Eye diseases represent a growing public health challenge in Portugal, significantly compromising the population’s quality of life. The increase in their prevalence is associated with various factors, such as demographic ageing, excessive use of digital devices, inadequate lifestyle habits and limited access to ophthalmological consultations, especially in regions with less health service coverage. These factors contribute to the increase in cases of avoidable visual impairment, highlighting the urgent need for more accessible and less invasive screening strategies. Exergames
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VIRTUAL REALITY EXERGAMES AS A TOOL FOR DIAGNOSING EYE DISEASES
Publication type: Article Summary
Original title: VR Exergames for ocular diseases diagnosis
Article publication date: February 2019
Source: Repositório da Universidade Nova de Lisboa
Author: Miguel Miranda
Supervisors: Filipe Sousa & Sofia Cavaco
What is the goal, target audience, and areas of digital health it addresses?
The study aims to develop an innovative tool based on virtual reality exergames to facilitate the early detection of eye diseases. The target audience includes healthcare professionals such as ophthalmologists, optometrists and researchers in the field of ophthalmology and digital health technologies, as well as healthcare managers interested in innovative solutions for the early screening of eye pathologies. The study falls within the areas of digital health, with a focus on gamification, telehealth, virtual reality applied to diagnosis and preventive health.
What is the context?
Eye diseases represent a growing public health challenge in Portugal, significantly compromising the population’s quality of life. The increase in their prevalence is associated with various factors, such as demographic ageing, excessive use of digital devices, inadequate lifestyle habits and limited access to ophthalmological consultations, especially in regions with less health service coverage. These factors contribute to the increase in cases of avoidable visual impairment, highlighting the urgent need for more accessible and less invasive screening strategies.
Among the most prevalent ophthalmological conditions are age-related macular degeneration (characterised by the progressive deterioration of the macula – the central region of the retina responsible for detailed vision – resulting in progressive loss of central vision), glaucoma (a condition associated with increased intraocular pressure, causing irreversible damage to the optic nerve and consequent gradual loss of the visual field) and diabetic retinopathy (a microvascular complication of diabetes, causing changes to the retina such as microaneurysms, haemorrhages and macular oedema, which can lead to a significant reduction in visual acuity).
In addition to these pathologies, there are visual disorders which, although they don’t necessarily result in blindness, affect the quality of vision. These include refractive errors such as myopia, hyperopia and astigmatism, which result from changes in the curvature of the cornea or the axial length of the eye, compromising the focussing of light on the retina. Other conditions, such as colour blindness, affect colour perception due to dysfunctions in the retinal cones, while loss of peripheral vision and impaired contrast sensitivity interfere with spatial perception and distinguishing objects in low-contrast environments.
What are the current approaches?
Currently, the diagnosis of ocular pathologies is based on various conventional ophthalmological tests, such as ophthalmoscopy, fundoscopy, optical coherence tomography, tonometry and campimetry. Although these methods offer high precision, they present significant challenges, including the need for sophisticated equipment, high costs and the requirement for specialists to carry them out. In addition, many of these tests can be uncomfortable and difficult to access in regions with limited resources, compromising screening and early diagnosis.
To meet these challenges, emerging technological approaches have been explored, seeking to improve the accessibility and effectiveness of diagnosis. These include virtual reality exergames, a category of video games that combine entertainment and physical or cognitive exercise, promoting active user interaction. In the context of eye health, exergames are emerging as promising tools to complement traditional screening and visual assessment methods. Games such as EyeSpy 20/20 and DoDo Game have been developed to assess parameters such as visual loss, contrast sensitivity and color perception deficiencies. These exergames incorporate widely used ophthalmological tests such as the Snellen, Ishihara and Pelli Robson, providing interactive and engaging screening.
Despite the advances, they still face significant challenges, such as the variability of the devices used, the accuracy of the results obtained and the need for rigorous clinical validation to guarantee their reliability. In addition, issues relating to the standardization of assessment protocols and the adaptation of tests for different populations still need to be resolved. However, with advances in technology and the incorporation of more sophisticated sensors, these tools are expected to play an increasingly relevant role in the early detection of eye diseases, making diagnosis more accessible, interactive and efficient.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study consisted of the development of EyeCare, a multimodal exergame that integrates artificial intelligence, eye tracking and motion sensors for more accessible, dynamic and personalized eye screening. EyeCare is an interactive game in which users solve puzzles to escape from a forest, while being evaluated for various visual functions. Unlike conventional methods and existing exergames, which apply standardized tests, EyeCare automatically adjusts the complexity of the tasks based on the user’s performance. This adaptive mechanism allows for the early detection of atypical patterns that may indicate ophthalmological changes, making the assessment more sensitive and effective.
EyeCare simultaneously analyses visual acuity, contrast sensitivity and color perception, using validated tests such as Snellen optotypes, luminous stimuli and color patterns inspired by the Ishihara test. Eye tracking monitors gaze fixation, eye movements and response times to visual stimuli, while movement sensors assess motor coordination. In addition, tactile interaction makes it possible to measure the accuracy of responses. All the data is processed by machine learning algorithms, identifying patterns indicative of pathologies such as macular degeneration and glaucoma.
The impact of this study was evaluated in three main dimensions: diagnostic accuracy, accessibility and clinical acceptance. Its effectiveness was validated by comparing it with conventional ophthalmological tests, analyzing sensitivity, specificity and the rate of false diagnoses. To assess accessibility, tests were conducted on different devices, verifying the feasibility of remote screening. Clinical acceptance was measured through usability studies with users and surveys of health professionals, ensuring the feasibility of adopting EyeCare in ophthalmological practice.
What are the main results? What is the future of this approach?
The results of this study demonstrated EyeCare’s promising performance, with the ability to identify multiple ophthalmological pathologies, including astigmatism, changes in visual acuity and colour blindness, in a single gaming session. The system achieved an overall accuracy of approximately 78%, with a hit rate of 89% in the individual tests. In addition, the user experience was evaluated positively, with high ratings for usability and design, highlighting the potential of the exergame as an innovative tool for non-intrusive eye disease screening.
For the future, the study proposes several improvements that could increase diagnostic accuracy and enrich the interactive experience. Among the suggestions is the integration of the smartphone camera for more precise eye tracking, which could, for example, improve the visual field assessment. Other optimizations include the introduction of dynamic levels and randomly generated scenarios, making the game more immersive, fixing bugs and improving sound elements and the graphic interface. Another relevant aspect for the evolution of EyeCare is the expansion of the tests to a younger audience (under 22), a representative segment of the target audience that was not sufficiently addressed at all.
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Home / Publications / Publication
VIRTUAL REALITY EXERGAMES AS A TOOL FOR DIAGNOSING EYE DISEASES
Publication type: Article Summary
Original title: VR Exergames for ocular diseases diagnosis
Article publication date: February 2019
Source: Repositório da Universidade Nova de Lisboa
Author: Miguel Miranda
Supervisors: Filipe Sousa & Sofia Cavaco
What is the goal, target audience, and areas of digital health it addresses?
The study aims to develop an innovative tool based on virtual reality exergames to facilitate the early detection of eye diseases. The target audience includes healthcare professionals such as ophthalmologists, optometrists and researchers in the field of ophthalmology and digital health technologies, as well as healthcare managers interested in innovative solutions for the early screening of eye pathologies. The study falls within the areas of digital health, with a focus on gamification, telehealth, virtual reality applied to diagnosis and preventive health.
What is the context?
Eye diseases represent a growing public health challenge in Portugal, significantly compromising the population’s quality of life. The increase in their prevalence is associated with various factors, such as demographic ageing, excessive use of digital devices, inadequate lifestyle habits and limited access to ophthalmological consultations, especially in regions with less health service coverage. These factors contribute to the increase in cases of avoidable visual impairment, highlighting the urgent need for more accessible and less invasive screening strategies.
Among the most prevalent ophthalmological conditions are age-related macular degeneration (characterised by the progressive deterioration of the macula – the central region of the retina responsible for detailed vision – resulting in progressive loss of central vision), glaucoma (a condition associated with increased intraocular pressure, causing irreversible damage to the optic nerve and consequent gradual loss of the visual field) and diabetic retinopathy (a microvascular complication of diabetes, causing changes to the retina such as microaneurysms, haemorrhages and macular oedema, which can lead to a significant reduction in visual acuity).
In addition to these pathologies, there are visual disorders which, although they don’t necessarily result in blindness, affect the quality of vision. These include refractive errors such as myopia, hyperopia and astigmatism, which result from changes in the curvature of the cornea or the axial length of the eye, compromising the focussing of light on the retina. Other conditions, such as colour blindness, affect colour perception due to dysfunctions in the retinal cones, while loss of peripheral vision and impaired contrast sensitivity interfere with spatial perception and distinguishing objects in low-contrast environments.
What are the current approaches?
Currently, the diagnosis of ocular pathologies is based on various conventional ophthalmological tests, such as ophthalmoscopy, fundoscopy, optical coherence tomography, tonometry and campimetry. Although these methods offer high precision, they present significant challenges, including the need for sophisticated equipment, high costs and the requirement for specialists to carry them out. In addition, many of these tests can be uncomfortable and difficult to access in regions with limited resources, compromising screening and early diagnosis.
To meet these challenges, emerging technological approaches have been explored, seeking to improve the accessibility and effectiveness of diagnosis. These include virtual reality exergames, a category of video games that combine entertainment and physical or cognitive exercise, promoting active user interaction. In the context of eye health, exergames are emerging as promising tools to complement traditional screening and visual assessment methods. Games such as EyeSpy 20/20 and DoDo Game have been developed to assess parameters such as visual loss, contrast sensitivity and color perception deficiencies. These exergames incorporate widely used ophthalmological tests such as the Snellen, Ishihara and Pelli Robson, providing interactive and engaging screening.
Despite the advances, they still face significant challenges, such as the variability of the devices used, the accuracy of the results obtained and the need for rigorous clinical validation to guarantee their reliability. In addition, issues relating to the standardization of assessment protocols and the adaptation of tests for different populations still need to be resolved. However, with advances in technology and the incorporation of more sophisticated sensors, these tools are expected to play an increasingly relevant role in the early detection of eye diseases, making diagnosis more accessible, interactive and efficient.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study consisted of the development of EyeCare, a multimodal exergame that integrates artificial intelligence, eye tracking and motion sensors for more accessible, dynamic and personalized eye screening. EyeCare is an interactive game in which users solve puzzles to escape from a forest, while being evaluated for various visual functions. Unlike conventional methods and existing exergames, which apply standardized tests, EyeCare automatically adjusts the complexity of the tasks based on the user’s performance. This adaptive mechanism allows for the early detection of atypical patterns that may indicate ophthalmological changes, making the assessment more sensitive and effective.
EyeCare simultaneously analyses visual acuity, contrast sensitivity and color perception, using validated tests such as Snellen optotypes, luminous stimuli and color patterns inspired by the Ishihara test. Eye tracking monitors gaze fixation, eye movements and response times to visual stimuli, while movement sensors assess motor coordination. In addition, tactile interaction makes it possible to measure the accuracy of responses. All the data is processed by machine learning algorithms, identifying patterns indicative of pathologies such as macular degeneration and glaucoma.
The impact of this study was evaluated in three main dimensions: diagnostic accuracy, accessibility and clinical acceptance. Its effectiveness was validated by comparing it with conventional ophthalmological tests, analyzing sensitivity, specificity and the rate of false diagnoses. To assess accessibility, tests were conducted on different devices, verifying the feasibility of remote screening. Clinical acceptance was measured through usability studies with users and surveys of health professionals, ensuring the feasibility of adopting EyeCare in ophthalmological practice.
What are the main results? What is the future of this approach?
The results of this study demonstrated EyeCare’s promising performance, with the ability to identify multiple ophthalmological pathologies, including astigmatism, changes in visual acuity and colour blindness, in a single gaming session. The system achieved an overall accuracy of approximately 78%, with a hit rate of 89% in the individual tests. In addition, the user experience was evaluated positively, with high ratings for usability and design, highlighting the potential of the exergame as an innovative tool for non-intrusive eye disease screening.
For the future, the study proposes several improvements that could increase diagnostic accuracy and enrich the interactive experience. Among the suggestions is the integration of the smartphone camera for more precise eye tracking, which could, for example, improve the visual field assessment. Other optimizations include the introduction of dynamic levels and randomly generated scenarios, making the game more immersive, fixing bugs and improving sound elements and the graphic interface. Another relevant aspect for the evolution of EyeCare is the expansion of the tests to a younger audience (under 22), a representative segment of the target audience that was not sufficiently addressed at all.
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SPMS participates in the TEF-Health initiative as a partner in a consortium composed of 51 entities from 9 European Union countries. This action is co-financed by the European Commission and has a duration of five…
FMUP Creates Inhealth Junior Academy for High School Students
The InHealth Junior Academy — Academia Júnior de Inovação em Saúde is an initiative of the Departamento de Medicina da Comunidade, Informação e Decisão em Saúde da Faculdade de Medicina da Universidade do Porto (FMUP)….
SPMS Represents Portugal as Vice-president of GDHP
The GDHP is an intergovernmental organization in the digital health sector that facilitates cooperation and collaboration between government representatives and the World Health Organization (WHO). Its purpose is to foster policymaking that promote the digitalization…
Digital Transformation of Health at INCoDe.2030 in Tomar
The “National Digital Skills Initiative e.2030, Portugal” (INCoDe.2030) is an initiative that aims to improve the Portuguese population’s level of digital skills, placing Portugal at the level of the most advanced European countries in this…
Braga Hospital Evaluates Memory With Interactive Game in Patients With Multiple Sclerosis
Multiple Sclerosis is known as a chronic disease of the central nervous system, with a wide variety of motor and sensory symptoms that can lead to work disability, socioeconomic burden, and reduced quality of life…
Neurosurgery Teleconsultation Wins Innovation Award
The aim of the BI Award for Innovation in Healthcare is to recognize innovative projects in the healthcare sector that improve the quality of life for the Portuguese people. In 2021, the specific theme was…
HealthData@PT: New SPMS Initiative for Health Data
Action HealthData@PT is launched in the context of the implementation of the European Health Data Space, and is an initiative approved by the European Commission under the EU4Health 2021-2027 programme. This initiative contributes to the…
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