Public Health Implications of eSports- Focus on eye health

ESports (electronic sports) is a competitive gaming sport where approximately 30% of the world’s population (2.2 billion people) is estimated to be active gamers and the numbers will increase to 2.73 billion by 20211. It is also the fastest-growing market in Southeast Asia and a blooming industry with Asia-Pacific accounting for 47% of the total global market2.

The eSport players practiced around 3-10 hours/day in front of electronic devices and 40% of them admitted not performing any physical exercise2. Thus, eSports may have different health impacts on the players than that of regular sports.

A study published in BMJ Open Sport and Exercise Medicine examined the impact of eSport on the health of 65 players. The greatest impact was on eye health as 52% of players reported eye fatigue while 41%, 36% and 30% of the players complained of back and neck pain, wrist pain and hand pain, respectively. However, only 2% of the complainants took professional aid for their ailments2.

The public health concerns associated with eSports include various psychosocial and physical adverse effects. Gaming disorder/addiction, hazardous gaming, social isolation, family conflicts, poor academic performance, attention problems, low daily life satisfaction, mental fatigue, aggression and irritability, impulsivity, depression, anxiety, obsessive-compulsive disorder, substance use disorders, suicidal ideation, obesity, deep vein thrombosis, musculoskeletal issues, carpel tunnel and visual disturbances are the issues highlighted with excessive screen time and sedentary lifestyle1.

Most of these health concerns are reversible with appropriate rest, physical activity, nutrition, evaluation of vision, social and addictive behaviors and inquiry along with timely management of musculoskeletal issues3.

Interestingly, vision is considered the most valued sense among all other senses (hearing, balance, touch, taste, smell, temperature and pain). In a survey of 250 individuals, 220 (88%) participants considered sight as the most valued sense4.

According to DiFrancisco-Donoghue and colleagues3, the greatest impact of eSports is on vision (accounting for eye fatigue in 52% players), which is the most valued sense; therefore, it is bound to diminish the quality of life of the player.

The digital screen devices, such as computers, laptops and smartphones are sources of blue light. Excessive screen time (e.g. eSport players), apart from eye fatigue and other musculoskeletal issues, is associated with greater exposure to blue light (short wavelength), which has the potential for cumulative retinal damage5.

Diet-derived lutein (L) and zeaxanthin (Z), which known to absorb blue light, are found in the macular pigment and could protect the macular from blue light-induced damages6.

The 2017 study of Stringham et al.7 ascertained the protective role of macular carotenoids (L, Z and mesozeaxanthin) supplementation on several visual and physical parameters of at least 6 hours of screen time on 48 healthy young adults. The supplementation of 24 mg/day macular carotenoids for 6 months resulted in statistically significant improvements in macular pigment optical density (MPOD; p= 0.015), eye fatigue (p= 0.016), eye strain (p= 0.046), headache frequency (p= 0.029), overall sleep quality (p= 0.01) and all visual performance measures [disability glare (p= 0.021), photostress recovery (p= 0.011), contrast sensitivity (p= 0.002) and critical flicker fusion (p< 0.001)] versus placebo (p< 0.05). However, the human body cannot synthesize carotenoids (L and Z). These carotenoids can only be derived from diet, and the richest sources are green leafy vegetables, yellow-orange fruits and vegetables, wheat and pastas8.

Eyes and vision functions are the most valued sense and are most impacted in eSport players. With appropriate rest and intake of foods or supplements rich in macular carotenoids, they can minimize the deleterious effect of blue light that they are constantly exposed to. Furthermore, other health issues should be timely evaluated for eSports players.

References


1. Chung T, Sum S, Chan M, Lai E, Cheng N. Will esports result in a higher prevalence of problematic gaming? A review of the global situation. Journal of Behavioral Addictions. 2019;8(3):1-11.
2. Wijman T. The Global Games Market Will Generate $152.1 Billion in 2019 as the U.S. Overtakes China as the Biggest Market | Newzoo [Internet]. Newzoo. 2019 [cited 7 December 2019]. Available from: https://newzoo.com/insights/articles/the-global-games-market-will-generate-152-1-billion-in-2019-as-the-u-s-overtakes-china-as-the-biggest-market/
3. DiFrancisco-Donoghue J, Balentine J, Schmidt G, Zwibel H. Managing the health of the eSport athlete: an integrated health management model. BMJ Open Sport and Exercise Medicine. 2019;5(1):e000467.
4. Enoch J, McDonald L, Jones L, Jones PR, Crabb DP. Evaluating Whether Sight Is the Most Valued Sense. JAMA Ophthalmology. 2019;137(11):1317-1320.
5. Chamorro E, Bonnin-Arias C, Perez-Carrasco MJ, Munoz de Luna J, Vazquez D, Sanchez-Ramos C. Effects of light-emitting diode radiations on human retinal pigment epithelial cells in vitro. Photochemistry and Photobiology. 2013;89(2):468-473.
6. Bone RA, Landrum JT, Friedes LM, Gomez CM, Kilburn MD, Menendez E, Vidal I, Wang W. Distribution of luteinn and zeaxanthin stereoisomers in the human retina. Experimental Eye Research. 1997;64(2):211-218.
7. Stringham JM, Stringham NT, O’Brien KJ. Macular Carotenoid Supplementation Improves Visual Performance, Sleep Quality, and Adverse Physical Symptoms in Those with High Screen Time Exposure. Foods. 2017;6(7):47.
8. Humphries JM, Khachik F. Distribution of lutein, zeaxanthin, and related geometrical isomers in fruit, vegetables, wheat and pasta products. Journal of Agricultural and Food Chemistry. 2003;51(5):1322-1327.