Effect of the 20-20-20 rule during laptop gaming on binocular vision and dry eye parameters in healthy adults

Purpose To compare the effects of adherence versus non-adherence to the 20-20-20 rule during prolonged digital gaming on binocular vision function and dry eye parameters.Methods This study involved 100 healthy adults from April 2025 to July 2025, recruited through a controlled lab-based experiment. Binocular vision parameters included Near point of Accommodation (NPA), Near Point of Convergence (NPC), Binocular accommodative facility (BAF), Vergence Facility (VF). Tear quantity evaluation included the Schirmer-I test, symptoms assessments included Convergence insufficiency symptoms survey (CISS) questionnaire and Ocular Surface Disease Index (OSDI) questionnaire. Participants were divided into two groups: Group A adhered to the 20-20-20 rule during 40 minutes of gaming, and Group B did not adhere to this rule. The participants played an “Endless running game” for 40 minutes, with the primary investigator monitoring each participant during the task .Results On comparing post-intervention results between participants who adhered to the 20/20/20 rule and those who did not, statistically significant differences were found in near point of accommodation (NPA), near point of convergence (NPC), and vergence facility (VF) (p < .05). In each of these parameters, greater deterioration was observed among individuals who did not adhere to the 20/20/20 rule.Conclusion The 20-20-20 rule appears to be an effective strategy for preventing binocular vision dysfunction and ocular surface changes associated with prolonged digital gaming.