By Linda Conlin, Pro to Pro Managing Editor

Can video games aid in assessing vision health? Researchers at Stanford Medicine think so. Khizer Khaderi, MD, a clinical associate professor of ophthalmology and his team wanted to find a more holistic measurement of visual, cognitive, and physical function. Researchers used natural human interaction with video games to evaluate field of view, accuracy, multi-tracking, endurance, and detection. To evaluate subjects’ performance, they developed the vision performance index (VPI). The index is a number based on five domains of vision, such as the ability to sustain visual attention and a person's field of view, measured by clicks of a mouse in two video games played on an iPad. (Ahmed Y., Reddy M., Mederos J., McDermott K.C., Varma D.K., Ludwig C.A., Ahmed I.(I.).K. & Khaderi K.R Democratizing healthcare in the Metaverse. How video games can monitor eye conditions using the Vision Performance Index: A pilot study, Ophthalmology Science, 2023, doi:

Ninety-three patients with dry eye disease, glaucoma, cataract, diabetic retinopathy (DR), age-related macular degeneration (AMD), and healthy individuals, aged 20 to 87 years participated in the study. The VPI used a mean score of 100, with higher scores indicating better performance. Software that allowed tabulation of VPI scores was integrated into two video-game applications: Balloon Pop and Picture Perfect. In Balloon Pop, balloons of varying speed, size, color, and transparency move upwards on the screen. The user was instructed to correctly click on striped balloons among solid balloons. In Picture Perfect, two variations of the same image are displayed side-by-side on the screen. The user was instructed to identically match a distorted image to a target image by adjusting image properties including hue, saturation, brightness, and contrast.

Each person played two rounds of Balloon Pop and Picture Perfect. Color detection was significantly lower in patients with DR and glaucoma compared with those without eye disease. The study showed that participants with DR and AMD selected the correct balloons less often. Participants with cataracts and DR had difficulty discerning contrast. Finally, participants with dry eyes had trouble matching saturation.

More research is needed but considering that consumers already are familiar with wearable technologies such as Apple Watch that allow patients to electronically send electrocardiogram readings taken from the device to their cardiologist if there are irregularities, with the VPI, a patient can be prescribed to play a videogame to potentially monitor ocular disease. Because researchers are obtaining the VPI in a non-invasive way, Khaderi anticipates more people will want to proactively engage with the games. He says, "Infusing science into games is like sneaking broccoli into ice cream."