Purpose: Three-dimensional (3D) video games played using virtual reality head-mounted displays (VR-HMDs) are becoming increasingly popular. However, the use of this technology may lead to visual symptoms and discomfort by disrupting the normal linkage between the accommodation and vergence systems. This study aimed to investigate the effect of playing 3D video games using VR-HMDs on different oculomotor functions (i.e., accommodation and/or vergence system parameters) and to quantify symptoms associated with playing games using VR-HMD technology. Methods: Twenty - six male and female young adults (age range 19-27 years) with normal binocular vision completed this study. Different clinical accommodative and vergence measurements were collected before and after playing 3D video games using a VR-HMD system for 45 minutes. In addition, visual- and non-visual-related symptoms were measured before and after the video game sessions using the standardized Simulator Sickness Questionnaire. Results: The majority of accommodative parameters--including negative relative accommodation, accommodative accuracy, and monocular and binocular accommodative facilities--were significantly affected after playing 3D video games. With respect to vergence system measurements, the horizontal negative fusional vergence range at near and vergence facility test outcomes were affected significantly after the 3D video game sessions. Significant increments in different types of symptoms (i.e., visual and nonvisual) were also observed after playing 3D video games using the VR-HMD system. Conclusions: Playing 3D video games using VR-HMD systems can lead to a deterioration of certain oculomotor functions (i.e., accommodative and vergence systems). Players can be expected to experience eyestrain and discomfort after just 45 minutes of playing.
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