By Dr. Pablo Barrecheguren (@pjbarrecheguren)
Nowadays, the video game industry is one of the most important in the world, with a large part of the population consuming this type of product (e.g., 42% of the Spanish population) and generating worldwide sales of $108.9 billion in 2017. Given the magnitude of this industry, many researchers have wondered whether it would be possible to use video games for therapeutic purposes, and one of the best documented cases are studies on amblyopia.
Lazy eye problems
Amblyopia, commonly known as lazy eye, is one of the most common vision disorders in children. With a prevalence of approximately 2.4%, amblyopia affects about 15 million children worldwide. Amblyopia is a neurological condition since “the lazy eye” itself is structurally normal even though there is an imbalance that favors the use of one eye over the other in the part of the nervous system that controls the eyes. This results in vision problems and has a negative impact on quality of life since it may impede reading, delay the development of motor skills, and even reduce children’s self-esteem by affecting their personal image.
While this problem has been known for years, the gold-standard treatment for amblyopia has hardly changed in the last decades. This treatment entails covering the healthy eye with a patch thus forcing the use of the lazy eye. The underlying idea is that patching the stronger eye reinforces the nerve connections between the brain and the weaker eye to the point that the neurological imbalance between the two eyes disappears.
This is highly age-dependent since the older the patient, the less brain plasticity. Four-year-old patients had to patch for on average 170 hours, for around 236 hours to achieve a similar effect in patients aged between five and six, and for more than 400 hours those over seven years of age.
To this excessive number of hours must be added the discomfort and vision loss suffered by the child during the treatment; moreover, since these are neuroplastic processes it is possible for improvements to be reversed once the treatment has ended (approximately 25% of patients experience a recurrence during their first year off treatment).
Video games to improve visual perception
In this regard, there is a growing scientific literature indicating that playing certain types of video games can improve several aspects of visual perception in adults. Specifically, first-person shooter video games (such as the Call of Duty series, Battlefield or the popular eSport Overwatch) seem to have this effect, while in other genres such as simulation video games or puzzle games such as Tetris these effects have not been observed.
The idea of using video games as therapy to reorganize the connections of the visual nervous system has a lot of potential since video games are a very attractive product for small children and one of the problems that faces the treatment of amblyopia is its duration and that it is extremely uncomfortable, so the collaboration of the patient is often limited and this could be solved with the gamification of treatment. In addition, if training through video games is an effective approach, the hundreds of hours of current treatment may not be necessary to cure amblyopia.
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Study using the video game The Magical Garden
A recent study made twenty-one patients with unilateral amblyopia complete a total of twenty hours of the Magical Garden, a first-person video game created with the graphics engine of the popular first-person shooter game Unreal Tournament, though all violent content from the original was removed. Participants just had to move around the settings, collect objects and point to moving objects like robots that appeared on screen. Playing this action video game resulted in improved visual abilities and participants’ improvements were largely retained 6-10 weeks after the completion of training. This study has paved the way to a potential therapeutic use of video games to treat neurological problems.
- Fronius, M., Cirina, L., Ackermann, H., Kohnen, T., & Diehl, C. M. (2014). Efficiency of electronically monitored amblyopia treatment between 5 and 16 years of age: New insight into declining susceptibility of the visual system. Vision Research, 103,11–19.
- Gambacorta, C., Nahum, M., Vedamurthy, I., Bayliss, J., Jordan, J., Bavelier, D., & Levi, D. M. (2018). An action video game for the treatment of amblyopia in children: A feasibility study. Vision Research, 148 (March 2018), 1–14.
- Green, C. S., Li, R., & Bavelier, D. (2010). Perceptual learning during action video games. TopicS. Special Issue on Perceptual Learning, 2(2), 202–216.
- Lee, H. J., Tran, D. D., & Morrell, H. E. R. (2018). Smoking, ADHD, and Problematic Video Game Use: A Structural Modeling Approach. Cyberpsychology, Behavior, and Social Networking, 21(5), 281–286.
- Tetik, B. K., Kayhan, D., Sertkaya, S., & Sandikci, K. B. (2018). Evaluation of the effects of digital play addiction on eating attitudes. Pakistan Journal of Medical Sciences, 34(2), 482–486.
- Wu, C., & Hunter, D. G. (2006). Amblyopia: Diagnostic and therapeutic options. American Journal of Ophthalmology, 141(1), 175–184.
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