Play, pressure, and pachychoroid: A case series on e-sports players

PurposeThe pachychoroid disease spectrum is characterized by choroidal thickening, vascular hyperpermeability, and structural alterations in the choroidal circulation. This can lead to central serous chorioretinopathy (CSC), which is clinically seen as retinal pigment epithelium detachments and subretinal fluid accumulation. Despite the fact that corticosteroid exposure is a main risk factor for CSC, its pathogenesis is unknown. This paper describes a case series in which individuals engaged in competitive video gaming presented with pachychoroid disease, and sheds light on the impact of prolonged screen exposure and e-sports-related stress on pachychoroid disease.Case presentationWe report 8 male e-sports players diagnosed with pachychoroid disease, including 6 with CSC and 2 with uncomplicated pachychoroid. All reported average daily screen exposure of 5-10 h and heightened stress during tournaments. Some cases resolved with lifestyle changes, while others required medical intervention. Reduction in video gaming and stress was correlated with symptomatic improvement.ConclusionsHigh-intensity e-sports may contribute to pachychoroid disease through prolonged screen exposure and sustained stress. Live streaming and competitive pressure may amplify these effects. Stress management and regulated screen time could mitigate risks. This case series highlights a possible association between prolonged gaming stress and pachychoroid disease. Awareness and the implementation of preventive measures are essential for maintaining ocular health in e-sports players. Further research with larger cohorts is needed.