Note – if using Bing Chat through campus you will need to break this up into 3-4 pieces. With GPT-4 it can be done in a single copy/paste.

Background & Importance

In 2022, over 200 million individuals across the country reported playing video games regularly, with an average weekly gaming time of 13 hours. While “gaming” is a broad term that includes both recreational and competitive levels, esports, or organized, competitive video gaming, is a distinct subset. Esports differs from regular computer use, such as office work, due to the higher input demands, with competitive players reaching up to 400 actions-per-minute. Esports is a rapidly growing digital phenomenon worldwide, spanning multiple levels of play, including high school, college, and professional competition. A local university has also seen development in this area with the introduction of a Gaming Arena and expansion of the University Esports Club.

However, the growing popularity of esports brings new health-related issues for its participants. Increased screen time leads to more sedentary behavior, and over 40% of gamers and esports athletes report musculoskeletal pain in the neck, back, shoulders, hands, or wrists. Eye health is another major concern, with increased screen time associated with more eye discomfort. Computer Vision Syndrome (CVS), a medical condition associated with exposure to digital screens, causes symptoms such as increased tearing, headaches, and blurred vision after prolonged use. Eye fatigue is the top physical complaint of collegiate esports players, with over 50% reporting ocular symptoms. Additionally, esports athletes often have abnormal sleep patterns and a high prevalence of sleep disturbance.

Despite these health concerns, very few esports players and gamers seek care from a medical professional. This has resulted in large gaps in the medical literature regarding esports and gamer health. While musculoskeletal pain and eye health are documented medical issues in this population, few specifics are known about the predominant symptomology of these conditions or their successful treatment and prevention. Consequently, there is minimal information available to develop evidence-based guidelines for the healthcare of esports players and recreational gamers.

Project Goals and Outcome Metrics

The aims of this proposal are to evaluate the potential influence of eye fatigue/CVS on objective measures of visual-motor performance, a skill set linked with high-level esports performance, and assess any potential association between eye movement patterns during gameplay and the incidents and/or severity of CVS symptoms. Once delineated, these data will be the springboard for additional research questions exploring CVS treatment and prevention strategies, as well as methods for improving visuomotor performance, to inform esports players of all levels. We anticipate that, upon completion, the presented proposal will result in the production of multiple published manuscripts.

The proposed study will address the following research questions:

• RQ1: Is there a negative association between the incidence/severity of self-reported CVS symptoms and visual-motor performance in collegiate esports players?
• RQ2: Is there an association between the incidence/severity of self-reported CVS symptoms and certain eye movement patterns while playing esports in collegiate esports players?
• RQ3: Is there a negative association between the incidence/severity of self-reported CVS symptoms and visual-motor performance in competitive collegiate esports players after 120 minutes of esports participation?
• RQ4: Is there a positive association between planned ocular breaks during 120 minutes of esports participation and the incidence/severity of self-reported CVS symptoms in competitive collegiate esports players?
• RQ5: Is there a positive association between planned ocular breaks during 120 minutes of esports participation and visual motor performance in competitive collegiate esports players?

Project Description, Approach, Methods

Participants: Twenty (18-24 years) healthy collegiate esports players will be recruited. Participants will be excluded if they are not an active member of a competitive collegiate esports team or have experienced an ocular, neurologic, vestibular, or dominant upper extremity injury within the proceeding 6 weeks.

Study Design: This study will involve esports players participating in approximately 120 minutes of competitive esports play that is outside of a formal competitive event, referred to as a “scrimmage”. This time interval was chosen based on an average game duration of about 30 minutes for the majority of popular esports titles with most competitive events utilizing a “Best of Three” or “Best of Five” structure. Therefore, the average total time of computer screen exposure during a typical esports competition is about 120 minutes. We will utilize a repeated-measures cross-sectional study design at two within-session timepoints (pre- and post-scrimmage). The experimental session will take place in a local Gaming Arena and will last approximately 160 minutes (including pre/post collection times and scrimmage duration). The Computer Vision Syndrome Questionnaire (CVS-Q) will be used as a subjective measure to assess participant’s perceived CVS symptoms. Senaptec Sensory Performance tablets and their proprietary application will be used to obtain objective measures of visual-motor performance to investigate any potential impact of eye fatigue on this metric. Data collection will begin pre-scrimmage and will be obtained in the following order: (1) CVS-Q and (2) visual-motor performance modules on Senaptec tablets. Following completion of the pre-test assessment battery, players will then take part in a game-specific scrimmage lasting 120 minutes. At the completion of the scrimmage, each player will again complete the assessment battery in reverse order: (1) visual-motor performance modules on Senaptec tablets) and (2) CVS-Q. For the final phase of the study, players will return to the local Gaming Arena to individually compete in a single game of the same esports title used in the previous phases during which eye movement patterns will be obtained via a Tobii Pro Nano screen-based eye tracker.

Measurements

CVS-Q: The CVS-Q is a reliable and validated tool for assessing the prevalence of CVS by evaluating the frequency and intensity of 16 symptoms. Data collected on the CVS-Q is used to calculate a total score ranging from 0-12. A score of greater than or equal to 6 is considered consistent with a diagnosis of CVS.

Visual-Motor Performance: Utilizing Senaptec Sensory Performance tablets and their proprietary application, players will be assessed on six dimensions of visual-motor performance: eye-hand coordination, go/no-go, response inhibition, spatial memory, spatial sequence, and multiple object tracking.

Eye Movements Patterns Tracking: Tobii is a global leader in eye tracking technology that has developed screen-based eye trackers to capture accurate details of eye movement patterns, including blink rate, gaze point, and pupil date. The Tobii Pro nano screen-based eye tracker model was designed with research indications in mind and has been used in several published studies.

Statistics: A preliminary power analysis related to Ocular Discomfort Total Score (with components similar to the CVS-Q which has been validated, as previously stated) indicate that a sample size of 20 subjects will provide power = 0.94 (based on the previous study’s high effect size; cohen’s d = 0.83) at an alpha level = 0.05. Thus, the proposed sample size of N = 20 is more than adequate to test the study research questions. Data for RQ1 and RQ2 will be analyzed using individual paired-samples t-tests to compare within-subject means between the pre- and post-assessment time points. RQ3 will be analyzed by submitting all six visual-motor performance measures to a one-way repeated measures multivariate analysis of variance (MANOVA) to determine within-subject differences across the pre- and post-assessment time points.