New Technologies Help Extend the Potency and Reach of Vision Therapy – Part 1
This two-part series considers some of the science behind ‘gaming’ for visual and motor rehabilitation and train. So-called ‘intelligent’ games are now a popular field for development and research among software developers, including some world-leading firms such as UbiSoft as well as two newer smaller players in this market, both of which are led by doctors specializing in optometric vision rehabilitation.
The principles underlying optometric vision therapy for vision and motor skills development have not changed significantly since A.M. Skeffington first elaborated his conceptualization of human visual development – we still engage the same underpinnings of visual perception, visual motor coordination, motor planning, and vestibular and proprioceptive senses. To highlight this unwavering neurocognitive structure, new advances in science and technology have shown that actively engaging these systems still remains the best way to address a vast array of visual and behavioural concerns in pediatrics and restorative therapies. Here is a very brief sampling:
- An iPod treatment for amblyopia: An updated binocular approach: https://newsfromaoa.files.wordpress.com/2012/01/optmd1100034.pdf
- The iPod binocular home-based treatment for amblyopia in adults: efficacy and compliance: http://www.ncbi.nlm.nih.gov/pubmed/25131694
- Evaluation and development of a novel binocular treatment (I-BiT™) system using video clips and interactive games to improve vision in children with amblyopia (‘lazy eye’): study protocol for a randomised controlled trial: http://link.springer.com/article/10.1186/1745-6215-14-145/fulltext.html
- Tetris Video Game Helps Treat Lazy Eye: http://www.medicalnewstoday.com/articles/259547.php
What makes these new approaches any different? That’s a big question. On the one hand, no, the patient has not changed physically, and the requirements of successful therapy remain. In the end, new tech simply presents therapeutic constructs similar to traditional tools and methods. The great difference, and that which makes new technology worth investigating, is that newly evolving tools have proven themselves to provide the same benefits but in perhaps greater measure, with additional tools for clinicians, and in a much more accessible fashion.
Case 1 – GeoBee! – Portable Enhanced Geo-boarding
VisionMechanic, Inc., (visionmechanic.com and on FaceBook ‘VisionMechanic’) has now released its first commercial product to the retail market under the banner ‘GeoBee!’. GeoBee! is a broad extension and expansion of traditional geo-board construct, which was elaborated to a paper model by Dr. Jerome Rosner, which had many advantages for classroom training over the clunky and limiting nail boards.
GeoBee! is on its surface very simple: The game starts by presenting target patterns in a small screen. The user must trace the pattern out in a larger response area paying careful attention to accuracy and timing. The game ‘plays’ the user in that if play is very accurate and fast, GeoBee! will raise ‘The Bar’ to make play more difficult and play parameters more stringent. Conversely, if the player is struggling, the GeoBee! Vision Development Engine (VDE) will lower the bar to ensure players can succeed at an optimal level. The goal remains to keep pushing skills forward while maintaining optimal levels of eustress to maximize learning during gameplay. The game has many other advantages including a high degree of portability and affordability while providing important tools for training vision, motor skills, literacy/numeracy, amblyopia, even attention. Game play is also swift allowing for rapid cycling of ‘frames’, or target patterns. In early trials, GeoBee! has proven to be most engaging, even by the most resistant clients, and skills gained on screen appear to transfer to pen and paper. See: http://visionmechanic.com/the-science-of-geobee-2/
Says Caroline, a vision therapist working in Calgary, Alberta: “When I introduced GeoBee to my patients (children and adults), their focus level with the activity was much better compared to the classic paper version because they want to ‘beat the game!’ Since the patients are very engaged with the game, their compliance with therapy is better and improvement in visual skills became faster. This is also very useful for patients with behavioral issues such as attention deficit disorder and autism. I think this game is great to incorporate in a classroom setting as well because this game trains many ‘pre-reading’ skills and easy for teachers to implement. ”
GeoBee! is best described as a skills development platform, with virtually unlimited customization possible: From unlimited pattern libraries for a broad array of clinical needs, to control over audible prompts, difficulty levels, and even remote monitoring through email reports. Updates in the coming months will include a professional version to allow for much greater therapist control, even by remote, as well as anaglyphic mode. Anonymous data from around the world will allow clinicians to test children and report results against large data pools by region, age, or a number of other metrics.
Dr. Debbie Luk, FCOVD, was one of the early beta testers: “I am excited to discover that GeoBee as an innovative, fun and stimulating training tool for my patients. GeoBee is a great adjunct to home vision rehabilitation training because it automatically adjusts the challenge level. Plus, it allows the doctor and patient to monitor and see the progress. This is especially valuable for patients who do not have easy access to a vision therapy clinic, and we can do remote training effectively. Unlike the paper and pencil geo-pattern exercise, I especially love this tool because incorporates a variety of visual skills in a fun way. For instance, visual memory, visual perception, spatial attention and mental flexibility, all of which are crucial skills required for spelling, comprehension and numeracy. I also love how this video game goes one step further and has a lazy eye training mode using red-green glasses. The overall design of the game is beautiful and patients are immediately drawn to it! I would highly recommend GeoBee! as a visual rehabilitation tool for patients with reading/learning difficulties, traumatic brain injuries and lazy eye.”
Eye Movement and Posture Monitoring
Designers around the world are working towards incorporating accurate, reliable, and accessible visuomotor measurement and tracking into their portable platforms, but this is not yet possible with current hardware limitations. A number of elements need to fall into place before remote posture and visuomotor skills monitoring become widely available. Eye position and movement metrics must be measured in one of two ways: First, stationary devices attached to or built-into devices such as tablets or desktops ‘watch’ the positioning and gaze of the eyes from some variable distance; because the head moves in relation to the tracking device, there is no way of establishing a baseline. Still, this basic functionality is widely available through new tablets and phones as means of controlling basic device functions, such as when to go to sleep. The other option currently is to employ wearable devices using infrared emitters and sensors to follow eye movements at close range on a quasi-fixed position relative to the head. These are generally quite expensive, and they must be fit precisely to ensure a proper baseline position is established from the outset each and every time the device is re-applied.
While GeoBee! is designed for a broad audience with tools to develop more generalized cognitive and visual/visual-motor skills, Vivid Vision has taken a different approach using cutting-edge wearable hardware to address a particular clinical needs: Management of suppression in amblyopia, and just maybe, good enough visual motor monitoring to take it even further. More on this in the second part of this two-part series.