Blink rate self-regulation, tear volume and ocular symptoms in expert and naïve action video game players

Clinical relevance Alterations in blink rate and dynamics are common during visually demanding tasks such as video gaming or digital device use, leading to tear film instability and ocular and visual symptoms.Background Sustained visual attention during gaming may reduce blink frequency and alter tear production, increasing ocular surface symptoms. The aim of this study was to determine whether experienced action video game (AVG) players exhibited adaptations in blink rate and tear volume compared with non-video game (NVG) players, and to explore the relationship between these adaptations and ocular symptoms.Methods Thirty participants (17 AVG and 13 NVG) were enrolled. All participants played Call of Duty: Modern Warfare® (Zombies mode) for 25 minutes under controlled conditions. Blink rate was recorded at baseline and during dynamic and non-dynamic scenes using the Pupil Core eye tracker. Tear volume was assessed with the Schirmer test before and after gameplay. Dry eye symptoms were evaluated using the SANDE questionnaire at baseline and the IOSS questionnaire every five minutes during gameplay.Results No significant group differences were observed at baseline in blink rate, tear volume, or SANDE scores (all p > 0.05). During gameplay, AVG players exhibited significantly lower blink rates than NVG players in both dynamic (5.94 ± 2.61 vs. 7.88 ± 2.40 blinks/min, p = 0.045) and non-dynamic scenes (10.44 ± 3.34 vs. 13.73 ± 3.82 blinks/min, p = 0.018). Schirmer test values did not differ significantly pre – post session (p > 0.05). IOSS scores increased during gameplay in both groups (p < 0.0001), appearing earlier in NVG players.Conclusion Expert AVG players demonstrate altered blink behaviour compared with NVG players, possibly reflecting adaptations that minimise visual information loss. These adaptations may influence ocular surface health during prolonged visual tasks. Further research is warranted to clarify the mechanisms underlying these changes.