On April 18 not long ago, a video game “Happy Horizon Planet” won the national Class 2 medical device certificate, which is the first certificate for digital therapy in the domestic game industry.
At present, a number of foreign games have been approved for disease treatment, such as Boson X for improving depression and Endeavor RX for treating ADHD. “Happy Horizon Planet” is currently the only game-based artificial intelligence (AI) treatment software approved by the National Medical Products Administration (NMPA) in China for the treatment of strabismus and amblyopia in children aged 5-8.
Amblyopia, refers to the visual development period, due to form deprivation (can be simply understood as the eyes are covered due to various diseases, the light cannot enter the state of the eyes), monocular strabismus, refraction Abnormal visual experience such as staggered (that is, a large difference in the refractive power of both eyes) and high refractive error (mostly binocular hyperopia), resulting in low best-corrected visual acuity in one or both eyes, or a difference in visual acuity of more than 2 lines between eyes, no eye examination Diseases with organic lesions (Figure 1).
(Figure 1 Amblyopia)
In other words, amblyopia is when there is no substantial eye damage, but after removing risk factors (form deprivation, strabismus, etc.), normal vision cannot be achieved by wearing glasses with refractive correction. According to the etiology, amblyopia can be divided into form deprivation amblyopia (generally refers to amblyopia caused by ptosis, congenital cataract blocking the passage of light), strabismus amblyopia, anisometropic amblyopia, and refractive amblyopia. Amblyopia is relatively common in my country, with a prevalence of about 2% to 4% [1].
Strabismus refers to the abnormality of the visual axis direction of the other eye (that is, the path of light entering the eyeball) when one eye is fixed, and it deviates from the direction parallel to the visual axis, which is manifested as abnormal eye position. In layman’s terms, when one eye is looking forward, the other eye is looking to the side (as shown in Figure 2). The prevalence of strabismus in my country is about 3% [2].
(Fig.2 strabismus)
Treatment of strabismus and amblyopia in children mainly includes removal of risk factors (ie, ptosis correction, congenital cataract surgery, refractive correction), suppression of the dominant eye (covering therapy), and fine vision training. .
Covering therapy is one of the commonly used treatments for amblyopia. The purpose is to cover the dominant eye (that is, the eye with better vision) through eye patches and other objects, so as to reduce or eliminate the inhibitory effect of the dominant eye on the amblyopic eye. Force the use of the amblyopic eye, and promote the improvement of the amblyopic eye’s visual acuity (as shown in Figure 1). But wearing a blindfold can make older children psychologically uncomfortable — most children don’t like to be too different from their peers, and they’re afraid of other people’s comments and curiosity.
The rehabilitation treatment of strabismus amblyopia mainly consists of fine vision training such as piercing beads (Figure 3), tracing and puncturing, which can stimulate the function of amblyopic eyes, promote vision development, and improve vision. .
(Figure 3 Beading Training)
However, the traditional rehabilitation treatment process, which usually lasts for more than half a year, is long and tedious, and the treatment must be started from an early age, which is difficult for young children to adhere to. This requires parents to pay attention to the whole process of the child’s treatment and invest a lot of time and energy, which is not easy for parents.
“Happy Horizon Planet” seems to be just an “ordinary” barrage shooting training game. After entering the game, the player will play a cute little dinosaur. In the childlike scene setting, pick up flowers to defeat the enemy (Figure 4). There are 5 fantasy continents, 15 kinds of fun props, 16 characteristic maps, and 46 strange creatures in the game, which constitute this “Fantastic Adventure”.
(Figure 4 game interface)
Actually, this “game” is not simple – it is essentially a strabismus amblyopia treatment system based on a variety of internationally certified training methods, including red light stimulation therapy, fine vision training , grating visual stimulation and fusion, stereo vision training and other light stimulation therapy, also combined with red and blue binocular separation to achieve three-level functional training.
The main creative team completed the game design from the perspective of children, and the final result presented beautiful pictures, simple operation and strong interest, which is quite attractive to young children, allowing children to enjoy the game while playing happily. The rehabilitation training for strabismus and amblyopia was completed unconsciously, and it was easy to adhere to, that is to say, the treatment compliance was improved.
When it comes to games, many parents worry most about whether their children will become addicted to playingWoolen cloth?
That will not only delay normal study and life, but also may be short-sighted, or cause spinal development problems due to long-term poor posture, which will outweigh the gains.
In addition, how can parents understand the effects of their children’s training?
In response to these problems, the R&D team has also made plans in advance. The developer has designed a separate parent-side app for the treatment system, which has functions such as customizing training duration, regular push of training information, and one-click exit training (Figure 5). The evaluation system embedded in the therapy can evaluate the vision of amblyopic eyes, match the optimal training difficulty, and achieve the goal of refinement and individualization.
The whole treatment process will generate a detailed statistical report and push it to the parent, including the training intensity, abnormal attention monitoring of the child and other statistics, which will help parents understand the child’s training progress in real time. Precise control of the training process.
(Figure 5 Parent App interface)
For example, the child has been training continuously for a long time this day, and the stimulation intensity has reached the standard. Parents can use the one-key exit function to make the child pause the training, relax the eyes for a while, and prevent addiction.
Such “smart assistants” can help parents achieve a precise and personalized training process. If the child’s training effect is good, parents can slightly reduce the attention and reduce the burden.
Not only that, the therapy also features real-time attention monitoring and AI intelligent error correction. Through the front-facing camera of the tablet and smartphone, the therapy continuously monitors the patient’s posture and the correct wearing of the goggles and other elements of rehabilitation during the treatment. Once an abnormality is detected, therapy is paused and prompted until the patient is well positioned and the blindfold is worn. For example, the child is prominently reminded at the bottom of the screen not to get too close to the screen or to maintain an upright posture (Figure 6).
(Picture 6 The game will give a warm prompt at the bottom of the screen)
Finally, the therapy has also designed a doctor-side app, which can visualize the treatment results, so that medical staff can adjust the personalized treatment plan for the child in time. In other words, both parents and medical staff can fully participate in the child’s treatment process to effectively ensure the treatment effect.
At present, this new digital therapy has gradually entered the clinic and has been applied to the rehabilitation of children with strabismus and amblyopia aged 5-8. However, the evaluation of the treatment effect still needs the support of more clinical research data in the future.
It should be emphasized that not all types of amblyopia are suitable for use of this play therapy, and no matter what training method is used, it must be carried out under the supervision of a doctor. In the process of children’s treatment, parents should also play a good role in supervising and guiding the whole process.
This article is neutral science content and does not involve any product promotion. The treatment plan introduced in this article has clear indications and needs to be used under the guidance of a doctor after diagnosis. If you want to use this treatment, please go to a regular hospital for treatment and follow the doctor’s advice.
Reviewer: Wu Xi
Chief Physician, Department of Ophthalmology, Peking University People’s Hospital
References
[1] Ge Jian, Wang Yuli. Ophthalmology. 3rd ed. Beijing: People’s Health Publishing House. 2015. 215-218.
[2] Zhao Kanxing, Yang Peizeng, Fan Xianqun. Ophthalmology. 9th edition. Beijing: People’s Health Publishing House. 2018. 237-253.
Author: Jin Yuling
Editors: Ye Yichu, Wu Jiaxiang, Ye Zhengxing
Typesetting: Li Yongmin | Operation: Han Ningning | Coordinator: Ye Yichu