Evaluation of Eyelander: a video game designed to engage children and young people with homonymous visual field loss in compensatory training

Introduction: Rehabilitation can improve visual outcomes for adults with acquired homonymous visual field loss. However, it is unclear whether (re)habilitation improves visual outcomes for children because previous training schedules have been tiresome, uninteresting, and failed to keep them engaged. In this study we assessed whether children and young people with homonymous visual field loss would adhere to six weeks of unsupervised compensatory training using a specialised video game. Methods: Participants aged between 7 and 25 with homonymous visual field loss completed table-top assessments of visual search across four site visits. Two baseline assessments separated by four weeks evaluated spontaneous improvements before training began. Participants were then given a copy of the video game to use unsupervised at home for six weeks. Two follow-up assessments separated by four weeks were then conducted to evaluate immediate and acutely maintained effects of training. Results. 15 candidates met the inclusion-exclusion criteria, 9 participated, and 8 completed the study. Participants completed an average of 5.6 hours training unsupervised over the six weeks. Improvements on in-game metrics plateaued during week 3 of training. The time taken to find objects during table-top activities improved by an average of 24% (95% CI [2%, 46%]) after training. Discussion: The findings demonstrate that children and young people with homonymous visual field loss will engage with gamified compensatory training, and can improve visual outcomes with less time commitment than adults have required with non-gamified training in previous studies. Appropriately powered, randomised controlled trials are required to evaluate the validity and generalisability of observed training effects. Implications for practitioners: We conclude that (re)habilitation specialists can use specialist video games and gamification to engage children and young people with homonymous visual field loss in long-term unsupervised training schedules