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Hardware 27 May 2017, 14:00

author: medic

Are video games bad for health? Gaming myths debunked

For years, doctors have condemned the allegedly harmful effect gaming has on our health. Do these accusations have anything to do with facts or are they nothing more than stereotypes? Let’s find out!

During their short but very dynamic history, video games have achieved a stunning commercial and cultural success. By attracting a wide public and drawing in many ambitious, talented creators, they have formed a key branch of the entertainment market, and their popularity has spread across the entire globe. Their rise to fame, however, was quickly accompanied by numerous controversies.

Since the beginning of their road to current popularity, video games have been accused of their allegedly negative influence on the social development of children, promotion of aggression and brutality, or, last but not least, negative effects on health. I would like to focus on the latter of those accusations, verifying whether the myths, often formulated as long ago as in the 80s, stand up against the latest findings in medical science and technology.

And your eyes will melt away...

Old CRT monitors were hardly trustworthy when it came to health. - 2017-05-27
Old CRT monitors were hardly trustworthy when it came to health.

First myths

First health-related concerns that arose around video gaming focused by default on the organ most heavily exploited by gamers, namely the eyes. In the era of CRT monitors, with their somewhat disturbing tendency to cause rustling of all the things that could acquire even the slightest static charge, our imagination ran wild. That’s why PC users back in the day shielded themselves with grounded panes of glass that, allegedly, were blocking the harmful radiation that was emitted from the heart of the monitor – an old-type Iranian nuclear reactor hidden under the screen’s hunched back.

That’s how the first big myth came into being, according to which the things emitted from the monitor screen were harmful to the eyes by definition. Was it justified? Well, in the era of first-generation CRT monitors it wasn’t complete nonsense at least. The picture on CRT monitors was generated by bombarding the matrix with electrons, which, when passing it, generated a short burst of light at the point of impact. The same technology led to the generation of X-rays – yes, the same that are used for body scanning – and UV along with the relevant visible spectrum. The necessary safety norms were quickly enforced, however, and the later, newer CTR monitors emitted safe levels of secondary radiation.

LCD saves the day

With the introduction of the LCD technology, radiation stopped being an issue. In the new, “flat” monitors the picture is generated on a liquid-crystal matrix, comprising millions of small crystals which, when arranged correctly, form a colored frame that is backlit with a fluorescent tube or LEDs. Which means that in this case our eyes are treated to the typical visible spectrum light, one we see constantly. At this point I’d be glad to put this myth in the “busted” box and never trouble myself with it again. Unfortunately, even the visible light alone can be an issue – and namely the specific frequency corresponding to the color blue. Basically, all colors displayed on our monitors are a combination of the three primary colors – red (R), green (G), and blue (B).

What about the blue light?

To retain the right color temperature and provide vivid, attractive colors the image needs to include a significant content of blue. It has been known for a long time that the blue light is much more tiring to the eyes than the other two colors, but the latest research suggest that the reason for this particular quality of blue light is its ability to penetrate deep into the structure of the eye, which may lead to retina damage (and in more than one way – through energy, chemical reactions, and temperature) and accelerate the growth of a serious medical condition known as macular degeneration. The macula is the area of the greatest concentration of photoreceptor cells in the whole retina and any damage to it leads to sight deterioration or even complete loss of vision.

A wise medic – important in life and in games. - 2017-05-27
A wise medic – important in life and in games.

For now, however, there is relatively little data on this phenomenon, and scientific publications, such as the article under the title “Effects of blue light on the circadian system and eye physiology”, published last year in the Molecular Vision magazine, stress the necessity of further research, and especially establishing the precise amount of blue light and exposition time needed to elicit negative changes in the eye structure. If, however, a corellation between the two is proven, we will have a much bigger problem on our hands that just gaming, because it will apply to all artificial lighting and many other elements of our everyday environment.

While it’s hard to predict the conclusion of this research, I believe the issue will not be as relevant to gamers – after all, video games make use of a very diversified color palette, often dominated by warm colors. A gamer is in a much better situation than a person who would spend the same amount of time staring into a blank MS Word document. Many of the monitors currently available on the market are tagged as “low-blue light”, featuring special modes (switched on manually) that reduce blue light emission from our display. Which, in turn, translates into a washed-out, grayish color palette.

Bad for eyesight?

Since the topic has already caught our eye, let’s take a moment to analyze another common belief – the theory claiming that playing video games leads to nearsightedness, due to the short distance separating the player from the display. This issue was part of a broader discussion among scientists, concerning the effects of all activities that require long-term eye focus on close objects. To understand the assumptions behind those theories, let’s take a quick look on the anatomy and physiology of the human eye.

How does the eye work?

What enables us to focus our sight on objects at various distances is the elastic lens, focusing the lightwaves on our retina – a thin layer that pads the inside of our eyes and is capable of reacting to light stimuli. Thanks to pairs of small ciliary muscles, which contract, changing the shape of the lens – reducing its focal length – we can clearly see nearby objects. The expansion of those muscles, in turn, leads to flattening of the lens and enables us to focus on objects that are far away. The entire process is known as eye accommodation.

The most common reason for refractive errors i.e. eye’s inability to correctly focus light, is the innate elongation or shortening of the eyeball, which changes the distance between lens and retina, and, despite correct accommodation, renders the ciliary muscles’ efforts useless. Some ophthalmologists, however, believe that such defects may also appear due to an acquired weakening of the ciliary muscles and relaxation of Zinn’s membrane. As we already know, focusing on nearby objects for a long time keeps the ciliary muscles constantly contracted, which, according to the supporters of the aforementioned theory, may lead to a permanent sight defect due to strain.

So where are you, enemies of reading?! - 2017-05-27
So where are you, enemies of reading?!

Scientific data relevant to the case remains vague, but it seems like life habits may in fact be involved in the development of nearsightedness. However, what particularly interests us, the gamers, can be found in an article by a trio of Taiwanese researchers, published in the acclaimed academic journal PLOS One. They’ve systematically examined a large number of various available research papers, which has led them to a conclusion that what really causes acquired nearsightedness is not specifically staring at a monitor but… reading.

As we know all too well, in modern video games you can hardly find a longer paragraph of text, not to mention one written in a small font, which enables us to bust the nearsightedness myth, and state that to our eyes video games are healthier than books. Can you imagine a better thing to say to a gamer kid “oppressed” by their parents? Still, let’s not forget to take short breaks when gaming and look out through the window to give the ciliary muscles some time off. We may not damage them permanently, but they will get tired if overworked, leading to a temporary drop in their performance.

If you’re looking for medical care, make sure to visit Theme Hospital. - 2017-05-27
If you’re looking for medical care, make sure to visit Theme Hospital.

Playing in a dark room is fine

Let’s not waste any time, and proceed to debunk yet another peculiar myth, claiming that gaming in a low-light environment „damages sight” due to excessive contrast. Following such line of thought, we should assume that a night walk in the park does exactly the same, due to the excessive contrast between the lamplights and bushes. The human eye is equipped with a defense mechanism that prevents excessive amounts of light from entering the eye. Adaptation, as the mechanism is called, relies on controlling the diameter of the pupil, depending on the brightness of the environment, just like an aperture stop in a photo camera.

If the amount of received light is excessive, the eye will react accordingly in an instant. When playing in the night, the eye may get tired from the constant adaptation between the dark surroundings and the bright monitor, but it will not cause any permanent sight damage. Nevertheless, it’s good to use special sensors, installed in most modern monitors, which will adjust screen brightness to match the environment.

A desert in the eye

Dry eye requires some moisturizing. - 2017-05-27
Dry eye requires some moisturizing.

Having already thrashed so many ophthalmologist myths, is there a chance we will find one that holds water? Of course we will! If someone says that playing video games is tiring and irritating to your eyes, not to mention making them dry – they will be right. Staring at a monitor for a long time may both worsen and cause the so-called dry eye syndrome (DES). One of the many factors that may lead to the development of this condition is the reduced frequency of blinking, which happens when we focus our sight on a display. This, in turn, both reduces the production of tears and inhibits their distribution on the surface of the eyeball. The condition may be temporary – the eyes will return to their original state as soon as they regain their usual balance in a more comfortable environment – but when paired with other unfavorable factors the condition may become semi-permanent and cause trouble for a long time.

A dried eye is irritated, reddened, stings, and, in extreme cases, may suffer temporary sight deterioration. That’s why the DES is classified as the basic component of CVDTS – computer and visual display terminals vision syndrome. People suffering from a full-blown DES are advised to use artificial tears and consciously blink. Others should remember of the old but gold rule of moderation, which, when applied to gaming, means taking breaks often, and giving up on hours-long marathons in front of the screen.

Flickering

The last optical issue we have left to discuss is the display flickering, which was felt particularly in the CRT era, when it was related to the so-called screen refresh rate. The picture on a CRT monitor was generated dynamically, even when its contents remained the same. The cathode ray tube used to create it had to bombard the photoluminescent matrix with electrons – constantly, in short intervals – to sustain the impression of constant picture.

Although a single display refresh cycle lasted splits of seconds and was hardly visible, it had a significant influence on work comfort, causing headaches and fatigue. Newer CRT monitors were capable of much faster refresh cycle, reducing the negative effects. Anyone who’s had a CRT monitor probably remembers how tiring it was to look at the screen just after a reinstall of OS or GPU drivers, when the default refresh rate was set to 60Hz, and had to be manually changed to 100Hz.

LCD monitors

With the advent of LCD monitors, due to the completely different principles of image generation, which I’ve explained earlier, there was no need to “reproduce” the picture every split of second, and the term “refresh rate” gained a completely new meaning. Now it’s not the frequency of the flickering but the matrix’s ability to substitute a picture with a completely new set of pixels. Unfortunately, despite the technological revolution of the LCD monitors, the issue of flickering is still present, only due to completely different technical reasons.

This time the problem is not the picture itself, but the highlighting method. In first-generation LCD monitors the light was generated by the so-called “cold cathode”, employing technology similar to a fluorescent lamp; now the job is done by LEDs. Both methods have a weak spot when it comes to brightness regulation. Reducing the voltage leads to darkening but also changes the color of the light, leading to misrepresentation of actual colors. That’s why LCD producers came up with the idea that brightness reduction should be acquired indirectly.

They achieved it by implementing a very fast cycle of turning the light on and off, invisible to human eye and controlling the amount of light that reaches the eye in a unit of time, and giving off the impression of a darker picture. The method is called PWM – Pulse Width Modulation. Its influence on our physical well-being is significantly smaller than the refresh rate problems on CRT monitors, thanks to its much higher frequency. Which doesn’t change the fact that some people are particularly susceptible to this effect. That’s why many producers have introduced “flicker-free” monitors, relying on other methods of brightness regulation.

Bones and ligaments...

While most of the ophthalmologist myths can be easily busted, the common opinion that gaming, and in extension also sitting work in front of the computer, has a negative effect on human musculoskeletal system is, unfortunately, pretty much true.

Get over here! And fix your posture while playing games. - 2017-05-27
Get over here! And fix your posture while playing games.

A sound gamer in a sound body

What takes the biggest „beating” in the body of a gamer is the spine, which certainly doesn’t like being forced to spend a long time in a sitting position. This negative effect is multiplied by the numerous “comfortable” body positions a gamer can adopt, some of them being curiously twisted. In adults, it may lead to permanent spine deformations (reduced lumbar and cervical lordosis) and excessive burden on some spine sections – particularly near the lumbosacral joint. This, in turn, leads directly to chronic pains and discopathy, i.e. deformation of intervertebral discs, which may cause compression of the nerves coming from the spinal cord.

When it comes to children and youths, our first concern are problems with bad posture, which may be triggered or made worse by sitting in front of the monitor in an incorrect position fo a long time. The most prominent among them are scoliosis – permanent “spiral” deformation of the spine – and a condition known as “dorsum rotundum” – a result of an excessive curvature of the thoracic spine, which leads to vertebral wedging and formation of a roundback.

Well then… How do we deal with the aforementioned plethora of problems without giving up on the pleasures of gaming? First, we have to establish a balance between sitting in front of the monitor and engaging in physical activities, tailored to our age and health. Moderation and common sense are our biggest allies in this quest. What’s more, to avoid excessive stress on our spine, we need to make sure our body posture in front of the monitor is correct. Especially children need to be supervised in this matter, as it is difficult to make them sit the way they should.

Here are the rules of correct posture in front of the monitor:

  1. Our position should be symmetrical – almost any movement in any of our bigger joints translates into spine movement – if we cross our legs or sit on one of our tighs we will force unnatural bending on the spine. We should also avoid placing our monitor at the corner of our desk, as it will force us to constantly twist our torso;
  2. Knees should be at 90 degrees, with our feet in full contact with the floor;
  3. Our back and head should be leaning on a rest, and the chair should be properly regulated and adjusted to the natural curvature of the spine, providing a convex section matching our lumbar spine, supporting the natural curvature in that section. If we are in for a longer session, the back of our chair can be tilted so that the angle in our hip joint is equal to 135 degrees;
  4. The display should be located directly in front or slightly below our horizontal line of sight (this will also help with our tear distribution). However, a situation when we need to bend the cervical and thoracic sections of our spine to focus on a monitor placed too low is also bad;
  5. The height of our desk where the keyboard and the mouse are located needs to be adjusted so that our elbow joint rests at an angle of 90 degrees (preferably on an armrest), without compromising any of the previous rules;
  6. The wrist shouldn’t be bent upwards, downwards or sidewards, but lie on the extension of the forearm. For this, a pad will be useful, often provided with the keyboard, as well as a matched ergonomic computer mouse.

Pay attention to your wrists!

Keeping the wrist straight is particularly important to preventing a condition known as carpal tunnel syndrome (CTS). It is caused by excessive pressuring of one of the three main nerves in our hand – the median nerve, which passes through a tunnel formed by the hard and soft tissues of the wrist. The symptoms include pain and tingling of the fingers, muscle atrophy, as well as reduction in strength and precision of hand movements. The CTS may be caused by overstraining of wrist and keeping it bent in any direction for a long time.

That’s why when playing we should rest our wrists on a special pad, preventing them from taking a wrong turn. Console gamers should carefully choose their gaming pads, making sure their shape doesn’t force unnatural joint position on their wrists. Mild cases of CTS can be treated by changing our habits and giving our hand a few weeks of rest; most of severe ones, however, require a simple surgical intervention that will take the pressure off the nerve. Other than CTS, unnatural hand position during gaming may lead to problems with elbows, specifically the so-called tennis elbow.

Although there’s still no empirical evidence of how ergonomic keyboards benefit us, the theory seems to make sense. - 2017-05-27
Although there’s still no empirical evidence of how ergonomic keyboards benefit us, the theory seems to make sense.

Due to various upper limb conditions being a common occurrence among computer users, special keyboards, adjusted to the natural position of our hands, have been created. They look vastly different than typical ones, as their role is to relieve our hand of having to adopt forced, unnatural positions. While it may not be easy to get used to different key placement, it may prove to be a good solution for people suffering of severe cases of one of the aforementioned conditions.

For now, however, there’s too few of the new devices in people’s houses to clearly prove their effectiveness, although the theory behind them seems sound. The same goes for mechanical keyboards, which, in contrast with the popular membrane-based technology, are expected to reduce the risk of finger injuries. While many articles have been written on the topic, I was unable to find any respectable research that would prove such correlation.

A pain in the... head

As always and with everything – be reasonable. - 2017-05-27
As always and with everything – be reasonable.

The myth of epilepsy

Video game boxes often feature messages warning us of seizures (epileptic attacks) caused by flickering, shifting display picture. In adults such attacks may happen only due to predisposition – people suffering from epilepsy or organic brain disorders. That’s why, always, the first seizure during one’s lifetime should result in immediate consultation with a neurologist to establish the causes.

In children, seizures may occur even without any pathological foundations, being single, isolated occurrences. That’s why video games cannot be accused of “causing epilepsy”. Let’s also remember than not all seizures take the form of a “spectacular” tonic-clonic seizure – with convulsions and foaming at the mouth. Epilepsy may also cause such symptoms as distorted vision, temporary loss of conciousness, convulsions of a single limb, or auditory hallucination. If we see anything that worries us, it’s always a good idea to visit a doctor.

Addiction? You mean Facebook?

One of the major fears, especially among the family of a gamer, is the risk of addiction. It’s possible – that fact cannot be denied. It seems, however, that gaming addiction has already been ousted by another bad habit – compulsive usage of smartphones and social media. Video games take us to attractive, interesting worlds; give us a chance to do things impossible in real life. One thing they certainly cannot do is to fulfill all of the needs of a human being.

Social media, in turn, affect much more aspects of our daily functioning, as they fulfill numerous social needs, enabling us to take part in social life almost constantly and providing a non-stop stream of new information – something very attractive to a brain buried under the monotony of everyday life. I’ll go as far as to say that we may be on the verge of a pandemic, compared to which the addictive potential of video gaming will be of marginal importance.

Stereotype versus reality

Apparently video games can also be a good influence (an article from a Polish magazine about how games can complement a healing process). - 2017-05-27
Apparently video games can also be a good influence (an article from a Polish magazine about how games can complement a healing process).

Games can heal…

Despite numerous and very common negative beliefs concerning the infuence of video games on health, the truth is not as bad as it is presented. To provide a complete spectrum, it would also be good to take a look at the positive effects of gaming on health. I presented the topic myself in CD-Action, a Polish gaming magazine (August 2012 issue), in an article under the title “Games that heal” (Polish title: Gry lecza). I pointed out the usefulness of video games in the biofeedback method, which enables us to stabilize pulse and combat ADHD or anxiety. Games that require movement are helpful when it comes to promotion of physical activity with children and youths and preparation of convalescence plans. Even the cult-classic Tetris proved to be helpful, reducing the frequency of PTSD (Posttraumatic stress disorder) episodes when “applied” right after the traumatic experience.

… even your eyes!

What was the most unexpected thing was the potential of video games to treat eye conditions – lazy eye or sight deficiencies after surgical treatment of cataracts. I hope that those positive, and perhaps surprising to some of the readers, discoveries, as well as a realistic perspective on actual – and not supposed – dangers will help video games in improving their continuously bad reputation. We, the players, may in turn sleep well, as moderation and common sense allow us to enjoy the pleasures of digital entertainment without facing any negative effects, and basic knowledge of ergonomy helps us play safely and comfortably.

ABOUT THE AUTHOR

I’ve been a fan of video games since chilldhood. My interest in their effect on health has emerged naturally, as a consequence of my professional interests – myself being a doctor – during my specialization course in orthopaedic surgery.

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