Q&A: Gamers, digital screen users may be at greater risk for dry eye disease
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Prolonged periods of gaming may contribute to the development of dry eye symptoms in young adults, according to a study presented at the 2023 EastWest Eye Care Conference.
“There have been a number of different studies — not just looking at gamers, but anybody who has prolonged screen use — that have shown the production of dry eye symptoms like we did, but also associations with digital screen use and dry eye,” Edmund P. Farris, MD, study author and associate clinical professor of ophthalmology at New York Eye and Ear Infirmary of Mount Sinai in New York City, told Healio.
Farris and colleagues conducted a study of 41 college students, aged 18 years and older, at Quinnipiac University who had no previous history of eye surgery, steroid use or autoimmune disorders or history of treatment for dry eye.
At baseline, participants completed Standardized Patient Evaluation of Eye Dryness (SPEED) and Ocular Surface Disease Index questionnaires, and researchers performed visual acuity tests, tear osmolarity and matrix-metalloproteinase-9 (MMP-9) assessments, and unanesthetized Schirmer tear test, all of which were repeated at study conclusion.
In the Investigational Review Board-approved study, students were asked to continuously play video games for 4 hours, with a 5-minute break every hour and a maximum fluid intake of 500 cc during the study, in an environment with controlled temperature and humidity.
According to results, the average SPEED score almost doubled, with frequency of soreness and irritation increasing more than threefold and eye fatigue nearly doubling. Further, more than one-third of participants had elevated MMP-9s by the end of the study compared to normal levels at baseline.
For more insight into study outcomes, Healio spoke with Farris, who also serves as founder, investor and chief medical officer of Myze, which funded the study.
Healio: What trends have you seen in recent years among gamers or others with increased screen time?
Farris: Overall, I think the number of gamers has increased since the pandemic. There was a study in 2021 that stated there are approximately 225 million gamers in the United States, many of whom are gaming upwards of 4 hours a day. Now their device use is up to about 8 hours a day, plus gaming for 4 hours a day. That’s a substantial number of people and a substantial amount of time that these people are using digital devices and, specifically, gaming.
Healio: Why was limited fluid intake an important component of the study?
Farris: We wanted to control for hydration, because sometimes excess hydration can actually alter dry eye symptomatology and affect the parameters we were studying. We wanted to see what it would be like at a baseline state, so participants were allowed to drink regularly and were encouraged to eat prior to the study.
Healio: What can clinicians learn from this study?
Farris: After a short period — 4 hours in front of any digital device is not that long —people can definitely develop dry eye symptoms and signs, even healthy individuals. That’s really what it showed. This happened to be in gamers, but we think you can extrapolate the results to anyone that uses digital devices.
I’ve looked through literature and studies and we’re the only ones who have studied these specific parameters before and after digital screen use.
Healio: Did anything about the study surprise you?
Farris: The one thing that struck us was that 36% of the students who had a negative MMP-9 prior to the study had a positive MMP-9 score after the study. So not only are they developing symptoms, but they’re also developing inflammation that can be quantitatively assessed after just 4 hours of gaming. That’s significant, as well as the symptomatology.
I expected something to come out of the SPEED scores, which it did, but the MMP-9 scores was something we really were not expecting.
Healio: What can people who play video games as a hobby do to mitigate risk for developing dry eye symptoms?
Farris: Awareness is a lot of it. The development of dry eye signs and symptoms can lead to destruction of meibomian glands and destruction of the aqueous component of tears to function properly.
Aside from that, taking multiple breaks, staying well-hydrated, using artificial tears, lid wipes and other things to make sure their eyes are well-lubricated, since blink rates decrease while they’re staring at screens. One study showed there was as much as 50% reduced blink rate from just watching screens, especially when you’re concentrating on something.
Being aware will go a long way toward helping young people, middle-aged people and even older people mitigate symptoms.
Healio: Is there anything the video game industry could do?
Farris: There are professional gamers who not only would benefit themselves, but could also be ambassadors for their fans. This is a very large industry and they could help educate others.
Healio: What should future research focus on?
Farris: We would like to see a multicenter study. I don’t think anybody will fund a multicenter study unless we really get to the gaming industry, so that’s something we’re focused on. We would like to try to reproduce the results and look at blink rates, as well as other parameters.
Aside from that, I’d love to do a longitudinal study of intervention, to prove that intervention with treatments could help reduce inflammatory rates. By proving that, we could then show gamers and anybody who sits in front of a computer or a digital device that it’s good to take care of your eyes to keep this from progressing.
We’re really focused on making eye care part of everyone’s daily self-care. We all have a daily skin care routine, hair care routine, oral care routine: Shouldn’t we have a daily eye care routine, too?
Reference:
- Koetting C, et al. The effect of prolonged gaming on the development of dry eye symptoms in college age students. Presented at: EastWest Eye Conference; Nov. 1-4, 2023; Cleveland.
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