Headaches and viewing of 3-dimensional (3D) movies in theaters

Jaime Mirowsky, MS

New York University School of MedicineDepartment of Environmental Medicine

Presenter Disclosures

Jaime Mirowsky:

The following personal financialrelationships with commercial interestsrelevant to this presentation existedduring the past 12 months:

No relationships to disclose

Introduction

•3D movies have existed since the 1950s•Health effects, such as visual fatigue associated with the viewing of 3D movies have been recognized, but epidemiologic studies have not described the frequency of this effect.

•Emergence of 3D technology in recent years• Theaters, cameras, camcorders, phones, video games, TV.

Introduction

•3D movies have existed since the 1950s•Health effects, such as visual fatigue associated with the viewing of 3D movies have been recognized, but epidemiologic studies have not described the frequency of this effect.

•Emergence of 3D technology in recent years• Theaters, cameras, camcorders, phones, video games, TV.

How 3D images can cause health effects

•Blending of 2 images causes unnatural conflict between vergence and accommodation in the eyes•Vergence: movement of one’s eyes around vertical axes to focus on an object. •Accommodation: focusing on an object•Vergence and accommodation go hand in hand in normal vision, but 3D movies upset their usual relationship.

•Health effects that have been noted include, but are not limited to, headaches, sore eyes, tiredness

How 3D images can cause health effects

•Blending of 2 images causes unnatural conflict between vergence and accommodation in the eyes•Vergence: movement of one’s eyes around vertical axes to focus on an object. •Accommodation: focusing on an object•Vergence and accommodation go hand in hand in normal vision, but 3D movies upset their usual relationship.

•Health effects that have been noted include, but are not limited to, headaches, sore eyes, tiredness

Past studies…

•Increase in blinking frequency in 3D vs. 2D movies, closer distances to screen (Lee 2010)•n = 6

•Headache elevated in 3D vs. 2D images (Kuze 2008)•n = 11

•3D images with motion increase headaches vs. no motion (Yano 2004)•n = 5

Limitations of past studies

•Low sample numbers (n < 12)

•Use of red/green glasses •Newer technology uses polarized glasses

•LCD/HDTV screens

•Length of time much less than movie

•Used images rather than motion pictures

Objectives

•To determine the frequency of headaches among viewers of 3D as compared to 2D movies in theater settings

•To evaluate risk factors for adverse health effects of 3D movies and identify potential susceptible populations

3D movies and headaches

Group 1: 2D vs. 3D movies

Group 2:Effect of age

Group 3:Vision problems

n = 66, 38 n = 140 n = 85

Institutional Review Board – exempt statusCreate surveys - SurveyMonkey®

Distribute surveys – friends, colleagues, relatives

Analyze data – Exact methods used to calculate odds ratios, 95% confidence intervals odds using Egret for Windows. Exact

logistic regression calculated using SAS 9.3.

Other considerations…

•Gender

•Migraine susceptibility

•Contacts, prescription glasses

•Sitting location in theater

•Food/drink consumed, alcohol use

Group 1: 2D vs. 3D movie viewing

2D movie viewing 3D movie viewing

Odds ratios for headache among 3D compared to 2D

movie viewers

Number of respondents

Number (%) reporting headache

Number of respondents

Number (%) reporting headache

Odds ratio 95% CI

All subjects 58 2(3.5) 36 5(13.9) 4.4 (0.7 -49.2)Age

18 – 27 16 1 (6.3) 9 2 (22.2) 4.0 (0.02 -270)28 – 37 25 1 (4.0) 14 1 (7.1) 1.8 (0.02 -151)

≥ 38 17 0 (0) 13 2 (15.3) ∞ (0.25 - ∞)Gender

Male 17 0 (0) 13 0 (0) Indet (Indet - Indet)Female 36 2 (5.6) 18 5 (27.8) 6.5 (0.95 - 55)Missing 6 0 (0) 5 0 (0) Indet. (Indet - Indet)

Previously diagnosed with migrainesNo 51 2 (3.9) 28 4 (14.3) 4.0 (0.53 - 47)Yes 5 0 (0) 7 1 (14.3) ∞ (0.02 - ∞)

Group 1: 2D vs. 3D movie viewing

2D movie viewing 3D movie viewing

Odds ratios for headache among 3D compared to 2D

movie viewers

Number of respondents

Number (%) reporting headache

Number of respondents

Number (%) reporting headache

Odds ratio 95% CI

All subjects 58 2(3.5) 36 5(13.9) 4.4 (0.7 -49.2)Age

18 – 27 16 1 (6.3) 9 2 (22.2) 4.0 (0.02 -270)28 – 37 25 1 (4.0) 14 1 (7.1) 1.8 (0.02 -151)

≥ 38 17 0 (0) 13 2 (15.3) ∞ (0.25 - ∞)Gender

Male 17 0 (0) 13 0 (0) Indet (Indet - Indet)Female 36 2 (5.6) 18 5 (27.8) 6.5 (0.95 - 55)

Previously diagnosed with migrainesNo 51 2 (3.9) 28 4 (14.3) 4.0 (0.53 - 47)Yes 5 0 (0) 7 1 (14.3) ∞ (0.02 - ∞)

Group 2: risk factors for headaches among 140 viewers of 3D movies

Age groupNumber of

respondentsNumber (%) reporting

headacheOdds ratio

95% confidence interval

All Subjects

Age

140 24 (17.1)

18 – 29 85 19 (22.4) 1.030 – 39 43 5 (11.6) 0.5 (0.1 - 1.4)

≥ 40 12 0 (0) 0.0 (Indet - Indet)Gender

Male 64 7 (10.9) 1.0Female 76 17 (22.4) 2.3 (0.8 - 7.2)

Corrective lensesNo 56 7 (12.5) 1.0Yes 84 17 (20.2) 1.8 (0.6 - 5.5)

Diagnosed with migraines

No 125 16 (12.8) 1.0Yes 15 8 (53.3) 7.6 (2.1 - 28.5)

Group 2: risk factors for headaches among 140 viewers of 3D movies

Age groupNumber of

respondentsNumber (%) reporting

headacheOdds ratio

95% confidence interval

All Subjects

Age

140 24 (17.1)

18 – 29 85 19 (22.4) 1.030 – 39 43 5 (11.6) 0.5 (0.1 - 1.4)

≥ 40 12 0 (0) 0.0 (Indet - Indet)Gender

Male 64 7 (10.9) 1.0Female 76 17 (22.4) 2.3 (0.8 - 7.2)

Corrective lensesNo 56 7 (12.5) 1.0Yes 84 17 (20.2) 1.8 (0.6 - 5.5)

Diagnosed with migraines

No 125 16 (12.8) 1.0Yes 15 8 (53.3) 7.6 (2.1 - 28.5)

Group 2 cont.

EffectOdds ratio

95% Confidence Limits

Previously diagnosed with migraine headaches

No 1.0

Yes 7.8 (2.1 - 31.5)

Age (odds ratio per decade increase in age)

0.36 (0.10 - 0.94)

Multivariable analysis

Group 3: risk factors for headaches among 85 viewers of 3D moviesAge group

Number of respondents

Number (%) with headache during

movieOdds ratio 95% CI

Number (%) with headache within 1 hour after movie

Odds ratio 95% CI

All subjects 85 10 (11.8) 13 (15.3)

Age

18 – 27 53 6 (11.3) 1.0 7 (13.2) 1.0

28 – 37 17 3 (17.7) 1.7 (0.3 - 9.1) 0 (0) 0 (Indet - Indet)38 – 47 7 0 (0)

0 (Indet - Indet)3 (42.9)

4.7 (0.6 - 35)≥ 48 8 1 (12.5) 1.1 (0.04 - 12.5) 0 (0) 0 (Indet - Indet)

Gender*

Male 35 3 (8.6) 1.0 4(11.4) 1.0

Female 49 7 (14.3) 1.8 (0.3 - 11.4) 6 (12.2) 1.1 (0.23 - 5.7)How 3D movie was viewed

3D glasses only or 3D glasses + contact lenses

67 7 (16.3) 1.0 5 (7.5) 1.0

3D glasses plus eyeglasses

16 0 (0) 0 (0 - 2.1) 5 (31.3) 5.5 (1.07 - 28.4)

* Gender was missing for 1 individual

Group 3: risk factors for headaches among 85 viewers of 3D moviesAge group

Number of respondents

Number (%) with headache during

movieOdds ratio 95% CI

Number (%) with headache within 1 hour after movie

Odds ratio 95% CI

All subjects 85 10 (11.8) 13 (15.3)

Age

18 – 27 53 6 (11.3) 1.0 7 (13.2) 1.0

28 – 37 17 3 (17.7) 1.7 (0.3 - 9.1) 0 (0) 0 (Indet - Indet)38 – 47 7 0 (0)

0 (Indet - Indet)3 (42.9)

4.7 (0.6 - 35)≥ 48 8 1 (12.5) 1.1 (0.04 - 12.5) 0 (0) 0 (Indet - Indet)

Gender*

Male 35 3 (8.6) 1.0 4(11.4) 1.0

Female 49 7 (14.3) 1.8 (0.3 - 11.4) 6 (12.2) 1.1 (0.23 - 5.7)How 3D movie was viewed

3D glasses only or 3D glasses + contact lenses

67 7 (16.3) 1.0 5 (7.5) 1.0

3D glasses plus eyeglasses

16 0 (0) 0 (0 - 2.1) 5 (31.3) 5.5 (1.07 - 28.4)

* Gender was missing for 1 individual

Conclusions

•Headaches uncommon among 2D viewers vs. 3D viewers (4% vs. 14%, respectively)

•Other risk factors could include viewers •< 40 years-old•Prior diagnosis of migraine•Eyeglasses + 3D glasses•Females

•12 – 17% of viewers of 3D movies reported headaches

Limitations

•Surveys not designed to combine results•Different age brackets•Different questions asked

•Samples sizes still low

•Age cutoff at 18 years-old

•All movies grouped together

Future directions•More comprehensive study with larger sample sizes

•Animated vs. live-action movie

•Technology differences (how projected, type of glasses worn)

•Seating position

•Survey administered directly after movie watched

•Other studies using 3DTV, 3D video games, 3D camera/video cameras

Acknowledgements

•Dr. Michael Marmor

•Group 1:•Xin Cheng•Brittany Garrett•Sean Quarry•Michael Wajnrajch, MD•Group 2:•Jieying Jiang•Alexandra Munoz•June Kim•Julie Robinson•Eric Saunders

•Group 3:•Colleen Sabella•Alysha Urniasz•Joshua Vaughan•Lital Yinon•Enhan Zhang

•New York University Graduate School of Arts and Science