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An Optometrist’s Review of the Nintendo 3DS

For months, I’ve been reading, writing, and speaking about the Nintendo 3DS, all without actually seeing or using it. I was finally able to change that yesterday. After helping put the kids to bed, I slipped off to Best Buy and purchased a shiny black 3DS. I brought it home and Cristina and I spent a few hours setting it up and using it. We’ve had a Nintendo DS at Bright Eyes for years that we use as a reward activity during vision therapy, so it was immediately very familiar.

3D Effects

One of the biggest selling points of the 3DS is that the user does not need to wear special glasses to see the 3D effects. This is called autostereoscopic 3D and is definitely where 3D technology is going. It works surprisingly well, considering the small screen. You do have hold the screen flat relative to your head. If you angle the screen, you will either see double or lose the 3D effect. The 3D does work from positions other than dead-center. This means that, while not ideal, it is possible for more than one person to see the 3D effect at one time.

I was particularly interested to see how well the “3D volume” slider worked. This allows users to adjust the amount of 3D shown to suit their tastes and the particular game. It works amazingly, seamlessly well. I was able to adjust the 3D anywhere from none, to just-noticeable, to full with just a flick of my thumb.

Augmented reality3dsar2

One of the most intriguing aspects of the 3DS is its use of AR (augmented reality) as part of the game. This allows the viewer to play the game within the room or area that they are really in. (See picture to the right). Not only is this extremely fun, there are some potential visual benefits to this. If the game is getting further away, it is more likely that the user will hold the game further away and look further away, potentially reducing some strain on the eyes. (I should note that I don’t have any research on this, but it occurred to me while playing.)

3DS vs. DS

One of the biggest visual concerns with 2D game systems such as the original Nintendo DS is that children tend to hold the screens incredibly close – as close as 3 or 4 inches. A person of any age should not hold a book or game closer than their Harmon Distance (or the distance from the knuckle to the elbow). With the 3DS, the 3D effect is better when the game is held a foot or so away from the eyes, so this will naturally encourage users to stay within their Harmon distance.


Much has been made, appropriately, of the potential adverse effects of using 3D technology, due to the differences of 3DS and real-life 3D. Nintendo’s official warning of “vision damage” occurring for those six and under has gotten a lot of attention. While I haven’t seen any proof of this, I think it is reasonable because a person has to pretty visual sophisticated to use the 3DS. So I do recommend keeping it away from the young kids. They should be building with blocks and playing outside anyway,

3dsjustinFor the older kids and adults (like Justin, on the left) who use the 3DS, eyestrain is possible. Already, I’ve talked to patients who have experienced headaches, nausea, and blurred vision from the 3DS. I’m happy to report that after an hour neither Cristina nor I experienced any of these symptoms. However, we routinely do activities during vision therapy that require visual skill and flexibility. For that reason we are much more accustomed to the visual demands required by the 3DS.

The #1 thing to remember: moderation. Take frequent breaks, even if you feel OK. Use the 20/20/20 Rule – Every 20 minutes, look away from the screen at something 20 feet away for at least 20 seconds. Even Nintendo recommends that players take a 10 minute break every hour.

If you or your children do experience symptoms, or don’t see the 3D even with the 3D on “full” be sure to get a through eye exam to look for vision or eye coordination problems. And remember that eye exams are recommended at age six months, three years, and before kindergarten.

For more on potential health effects of the Nintendo 3DS, see my interview with PCWorld. See also the American Optometric Association’s press release on the subject


In summary, the Nintendo 3DS easy to use and fun. The 3D effects are effective and being glasses-free is very nice. The augmented reality really works well. When used in moderation for the appropriate ages, I do not see any harm. If you do have concerns, schedule an appointment at Bright Eyes either on our webpage or calling 813-792-0637.

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.
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Questions and Answers about Video Games and Vision

I was originally asked these questions by email for an interview about video games and vision. I was excited because there are a lot of myths and misconceptions about how video games can affect your eyes. Unfortunately, the interview was not published, so I decided to print them here. If you have questions like this, please let me know. -Dr. Nate

Does playing video games cause more stress to the eyes than watching tv?

Playing video games is considerably more stressful for the eyes than watching TV, but it depends a lot on which form the games take. Games on the TV like Playstation and Xbox are different than games on the computer, such as World of Warcraft, which are different than handheld games like those for Nintendo DS (and soon 3DS).

The visual system is designed for looking at things far away without effort, assuming the eyes are healthy and, if needed, the correct glasses or contacts are being worn. When looking up-close, the eyes have to change focus and position. The, over time, adds up in a big way. If the visual system is overwhelmed, gamers can have blurry vision, eye strain or headaches. If the eyes are too stressed to move properly, double vision and reduced performance can result. All this is made worse under stressful situations, overall fatigue, and times of extended mental concentration.

As a former gamer (before I had kids), I know that an awesome video game is much more likely to generate stressful situations, require extended mental concentration, and lead to fatigue from sleep deprivation than a random TV show. So gamers are already predisposed to have eye and vision problems.

But here is an additional twist: When we are under stress we have a “fight or flight” response. In this situation, our eyes are evolutionarily adapted to focus in the distance. This was useful when we were hunters and gatherers to help us see what we were hunting and what was hunting us. But it’s counter-productive when at the computer.

Finally, it’s known that people blink much less at the computer than at other times – as much as 60% less. When people don’t blink, the moisture on their eyes evaporates leading to dry, burning, irritated eyes and blurry vision. All of these things together are referred to as Computer Vision Syndrome (CVS.) Although CVS gets more attention in the workplace, it applies to recreational computer users, too.

What’s the best advice for video gamers regarding eye fatigue?

Hands down, the best advice is to take frequent breaks. There is a rule of thumb that eye doctors tell patients called the “20/20/20 Rule.” This means that every 20 minutes, look away from the screen at something specific at least 20 feet away for at least 20 seconds, like a clock or a picture. When looking away blink your eyes several times and take deep, relaxing breaths.

When looking away, take note if the object you’re looking at in the distance starts off blurry and then slowly gets clear, as this is an indication that your eyes are working too hard and that you should take a longer break. Unfortunately, that is much easier said than done, because video games are extremely engaging. When gamers are “in the zone” they often don’t stop to eat or drink, let alone take a 20/20/20 Rule break. Some people will put post-it notes on the monitors or set alarms to remind them.

Also, set up your gaming environment ergonomically. Make sure that your monitor is approximately two feet away from your eyes and not at an unusual angle. It’s best if there are soft lights on in the room so there’s not a big brightness difference between the screen and the surrounding space.

Remember to talk to your eye doctor during your annual exam about your computer use – both work AND at home. Let him or her know if you experience blurriness, fatigue, double vision, burning or discomfort at the computer. Some people think those things are just “normal” and ignore it, but that isn’t a good idea. Sometimes these symptoms are the sign of more significant underlying problems. Your doctor can do specialized testing to determine the problem. You may be given a prescription for special eyeglasses for the computer, eye drops to use, or a recommendation for therapeutic techniques called vision therapy.

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.
Dr Nate Google PlusBright Eyes Tampa on Google PlacesBright Eyes Tampa on FacebookBright Eyes Tampa on TwitterBright Eyes Tampa on YelpBright Eyes Tampa on foursquareWestchase Patch

A Warning about the Nintendo 3DS and Childrens Vision

Today there has been a lot of discussion about an unreleased hand-gaming system cleverly called the the Nintendo 3DS. The system is similar to the popular Nintendo DS, which has a small touch-screen, but the 3DS allows users to play games in 3D without the use of 3D glasses.

The DS can be a lot of fun and can even be used as therapy in some cases. However, its tiny screen and close viewing can cause eye fatigue, blurry vision, headaches, and discomfort with prolonged use. The best advice is to hold the game at Elbow Distance and take frequent breaks.

Not surprisingly, the new 3DS can provoke similar visual symptoms. Today, both CNN and the LA Times have both reported on the warning that Nintendo itself released:

“Vision of children under the age of 6 is in the developmental stage. Nintendo 3DS, 3-D, including 3-D movies and television, delivers 3-D images with different left and right eye images, which has a potential impact on the growth of children’s eyes.” (translation)

It is true that young children are still developing visual skills (adults do as well, just not as quickly) and it is likely that intense near work plays a role in the development of myopia or nearsightedness. So it is a good idea to minimize the amount of time young children spend on any near task, whether it be 2D or 3D. Playing outdoors is a great alternative.

For older kids and adults, the 3DS is probably a lot of fun. I definitely will try it out. But remember, as always, moderation is important. Take breaks every 20 or 30 minutes. If your eye doctor has prescribed glasses for reading, use them while playing. And if you do experience headaches, blurry or double vision, or other problems after playing the 3DS, be sure to have a thorough eye exam. That could be the indication of more serious problems.

UPDATE: For more info and background, see this VisionHelp post by Dr. Len Press.

See Well!

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

Dr Nate Google PlusBright Eyes Tampa on Google PlacesBright Eyes Tampa on FacebookBright Eyes Tampa on TwitterBright Eyes Tampa on YelpBright Eyes Tampa on foursquareWestchase Patch

Nintendo Flash Focus as Vision Therapy

If you have children who are old enough to ride a bike, then it is pretty likely that you’ve at least heard of the hand-held game system called the Nintendo DS. For the uninitiated, it is a small, portable video game system. As many parents will attest, these little devices can work wonders on long car trips and while waiting at the doctor’s office. But these parents also wonder if these tiny screens can be bad for their child’s eyes. Well, maybe. If they are used excessively without rest, then eyestrain, headaches, and even double vision can occur. As with any activity, frequent breaks are a good idea, and if you notice visual problems, contact your eye doctor.

However, there is a new game out called Flash Focus. It is designed specifically to improve certain visual skills, such as Dynamic Visual Acuity, Momentary Vision, Eye Movement, and Hand-Eye Coordination. Because it is fun, easy, and personalized, vision specialists who provide vision therapy are incorporating it into their programs as one more tool to improve the visual skills of their patients. This is great because it can add fun and variety to the therapy program while supporting some of the skills that are taught. At Bright Eyes Family Vision Care, we have incorporated Flash Focus into vision therapy either as part of the office or home activities for specific patients. So far, the patients are enjoying it.

Flash Focus was developed by Dr. Hisao Ishigaki, a Japanese sports-vision specialist. Sports vision is a type of vision therapy that assists athletes in improving visual skills to give them a leg up on their opponents. Many professional teams have a staff optometrist that will work with athletics to improve speed of visual recognition, depth perception, and spatial perception — the same type of skills that Flash Focus trains.

One word of caution: While the Flash Focus game can improve skills, it is not by itself a full vision therapy program. Likewise, the similar game Brain Age is not a substitute for proper assessment and treatment of learning problems, and Wii Sports is not a substitute for P.E. class in school. But these types of games can be fun and can supplement the activities that we do in vision therapy at the office. If you are using Flash Focus or any other therapy program, be sure to tell me at your next office visit.

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Be Well!

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.


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