Prolonged Gaming and Dry Eye

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How Does Gaming Affect the Ocular Surface?

At the recent EastWest Eye Conference, Cecelia Koetting, OD, FAAO, Dipl ABO, presented a poster titled, “The Effect of Prolonged Gaming on the Development of Dry Eye Symptoms in College Age Students.” The study, funded by Myze, examined the effects that consistent gaming has on the ocular surface with limited fluid intake in college students. In the study, a cohort of 41 college students were placed in a room to play video games continuously over a 4-hour period with a 5-minute break each hour. The participants were only allowed a maximum fluid intake of 500 cc, with the temperature and humidity measured in the room every hour.

Just before the study, SPEED and OSDI questionnaires were administered, and Snellen visual acuity at distance and near, tear osmolarity (Tear Lab), Schirmer test without anesthesia, and matrix-metalloproteinase-9 (MMP-9) levels (Quidel) were performed. These same tests were also performed at the conclusion of the study.

The results of the study were interesting, to say the least. The average SPEED score increased by 1.84x, but more specifically, the average frequency of soreness/irritation increased by more than threefold, and the corresponding average severity increased by two-and-a-half fold. The frequency of average eye fatigue nearly doubled, and the average severity of eye fatigue increased by a factor of 2.4. Additionally, 36% of participants who had normal MMP-9 levels before gaming had elevated levels of MMP-9 after gaming.

Dr. Koetting and her co-authors concluded that after 4 hours of continuous gaming with limited fluid intake, the average SPEED scores for college students nearly doubled. More than one-third of patients developed elevated levels of MMP-9 compared with their normal levels at baseline.

My Two Cents

According to the authors, this is likely the first study within the production of dry eye symptoms specifically focused on the gaming community. It proves what we have all suspected and have been discussing with our patients for years: that extended periods of gaming are not ideal for our patients. Now we have some science to back us up! Although 4 hours of gaming nonstop may seem excessive, I can assure you that if you pry into your patients’ lives, this is average for many of them. Kudos to this group and to Myze for this study!

OUTSIDE THE LANE

Candy-Like Drug Controversy

On October 30, the FDA held a public workshop to discuss the characteristics of candy-like nonprescription drug products. The aim was to define what makes a drug product candy-like, as these alternatives to conventional solid oral tablets are becoming more prevalent. To make things especially interesting, an FDA announcement recently noted that “no clear definition of candy-like drug product exists, and little research is available on consumer understanding of these products.”

These alternatives are often confused with candy, leading to misuse and accidental overdose, especially among young children. The workshop included presentations and discussions on various topics related to candy-like dosage forms. The FDA is seeking ways to define further features of nonprescription drug products that could be considered candy-like.

One of the ideas that was brought forth from the meeting came from a representative from the Centers for Disease Control and Prevention, which was the use of improved child-resistant packages, including “flow restrictors” in medicine bottles, to make it more difficult for children to quickly dump a number of pills into their hand. Suzanne Doyon, who represented the Connecticut Poison Control Center, suggested that drugmakers should be required to use “unit dose packaging,” such as blister packs, while other speakers argued that these products should either not be allowed to resemble specific types of candies by using characters or other “fun designs,” such as stars and diamonds on their packaging or in the design of the shape of the product itself. (Read more here.)

My Two Cents

This is something that I had never really thought too in-depth about. I give my 5-year-old son gummy multivitamins each day, and he loves the taste. They’re actually gummy worms, and he calls them “his worms.” He thinks they’re normal gummy worms, no matter how many times I call them vitamins. Personally, I don’t see an issue with candy-like medications or fun shapes, as it keeps kids more open to taking vitamins, which are essentially designed to make them healthier. This is, in my opinion, just another example of a time that we as parents need to explain to our kids that there is such a thing as too much of a good thing. Now, if only there was an easier way to get eye drops in a kid’s eye …

CAN YOU RELATE

Happy (belated) Halloween! One of my favorite things about the Halloween season is the day after, when I scroll through Facebook to see what all my friends and their families dressed up as.

This year, my son chose a costume that was a little unexpected. He was an “octopus”—but not the sea creature. While shopping for a Halloween costume a few weeks ago, I fully expected him to choose the usual Paw Patrol, Super Mario, Sonic the Hedgehog, etc, type of character. However, when walking down the aisle, he saw “a super cool robot” and fell in love with the costume. It was Optimus Prime from the Transformer movie series. Keep in mind, he’s never seen anything Transformer-related; he just loved the idea of being a robot. So, he told everyone he was “Octopus” for Halloween because the pronunciation of “Optimus Prime” proved too difficult. Last year, my little man demanded to be a tornado. Thankfully, his costume was premade this year!

That got me thinking: what are some of the best eye doctor-related costumes you’ve seen? This year, one of our doctors and their teams went as ophthalmic medication bottles with different cap colors. I thought that was a cute idea. Below are other ideas I thought up.

Eye Chart: Dress up as a walking eye chart.
Famous Glasses Wearers: Dress up as a famous person known for their glasses, such as Harry Potter or John Lennon.
Optical Illusion: Create a costume that is an optical illusion. This could be as simple as a shirt with an illusion print, or as complex as a costume that makes you look like you’re floating.
Eyeball Fairy: Attach lightweight eyeball ornaments to a tutu and add a pair of wings.
Three-Eyed Raven: Inspired by the character from Game of Thrones—add an extra eye!
Mad Eye Moody: From the Harry Potter series, replicate his magical, rotating eye.
Eye of Sauron: From Lord of the Rings, dress as the fiery eye atop Barad-dûr.
Mike Wazowski: The lovable, one-eyed character from Monsters, Inc.
Eyeball Martian: Dress up as an alien with eyes all over your body.
Four-Eyed Optometrist: Wear two pairs of glasses and joke about how you’re so dedicated to your work that you’ve developed an extra pair of eyes!
Eyes in the Back of Your Head: Attach fake eyes to the back of your costume and tell people it’s so you can keep an eye on everything.
Seeing Double: Coordinate with a friend to dress identically and tell people it’s a test for double vision.