Computer game helps eye specialists treat disease in children

An eye consultant has drawn on his teenage passion for computer programming to create a special test to check the vision of children as young as four, in a way that can flag up problems caused by glaucoma, drug side-effects, brain tumours and other conditions.

Mr Tariq Aslam, a consultant at Manchester Royal Eye Hospital and senior lecturer at The University of Manchester, found that it was very difficult getting children to sit still and concentrate while machines designed for adults measured what they could see at the edge of their vision. Crucial information could not be obtained because the children often moved their eyes wrongly or did not respond correctly. This was having an impact on the child's diagnosis and treatment options.
He realised that the ideal way to overcome a short attention span and lack of cooperation was to get children involved in playing a computer game, which would automatically measure their peripheral vision depending on exactly how they played.
Mr Aslam drew on his teenage passion for programming and electronics to write the software himself to achieve this, after researching game theory and psychology as well as taking the advice of children who tried each version. He also designed and built an electronically controlled apparatus which encourages the children to position themselves correctly as part of the whole game experience. The ‘Crazy Castle’ apparatus that resulted was assessed with the help of colleagues Waheeda Rahman and Peng Tee Khaw at Moorfields Eye Hospital in London, plus University of Manchester colleague David Henson.
The game console has now been piloted with young patients at Moorfields and proved very popular with the patients and their siblings, as well as achieving measurements that seem accurate.
"We built a large toy castle roughly a metre high,” explained Mr Aslam. "A pair of magic glasses is set into the front wall, and when the child looks right through them we know they are in the right position and so a drawbridge in the castle wall electronically opens to allow the child to see and play a game on a screen within. The aim of the game is to track a wizard inside the castle, and press a button to help him squash rogue tomatoes. While concentrating on the wizard in the centre of the screen, they then press a different button if they spot a ghost appearing at the corners. Their reactions are recorded automatically by the software using a laptop attached to the game screen.
"Parents do sometimes worry about their children spending too much time looking at computer screens, but in this case it could potentially help to save a child's sight or give valuable information to help treat their medical condition.”
Seventeen children aged four to 14 have tried the test, and given Mr Aslam's team plenty of feedback to help improve the game. Parents have also been very supportive, particularly when the test confirms the extent of their child's visual impairment, so they can help the child manage daily life to avoid accidents and falls.
Mr Aslam added: "The game system has shown great promise in this feasibility study to provide clinically useful information in a way that is accessible and enjoyable for the child with no discomfort or potential for harm. Based on this pilot, we aim to develop the software program and the hardware and to prove it has a greater diagnostic precision and sensitivity to identify visual field loss than existing tests. Our test would be quicker and more reliable and therefore require fewer hospital resources, as well as being more fun for the children.
“‘Crazy Castle’ does not require expensive equipment, so it could be adopted by most hospitals in the UK, and it is affordable for use in developing countries too. The game-based approach could also be adapted to carry out other eye tests such as checking contrast sensitivity and the sharpness of a child's vision."
The pilot study was funded by the National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology based at Moorfields Eye Hospital and UCL Institute of Ophthalmology, and the Special Trustees of Moorfields Eye Hospital, and supported by the NIHR Manchester Biomedical Research Centre. The findings have just been published by the British Journal of Ophthalmology, http://bjo.bmj.com/
Professor Peng Tee Khaw and Professor Graeme Black, the directors of the two biomedical research centres involved, welcomed the results of the research project. “This is a good example of an innovation that will directly benefit patients, which arose as a result of collaboration between two NIHR biomedical research centres,” they said.
Ends

Notes for editors

Footage of the Crazy Castle in action can be found at: http://www.manchesterbrc.org/AboutUs/News/article.php?id=26
The Moorfields Eye Hospital/UCL Institute of Ophthalmology NIHR Biomedical Research Centre is a partnership between Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology. Established in April 2007, its purpose is to conduct 'translational research' that is designed to take advances in basic medical research from the laboratory to the clinic, enabling patients to benefit more quickly from new scientific breakthroughs. Our centre is one of 12 biomedical research centres that were awarded to NHS/university partnerships with an outstanding international reputation for medical research and expertise, and experience of translating that research into the clinical setting.
The NIHR Manchester Biomedical Research Centre was created by the National Institute for Health Research in 2008 to effectively move scientific breakthroughs from the laboratory, through clinical trials and into practice within hospitals to improve patient care. As a partnership between Central Manchester University Hospitals NHS Foundation Trust and The University of Manchester, the Biomedical Research Centre is designated as a specialist centre of excellence in genetics and developmental medicine. www.manchesterbrc.org 
The University of Manchester, a member of the Russell Group, is the most popular university in the UK. It has 22 academic schools and hundreds of specialist research groups undertaking pioneering multi-disciplinary teaching and research of worldwide significance. According to the results of the 2008 Research Assessment Exercise, The University of Manchester is now one of the country’s major research universities, rated third in the UK in terms of ‘research power’. The University had an annual income of £755 million in 2008/09. www.manchester.ac.uk
Central Manchester University Hospitals NHS Foundation Trust is a leading provider of specialist healthcare services in Manchester, treating more than a million patients every year. Its five specialist hospitals (Manchester Royal Infirmary, Saint Mary’s Hospital, Royal Manchester Children’s Hospital, Manchester Royal Eye Hospital and the University Dental Hospital of Manchester) are home to hundreds of world class clinicians and academic staff committed to finding patients the best care and treatments. www.cmft.nhs.uk
Moorfields Eye Hospital NHS Foundation Trust is one of the world’s leading eye hospitals, providing expertise in clinical care, research and education. We have provided excellence in eye care for more than 200 years and we continue to be at the forefront of new breakthroughs and developments.   We are an integral part of one of the UK’s first academic health science centres, UCL Partners, and recently celebrated five years as one of the country’s first NHS foundation trusts.
UCL Institute of Ophthalmology is one of a number of specialised research centres linked to UCL (University College London) and is, together with Moorfields Eye Hospital, one of the leading centres for eye research worldwide. The most recent Research Assessment Exercise confirmed the outstanding quality of research carried out at the Institute, with 40 per cent of investigators ranked 4* (world-leading) together with a further 30 per cent ranked as internationally excellent. The combination of the Institute’s research resource with the resources of Moorfields Eye Hospital, which has the largest ophthalmic patient population in the Western World, opens the way for advances at the forefront of vision research.
For further information contact:
Kate Henry
Communications & Public Relations Manager
NIHR Manchester Biomedical Research Centre
Tel : 0161 276 3281
Mob : 07825 142219
Email: kate.henry@cmft.nhs.uk
Dominic Stevenson
PR & Communications Officer
Moorfields Eye Hospital NHS Foundation Trust
Tel: 020 7566 2628
Email: dominic.stevenson@moorfields.nhs.uk
Aeron Haworth
Media Relations
The University of Manchester
Tel: 0161 275 8383
Email: aeron.haworth@manchester.ac.uk