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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.
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Elbow Distance and Why it Matters

There can be no doubt that all of us, especially children, are doing hand held work more frequently and more intently than ever before. All you have to do is look around any restaurant, doctor’s waiting room, or mini-van, and you will see people of all ages do this. They are reading, playing hand held video games such as the Nintendo 3DS or the PSP, or using their iPhone or Blackberry to watch videos and keep in touch with others.

All of this technology is great, but it can come with a cost – visual discomfort that can interfere with proper vision.

In addition to using proper posture and taking frequent visual breaks from intensely focusing up closely, another important element is how close a person is to the object they are looking at in their hands. A good way to tell if it is the right distance is by using the “Elbow Distance” rule.

Research on human ergonomics has determined that the optimal visual distance for reading and other close work is the Harmon Distance or “Elbow Distance”. This distance is measured by placing a closed fist at the eyes. The point at the end of the elbow represents the closest distance a person should be from their near work.

The beauty of applying Elbow Distance is that as we grow, so do our arms. You would expect a child to hold objects closer to his face than an adult. So instead of a “one size fits some” rule of a certain number of inches, the “Elbow Distance” can apply to almost everyone. Go ahead and try it on yourself now and see if you hold a magazine or cellphone at your Elbow Distance or a little further.

Some people get so absorbed in their games or reading that when they get very close to their work, they are placing undue stress on their vision. I am also very guilty of this. When I get 4 to 5 inches from what I’m writing, my eyes have to work harder to keep the words clear because of the close distance. But if I keep the right distance, the visual system relaxes and performs more efficiently – and I can really tell a difference.

If children or adults frequently get extremely close to their books or games, this may just be a bad habit. But it can also be sign of a visual problem. Either way, it is best to get an exam performed by an eye doctor who specializes in visual efficiency. They can determine if there is a problem and if glasses or vision therapy might be needed.

Be well!

Dr. Nate

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



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