Can games improve health? #HI201 Last week! #MSMHI task: Evaluate a health-related mobile game app.
My knee jerk response is yes, there could be applications where games can improve health. But I am an ophthalmologist, can a mobile game app improve eye health? Hmmm… could be a problem. It is unconscionable not to mention the ills of computer games in this blog (lest my patients and parents read this).
Before I proceed then, let me disclose that I am not an avid fan of computer games. I did not take my son to the video arcades, believing it was a money trap that only served to strain the eyes and even induce seizures!
Furthermore, I am a paediatric ophthalmologist. I get questions (which I sometimes think are rhetorical) such as, “do computers and gadgets affect children’s vision?,” and “how much time should a child spend in front of their gadgets?” Moreover, I can actually gain financially from patients using games in a mobile app who develop symptoms of headache, blurring of vision, diplopia, sometimes even nausea and vomiting, when they consult the clinic.
The following eye problems from computers and gadgets have been observed and reported:
1. Reduced blink rate, which in turn leads to
2. Dry Eye Syndrome, (child can complain of blinking, drying, foreign body sensation, burning sensation)
3. Asthenopia or eye strain
4. Ciliary muscle fatigue or accommodative spasm
5. Induced refractive error, typically myopia and astigmatism, and
6. Induced strabismus in predisposed individuals.
7. Computer eye syndrome or video terminal display syndrome
8. Computer addiction affecting social skills and interaction
These being said, I have also found gadgets and computers useful in the clinic to get and sustain a child’s attention; for orthoptics especially for patients with intermittent exotropia; give the child something interesting to look at; provide a good diversion; aside of course from the obvious tools in the clinic such as the eye chart and auto refraction machine many are familiar with.
Proceeding with the game application that needs to be evaluated for this task, I migrated to food-based games just like Mr. Cardenas’ “Gobbles Eat and Run.” 
The first one I looked at was “Awesome eats.” Although it had music and started with teaching the player how to swipe, then sort, I didn’t last long and found the game boring. The skills required were too elementary, but the trivia provided was for a much older age group. For example, the snippet for trivia text read “if you can’t tell a hard boiled egg from fresh eggs, give them a spin. The egg resistant to spinning is uncooked, but if it spins, it is hard boiled.” I needed less than 5 minutes to judge this app, and forget about it.
I checked out “Eat this not that! Game by Men’s Health,” Classic Edition and was finally happy with what I saw. It didn’t require finger dexterity, or eye-hand coordination required in “temple run” type games.
The game simply presented two types of meals one is commonly confronted with, the player having only to choose which food to eat. The pictures looked like what one would see in a food magazine, or in an actual life setting. It teaches facts, with details about calories, and explains why one food choice is better than the other. It quells common misconceptions, and simulates one’s dilemma when choosing from a menu. There is a classical version, a kids version, and even a drinks version.
I actually plan to keep playing this game, learn from the choices and repeat the game to reiterate the right choices in my mind and my easily tempted appetite. Perhaps though, this game appealed more to the “older” age group, not the kids who grew up with moving frenzied targets, with speed of graphics that keep changing as the clock ticked. The game I would think is more cerebral, and appealed more to the problems that beset an older age group needing to make the right dietary choices. It is not the type of game that will induce a seizure.
In conclusion, yes, games can improve health, and is an excellent tool for fun learning and edutainment. Games can motivate, enhance, prevent, support, train and rehabilitate. [1, 2] That knowledge, however, is tempered by the fact that as an ophthalmologist, I know games can affect eye health. If not moderated and abused, can open a Pandora’s box of eye symptoms and findings, not to mention seizures (!) in predisposed population.
1. McCallum S. Gamification and serious games for personalized health. Studies in health technology and informatics 2012;177:85-96. http://www.miro.ing.unitn.it/download/Didactics/Misure2/2012%20pHealth%20-%20Gamification.pdf
2. Gamberini, Luciano, et al. “A game a day keeps the doctor away: A short review of computer games in mental healthcare.” Journal of CyberTherapy and Rehabilitation 1.2 (2008): 127-145. http://htlab.psy.unipd.it/uploads/Pdf/Publications/Papers/Cyber_rehab08.pdf
3. Cardenas, Isidor. Game based learning: theory and applications. Webinar given 30 November 2014, 1-2 pm.
How about using games for vision training? For athletes, I could envision some games which can be used to improve focusing ability, hand eye coordination and peripheral vision. Is there any medical condition in which video games could be used by your patients (or maybe in an older pediatric age group) and have some therapeutic value? Won’t video games help your patients develop focusing ability or does it always lead to eye strain as you mentioned?
Alvina Pauline D. Santiago, MD, FPAO, FPCS says
Actually, Yes, there are a few conditions…Off hand… forcing an amblyopic patient to use the eye when better eye is patched; patients with intermittent exotropia. It will, however, lead to eye strain eventually, when use is not regulated, and may occur earlier in predisposed individuals.