TABLE 1.

History and Physical Examination of Esports Athletes

History

History to include medical, surgical, obstetrical/gynecological (for females), and psychiatric history. Personal/social history to include occupation/schooling and performance in those activities, home situation and significant others, sources of stress, leisure activities, sleep hygiene (use a validated sleep questionnaire such as the Pittsburgh Sleep Quality Index),16 exercise, and diet/nutrition habits. Screen for addictive behaviors with substances such as tobacco, alcohol, and illicit drugs by using a screening tool such as ASSIST.18 Esports athletes should also be screened for depression, anxiety, and gaming addiction. Family history, immunizations and screening tests, and complete review of systems.

Physical examination

Vision evaluation  Assess the visual acuity and screen the visual fields.  Evaluate position and alignment of the eyes and assess extraocular movements.  Inspect the eyelids, sclera, and conjunctiva of each eye, cornea, iris, and lens.  Compare the pupils and test their reactions to light.  Assess the visual acuity using visual charts and phoropter.  Perform the Vestibular Ocular Motor Screen.  Assess near point of convergence to assess convergence amplitude.  Assess near point of accommodation to assess accommodation amplitude.  Perform fusional vergence by having the athlete read a line of print through a prism with increasing magnitude until the patient can no longer maintain a single image.17  Test smooth pursuit by having the patient follow an object moved across their full range of horizontal and vertical eye movements.  Test saccades by holding 2 widely spaced targets in front of the patient (such as the examiner's thumb on one hand and index finger on the other) and asking the patient to look back and forth between the targets in the horizontal and vertical plane.19 Musculoskeletal evaluation  Use the Inspection, Palpation, Active Range of Motion, Strength, and Special Tests mnemonic to perform components of the examination. Ergonomic assessment  Monitor placement, chair type and placement, desktop placement, keyboard/mouse/controller placement, and assessment of lighting.20  Proper ergonomics evaluation and game station fitting can benefit esports athletes by reducing injury risks, improve quality of performance, and reducing stress injuries.21  There are a number of ergonomics assessment tools available in the public domain that have been developed by organizations such as the National Institute of Occupational Safety and Health21:   WISHA Caution Zone Checklist and WISHA Hazard Zone Checklist;   Lifting and Lowering Tasks: The NIOSH Lifting Equation;   Entire Body Posture: Rapid Entire Body Assessment;   Upper-Body Posture: Rapid Upper-Limb Assessment; and   Hand-Arm Vibration Calculator.