous humors).
• Binocular vision and retinal function.
• Ability to perform horizontal and vertical eye movements.

These required skills are used to a great extent during the practice of e-sports, which affects vision functionality, causing what is known as digital eye fatigue.

What is eye fatigue and how does it affect gamers?

Digital eye fatigue or strain is characterized by visual alterations or eye discomfort related to the use of digital devices. It is caused by various pressures on the ocular system, such as tiredness, discomfort, dryness, glare, blurriness, accommodation dysfunction, and fixation disparity. 20% of gamers suffer from eye fatigue.

The symptoms of eye fatigue can be classified into those related to vision, eye movement, the ocular surface, external or environmental factors, and those related to the device used^1,4,9,10. We can detail these symptoms in the following table:

How to combat eye fatigue: any hotkey?

As previously mentioned, gaming practice leads to eye fatigue, which is not only caused by visual impairment but also by other factors that should be taken into account to prevent it. Let’s see some of them.

• Ergonomics: the strategy of looking at objects located more than 6 meters away for 20 seconds after using the display unit for more than 20 minutes is a very important recommendation. Similarly, sitting upright at a desk while maintaining the natural curvature of the spine improves thoracic mobility and tissue fluidity. Keeping screens at a distance of approximately 20 inches from the eyes, ensuring that the screen height is below eye level, placing work materials above the keyboard level and below the monitor level, and playing in places where lighting does not exceed 1000 lx (lumens).
• Muscular training: it is common for gamers to experience pain in their back, neck, and shoulders, as well as changes in heart rate. It is beneficial to perform cardiovascular training as well as strength training to increase endurance and help stabilize central musculature and the trunk (including neck and shoulders). Relaxation exercises, especially for the upper trapezius muscle (located on both sides of the spine in the upper region) and pectoral muscles, are also important.
• Cognitive training: incorporating calming and relaxation techniques, such as yoga or breathing exercises, can help with anxiety, stress, among others.
• Device adaptation: it is advisable to adjust the light from monitors to match the surrounding workspace light, aiming for a contrast adjustment of around 60-70%. Light filters that can be applied to screens, such as anti-reflective filters and specific tinted lenses (for each person’s tone and saturation), are very useful. It is also important to choose a clearly legible font of at least size 12, preferably in a dark color on a light background.
• Ocular care: the main recommendations focus on increasing eye blinking, constant hydration of the ocular surface (especially for people wearing contact lenses), both orally and topically. Retraining the oculomotor system with vestibular rehabilitation exercises (moving the eyes up-down, left-right, and frequently focusing on an object at different distances) or regularly visiting an ophthalmologist are also important.

The problem of dry eye in the world of gaming

Dry eye is a multifactorial condition of tears and the ocular surface that causes symptoms of discomfort, visual disturbance, and instability of the tear film, which can damage the ocular surface. It is accompanied by a reduction in tear film and inflammation. Symptoms include redness, burning, itching, foreign body sensation, and photophobia.

It occurs in up to 30% of the population, with a special incidence among gamers. Its onset affects functional vision, causing a significant decrease in reading speed and reaction time, reducing the quality of life for everyday or leisure activities by 60% and work activities by 30%.

Ways to hydrate the ocular area

The goals of relieving dry eye are:

• Increasing tear film stability,
• Protecting the ocular surface,
• Preventing the evaporation of water from the ocular surface,

In order to achieve this goal, topical treatments such as artificial tears (typically containing omegas, electrolytes, and hyaluronic acid) and ingredients for oral intake of antioxidants and omegas are used.

Omegas are part of the lacrimal structure and ocular surface, which help maintain moisture and prevent evaporation, while antioxidants protect the entire eye as the vision is constantly exposed to light of different intensities. The most commonly used antioxidants include blueberry, maqui berries, vitamins A, C, and E, carotenoids, among others.

Blue Light: The Invisible Enemy of Gamers

Blue light is defined as the visible light that falls within the 380-500 nanometer (nm) wavelength range. It is often divided into a blue-violet spectrum (~380-450 nm) and a blue-turquoise spectrum (~450-500 nm). Blue light accounts for one third of the composition of visible light and is classified as high-energy light.

Exposure to blue light can be harmful to the retina, especially with longer durations and wavelengths around 440 nm, which can induce photochemical damage. The symptoms associated with prolonged exposure to blue light, especially among gamers, affect ocular functionality and result in the same effects previously described (ocular irritation, blurry vision, dryness, burning, headaches, etc.).

Furthermore, blue light affects the body’s circadian rhythm, our natural wake-sleep cycle, making it difficult to fall asleep. Due to their high exposure to blue light, gamers may experience effects on their nervous system function and even modifications to their cardiovascular system.

To mitigate the effects of blue light, new forms of lighting have been incorporated into digital devices, such as blue light-filtering lenses, which can reduce phototoxicity by 10.6-23.6% without impairing visual performance.

It is important to emphasize that recommendations, even with the introduction of “blue light blockers,” include taking breaks between digital device sessions, performing eye exercises, and engaging in cognitive training, among other measures.

Naturally Rebalancing the Antioxidant Equilibrium of Your Eyes

As previously mentioned, the eyes are continuously exposed to light of varying intensity and duration, making it essential to provide extra antioxidant protection.

A diet that includes iron (vegetables and legumes), zinc (beef, dairy products, and whole grains), magnesium (nuts, green leafy vegetables, and bananas), vitamins C and E (vegetable oils, sunflower seeds, citrus fruits, leafy vegetables, and their juices), the group of B vitamins (liver, eggs, oats, fish, dried legumes, and potatoes), and omega-3 fatty acids, among others, promotes eye health.

Furthermore, the diet can be supplemented with dietary supplements that provide an additional antioxidant boost for visual function. Let’s take a closer look at some of them.

• Carotenoids: These are fat-soluble antioxidants that encompass over 600 compounds responsible for the yellow, orange, and red coloration of fruits, leaves, and flowers. The most common form is beta-carotene, which helps maintain the integrity of the eye structure and prevents the oxidation of fatty acids. Additionally, we find lutein and zeaxanthin, which belong to the xanthophyll group of carotenoids and are mainly concentrated in the retina, acting as light filters to reduce photochemical damage.
• Polyphenols: They constitute a family of around 5000 plant-derived molecules that play a role in protecting plants from UV radiation. The most commonly used polyphenols in supplements are the anthocyanins, which are a significant group of plant pigments responsible for the red, blue, and purple colors of many plants and fruits. The anthocyanins from blueberries (Vaccinium myrtillus) and maqui berry extract (Aristotelia chilensis) provide significant antioxidant power. Blueberries are acknowledged by the EFSA on hold as beneficial for maintaining visual health.
• Omega-3 fatty acids: These fats, particularly EPA and DHA, are found in high concentrations in ocular tissues, particularly the retina. Their presence supports tissue integrity and participates in the regulation of oxidative processes.
• Vitamins and minerals: The quartet zinc-selenium-vitamin C-vitamin E plays a crucial role as it forms part of the eye’s antioxidant enzymatic complex and acts as direct antioxidants, doubling the benefits of their presence.

Keep Your Eyes in the Game and Enjoy Gaming

Digital eye fatigue has been increasing, with prevalence rates ranging from 5-65% before 2020 to currently around 80-94%. The most significant risk factors for developing digital eye strain are using digital devices for more than 4 hours a day (as is the case for gamers), underlying refractive errors, and ocular dryness, among others.

It is a priority to raise awareness about the effects of excessive screen time, promote ergonomic practices and preventive measures, especially among professionals exposed to excessive or prolonged screen time. As training and competition in the field of e-sports continue to expand globally, it is necessary to conduct more extensive and in-depth research on this sport in the sports medicine field to identify the main factors that can affect performance and determine appropriate strategies.

Continuous exposure to light by the eyes not only causes dryness but also overloads the antioxidant system leading to an abundant generation of oxidative free radicals. The delicate balance between the generation and elimination of radicals is crucial for ocular physiology. Therefore, including nutrients such as antioxidant vitamins and minerals, omegas, polyphenols, carotenoids, among others, in our diet is a contribution to visual health that can be complemented with dietary supplements.

Content written and reviewed by the specialists of the Scientific Information area at MARNYS. This article is for informational purposes and does not substitute the consultation with a specialist.