Virtual reality (VR) can challenge the visual system, leading to temporary oculomotor changes, though the degree of change varies among individuals. While the vergence and accommodation system plays a crucial role in VR perception, it remains unclear whether individuals whose visual functions fall outside clinical norms experience larger changes. Thus, our study aimed to investigate whether changes in vergence and accommodation responses following VR gameplay differ between individuals with and without non-strabismic binocular and accommodative disorders. To assess this, both subjective and objective measurements were conducted before and after 20 min of playing Beat Saber. Results revealed significant alterations across both subjective measurements—near point of convergence and near point of accommodation—and objective measurements, including eye refraction, accommodation lag, and accommodative microfluctuations at far. Moreover, individuals with non-strabismic binocular and accommodative disorders exhibited larger accommodative microfluctuations at far compared to the control group. Overall, these findings indicate that considering individual differences in vergence and accommodation responses is important when evaluating the impact of VR on the visual system and can be helpful in the design and use of VR systems, particularly for individuals with binocular and accommodative disorders.

Extended Reality (XR) head-mounted devices have introduced new visual demands on end users, yet it remains unclear whether the visual system responds through transient, persistent, or adaptive changes. This scoping review was performed to identify current evidence on the visual system’s adaptation to three-dimensional (3D) immersive environments. Following the PRISMA-ScR methodology, a systematic search was conducted in PubMed, Scopus, Web of Science, and IEEE Xplore for peer-reviewed articles published between 2015 and 2025. Eligibility criteria included exposure to XR headsets and reported quantitative visual outcomes. Of 1,170 records screened, 43 met inclusion criteria, of which most used Virtual Reality (VR) (n = 27), a smaller number of studies used Augmented Reality (AR) (n = 14), and both VR and AR were used in two studies. Most studies (n = 36) assessed short-term visual changes using subjective symptom questionnaires, optometric tests, such as accommodative amplitude, near point of convergence, and eye-tracking metrics, resulting in changes of visual comfort and oculomotor function. Only a few studies examined whether visual changes persist after repeated or prolonged exposure (n = 8) or evaluated strategies to support visual functions to return to baseline (n = 4). Overall, the review highlights a lack of standardization, limited number of longitudinal studies, and insufficient investigation of return to baseline of visual function. As near-eye displays become progressively integrated into everyday and occupational settings, this uncertainty underscores the need for standardized, long-term research to inform evidence-based guidelines for visual health and safety.