Disability Racer: A Digital Game for Raising Awareness of

Ophthalmological: Related Issues

Luiz A. V. Le

, Douglas C. de Souza

, Tiago J. D. Souza

, Artur G. Hauache

Eduardo W. Stival

and Carlos N. Silla Jr.

1,2 a

Digital Games Course at the Polytechnic School of the Pontif

ıcia Universidade Cat

olica do Paran

a (PUCPR), Brazil

School of Information Technology, Halmstad University, Sweden

Keywords:

Educational Serious Game, Ophthalmic Awareness, Ophthalmic Conditions, Party-Game,

Ophthalmic Check-Up.

Abstract:

This paper presents an educational serious game aimed at raising awareness about ophthalmic issues. The

game, titled ’Disability Racer,’ is based on the mechanics of a car battle-royale and was developed for the

computer platform. It incorporates four ophthalmic conditions, challenging players to compete against each

other while experiencing impaired vision. To mirror real-life problem-solving, the ’glasses’ item has been

included, which, when collected, temporarily improves the player’s vision. In this way, the game promotes an

understanding of the importance of regular ophthalmic check-ups.

1 INTRODUCTION

Estimates from 2015 indicate that one in ﬁve people

in Latin America and the Caribbean has some degree

of visual impairment (de Oliveira et al., 2022). Con-

sidering this average, the other four people may not be

aware of how a visually impaired person perceives the

world around them. To raise awareness among these

people, an alternative is through digital games known

as serious games.

Serious games aim to do more than just entertain,

they seek to be a vehicle that intensiﬁes learning in

a dynamic, interactive, motivating and engaging way,

thus facilitating the learning process. Most of them

are accessible for people with disabilities. Taking this

into consideration, it is clear that serious games can

serve as a channel for learning and raising awareness

about complex or less familiar subjects (Noem

ı and

aximo, 2014).

Raising awareness about the experiences and chal-

lenges faced by people with a disability is crucial to

promoting inclusion and empathy in our society. Un-

derstanding these experiences in a more direct and en-

gaging way through a simulated experience can have

an even more signiﬁcant impact.

This article presents a serious educational game

called Disability Racer, with the aim not of providing

https://orcid.org/0000-0002-1603-9378

accessibility for individuals with limiting conditions,

but of providing an experience that allows people to

understand the vision of individuals with ophthalmo-

logical disabilities. Developed for the computer, in

which four players compete against each other while

experiencing eye problems on their screens. This way,

the game becomes more challenging for users.

2 RELATED WORK

Eye problems in children are often underestimated,

and parents may not be aware of these issues, which

can have serious impacts on their children’s visual

health. Early detection is crucial to avoid future com-

plications, therefore, parents should be alert to signs

of visual difﬁculties and seek ophthalmological eval-

uation regularly (Graziano and Leone, 2005).

Most cases of visual impairment can be corrected

by using low-cost glasses or lenses. This highlights

the importance of access to ophthalmologic eval-

uation, especially in communities with limited re-

sources. Democratizing access to glasses can signif-

icantly improve the quality of life and opportunities

for those with visual impairment (de Oliveira et al.,

2022).

Educational games are an effective tool for trans-

mitting content and values in an engaging and efﬁ-

190

Leão, L., C. de Souza, D., Souza, T., Hauache, A., Stival, E. and Silla Jr., C.

Disability Racer: A Digital Game for Raising Awareness of Ophthalmological: Related Issues.

DOI: 10.5220/0012706400003693

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 16th International Conference on Computer Supported Education (CSEDU 2024) - Volume 1, pages 190-201

ISBN: 978-989-758-697-2; ISSN: 2184-5026

cient way. They can be develop based on scientiﬁc re-

search, which makes them a valuable contribution to

contemporary education (Noem

ı and M

aximo, 2014).

Serious games represent another tool that can

cover a wide range of complex and under-addressed

areas, such as government, education, corporations,

and self-care. They offer an engaging and practical

approach to learning and training in diverse contexts

(Susi et al., 2007).

Serious educational games are a powerful and ef-

fective combination for learning, especially on com-

plex or less familiar topics. They allow the applica-

tion of theoretical concepts in practical scenarios, pro-

moting a deeper and lasting understanding. The in-

teractivity and immersion provided by serious games

result in dynamic and participatory learning, making

them valuable for developing knowledge in challeng-

ing areas (de Freitas, 2018).

Simulation games in higher education have gar-

nered considerable interest for their ability to actively

involve students with course content, fostering in-

creased engagement and motivation while facilitating

learning outcomes (Faisal et al., 2022).

The use of serious games to simulate experiences

such as myopia and blindness offers valuable tools for

transmitting awareness messages to the public. In-

creasing awareness among the public could help cre-

ate inclusive communities and improve the quality of

life for individuals with visual impairments (Melthis

et al., 2015).

A virtual reality serious game as a tool for

social awareness of disabilities has proven effec-

tive in tests and has the potential to assist in so-

cial awareness regarding ophthalmological symptoms

(Medeiros, 2022).

In fact, games with this focus have proven to be

highly effective in achieving their goals. For exam-

ple, the Phishy game, which aims to train a corpo-

ration’s employees on identifying phishing, demon-

strated its effectiveness in a company in which more

than eight thousand associates participated and com-

pleted the game. This program resulted in a signif-

icant improvement in employees’ ability to identify

phishing links (CJ et al., 2018).

Games like Riskio, a board game designed to

raise cybersecurity awareness among people with-

out a technical background who work in organiza-

tions. Riskio provides an active learning environment

in which players gain knowledge about cybersecurity

attacks and defense strategies by taking on the roles

of attackers and defenders of critical assets in a sim-

ulated scenario within a ﬁctional organization (Hart

et al., 2020).

Persuasive technologies have the ability to shape

behaviors, instruct and educate people effectively.

One example is PowerHouse, a computer game

to inﬂuence energy-related behaviors and to fos-

ter an energy-conscious lifestyle, especially among

teenagers (B

ang et al., 2006).

3 CONTRIBUTIONS

The game Disability Racer represents a valuable ad-

dition to the ﬁeld of serious games aimed at the com-

munity, introducing a topic little discussed. In addi-

tion to addressing a subject of social relevance, it dif-

ferentiates itself by offering a unique group gaming

experience. As it is a party game designed for four

players, the dynamics and immersion reach a greater

level. The interaction between participants, combined

with the context of the game, provides an engaging

and enriching experience, which goes beyond enter-

tainment and promotes a greater understanding of the

topic covered.

What makes the game truly innovative is the in-

verse approach to the concept of accessibility. Instead

of a game aimed speciﬁcally at people with disabili-

ties, the developers chose to highlight the life experi-

ence of individuals with visual impairments, placing

it as a ﬁlter on the screen for all players (Figure 1) . In

this way, a unique opportunity is provided for people

without disabilities to tangibly and interactively expe-

rience the perspective and challenges faced by those

who have visual limitations. This approach, in addi-

tion to being educational, creates empathy and pro-

motes greater awareness about the reality of living

with a visual impairment. The game is freely avail-

able from this link

4 GAME DEVELOPMENT

The Game development followed an interactive An-

alyze, Design, Develop, Implement, Evaluate (AD-

DIE) process (Molenda, 2003). The main idea of

the game is to tackle a challenging topic (ophthalmic

symptoms) and turn it into a fun experience, pro-

moting interactivity among friends with engaging and

captivating gameplay. For raising awareness about

regular visits to an ophthalmologist, the team con-

ceived an item that players would collect to temporar-

ily improve their vision. Thus, the ”glasses” item was

implemented in the game.

The game was produced using the Unity graph-

ics engine (Figure 2) in the CSharp language. All el-

https://alpaconegames.itch.io/dr

Disability Racer: A Digital Game for Raising Awareness of Ophthalmological: Related Issues

191

Figure 1: Screen during Disability Racer game play.

Figure 2: Game on Unity.

ements of the game (visual, textual, sound, effects,

etc.) were developed by the course students them-

selves and were subsequently evaluated by their peers

and course teachers, during an internal games fair that

takes place once every semester.

During the semester, there was also monitoring by

a professional linked to the ﬁeld of ophthalmological

health, who was responsible for validating the choices

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192

Figure 3: Working Game Screen.

Figure 4: Game Vision with the driver with Glaucoma.

and actions taken by the game development team and,

at the end of the semester, validating the game as a

tool that achieved its objective and could have a posi-

tive impact on society.

4.1 Main Game Mechanics

The game was developed to be played on PC with Du-

alShock 2 controllers. Players need to be gathered lo-

cally to be able to play. The game screen is divided

into 4 parts (local split) and each controller corre-

sponds to a player on the screen as shown in Figure

4.2 Ophthalmological Issues Addressed

in the Game

For greater immersion within the experience, some

speciﬁc vision problems were chosen with the aim of

emulating what the vision of a person with that prob-

Disability Racer: A Digital Game for Raising Awareness of Ophthalmological: Related Issues

193

Figure 5: Game Vision with the driver with Keratoconus.

lem is like.

In addition to the difﬁculty of production at the

time of development, several types of eye problems

were excluded from the possibilities of choice, as they

were extremely complicated to simulate correctly.

The vision problems chosen for the original ver-

sion of the game were glaucoma, keratoconus, my-

opia and the cataract. These are the common prob-

lems that affect young people and adults. We will fur-

ther describe them in the following subsections.

4.3 Glaucoma

Glaucoma is a slow degeneration of retinal ganglion

cells, which increases eye pressure and can lead to

blindness. The quality of life of people with glau-

coma is drastically affected, even bringing psycholog-

ical limitations to patients (Queiroz and Mota, 2021).

As glaucoma is a disease of genetic origin, pre-

ventive treatment can be correlated with consultations

and treatments carried out in ophthalmological evalu-

ations (Queiroz and Mota, 2021).

Figure 4 shows what glaucoma vision is like at

play.

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194

Figure 6: Game Vision with the driver with Cataract.

Figure 7: Game Vision with the driver with Myopia.

4.4 Keratoconus

Keratoconus is characterized by a deformation in the

cornea, causing it to assume a conical shape. It typ-

ically appears during adolescence, but also in young

adults, and can appear after frequent rubbing of the

eyes (Lopes et al., 2015). Figure 5 shows what the vi-

sion of Keratoconus looks like in play. Keratoconus’

main effect on vision is irregular astigmatism, causing

a major impact on daily life (Lopes et al., 2015).

4.5 Cataract

Very common in the elderly, cataract is the opaciﬁca-

tion of the ocular lens, in some cases it can also affect

adults and children, but it is more common in older

people due to natural aging. The disease makes it dif-

ﬁcult for light to enter the lens hair, making it difﬁcult

to form an image on the retina and disrupting the suf-

ferer’s vision (Lopes et al., 2021).

Figure 6 shows how the view of the Cataract is at

play.

Disability Racer: A Digital Game for Raising Awareness of Ophthalmological: Related Issues

195

Figure 8: Texture.

Figure 9: Interface.

4.6 Myopia

Being one of the most common visual abnormalities,

myopia disrupts vision, causing the image of distant

objects to form anteriorly on the retina. The appear-

ance of myopia is linked to genetic factors, but it can

also be related to the frequent use of screens. Fortu-

nately, it can be treated with the use of glasses, contact

lenses and refractive surgery depending on the case

(Gomes et al., 2020). Figure 7 shows how Myopia

vision is at play.

4.7 Game Art

The game’s art, as previously mentioned, was all de-

veloped by the team’s students. The game used as a

reference some well-known titles such as Vigilante 8:

Second Offense developed by Luxoﬂux in 1999 for

Playstation 1 and Nintendo 64 and Twisted Metal de-

veloped by Single Trac in 1995, also for Playstation

Some aspects were used that emulated graphic

limitations of the time, such as “dragged” textures and

low ﬁdelity in the 3D models created, in order to con-

CSEDU 2024 - 16th International Conference on Computer Supported Education

196

vey a feeling that people were actually playing a game

made for Playstation 1, which is exempliﬁed in Figure

8 .

For the game’s interface, a theme was used that

was very reminiscent of Rock’n Roll and Heavy

Metal, something that was very connected to young

people at the time of the Playstation 1. The game in-

tend to convey an idea of nostalgia that accompanies

the games of that time as shown in Figure 9.

4.8 Game Soundtrack

The game’s soundtrack was designed to convey the

same feeling as the games mentioned above, which

were created in the 90s, where Rock’n Roll was

widely used in games. The music and sound effects

feature heavy metal beats that also contribute greatly

to the player’s immersion.

5 THE GAME

Before the match starts, players will choose an eye

problem on the selection screen (Figure 10). On this

screen, only the name of the disability is displayed,

without any visual preview. This is done with the

purpose of surprising the player by revealing what

the vision of someone who has the selected disabil-

ity is like. This approach aims to provide an authentic

and impactful experience, allowing players to gain a

deeper understanding of the difﬁculties faced by indi-

viduals with this visual impairment.

After choosing a disability (Figure 10), players

have the option to select from up to six different

cars (Figure 11). This variety allows for greater cus-

tomization and the opportunity to identify each other

more easily during the game. After both selections

the game begins.

The game has competitive dynamics between four

players and challenges them to eliminate each other

until only one winner remains. Each player chooses a

simulated visual impairment before the game to play

with and experience how someone with such a vi-

sual impairment sees and, throughout the game, can

collect ”glasses” to temporarily improve their vision

(Figure 12). In addition to providing entertainment,

the game promotes awareness about the reality of liv-

ing with a visual impairment and also about the im-

portance of ophthalmological consultations and the

use of glasses.

6 TESTING AND

PERFORMANCE

The game was taken and tested at several events,

where the game was displayed on a table with a tele-

vision, with the developers nearby to assist if players

needed help. But one that stands out is the biannual

game showcasing event, PUCPR Game Show. It was

there that the game was exposed to around 200 peo-

ple, including children, young people, adults and even

the elderly. Through the feedback received and the

expressions visible on their faces (Figure 13), it was

possible to validate the effectiveness of the game. It

was evident not only the high level of fun provided,

but also the game’s ability to promote awareness of

the subject.

In addition to raising awareness, a lot of feed-

back was received related to representations of dis-

abilities. There were suggestions both from people

who pointed out the possibility of adjusting the con-

dition ﬁlters to make them more faithful to the techni-

cal reality, and from individuals who shared that their

own visual experiences were similar to what was pre-

sented in the game.

7 DISCUSSION

With the statistic that one in ﬁve people in Latin

America and the Caribbean has some degree of vi-

sual impairment, and considering that the other four

people may not be familiar with this experience, the

game played a crucial role. In all digital game’s ex-

hibition events, the development team received posi-

tive feedback regarding the awareness principle. This

testimony highlights the game’s ability to provide a

deeper understanding of the experiences of people

with visual impairments, thus promoting greater em-

pathy and awareness in the community.

As noted by (Graziano and Leone, 2005), eye

problems in children are often underestimated, and

parents may not be fully aware of these issues. At

a digital games exhibition event, the development

team received touching feedback from a woman who

shared: ”I was able to understand how my daughter

sees...”. This statement highlights the effectiveness

of the game in raising awareness among parents and

preparing them for concerns related to their children’s

visual health. It offers a unique experience that can

help parents better understand the difﬁculties of chil-

dren with eye problems.

As mentioned by (Susi et al., 2007), serious games

represent a powerful tool capable of addressing com-

plex and little-treated areas. By combining a serious

Disability Racer: A Digital Game for Raising Awareness of Ophthalmological: Related Issues

197

Figure 10: Ophthalmological disabilities selection screen for each player.

Figure 11: Car selection screen for each player.

topic with the dynamics of a multiplayer battle game,

it not only facilitated understanding of the subject, but

also provided a tangible validation of that understand-

ing. This was evident in feedback from players who

shared similar or identical experiences of visual im-

pairment.

As well as the educational aspect highlighted by

(Noem

ı and M

aximo, 2014), which proved effective

in exposing children who played the game to ophthal-

mological conditions previously unknown to them.

They reported learning and expressed that they did not

want to go through similar problems in the future.

The Disability Racer game stands out as a unique

educational tool when comparing it to games like

Phishy (Figure 14) (CJ et al., 2018), which aims to

train employees to identify phishing links in corpo-

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198

Figure 12: Player’s vision after collecting glasses.

Figure 13: Event: Friends having fun while playing.

rate environments. While Phishy focuses on cyber-

security, Disability Racer has the potential to prepare

parents to identify potential eye problems in their chil-

dren based on the descriptions they provide.

Similar to the game Riskio (Figure 15) (Hart et al.,

2020), which simulates the roles of attackers and de-

fenders in a ﬁctional organizational environment, Dis-

ability Racer also presents a unique dynamic where,

players face challenges that simulate the development

of eye problems when hit by other players or when not

regularly collecting glasses scattered across the map.

This serves as an indirect reference to the importance

of regular visits to the ophthalmologist.

The PowerHouse game (Figure 16) (B

ang et al.,

2006), in turn, persuasively uses its mechanics to pro-

mote awareness and change behaviors related to en-

ergy use. In Disability Racer, players are similarly

encouraged to collect glasses and avoid attacks from

other players to preserve their vision, indirectly re-

ﬂecting on possible elements that could harm vision.

Disability Racer: A Digital Game for Raising Awareness of Ophthalmological: Related Issues

199

Figure 14: Playing image of the Phishy game (CJ et al.,

2018).

Figure 15: Playing image of the game Riskio (Hart et al.,

2020).

Figure 16: Playing image of the PowerHouse game (B

ang

et al., 2006).

8 CONCLUSIONS

This article presented a serious educational game

called ”Disability Racer” designed to promote aware-

ness of eye problems. The game objective is to elim-

inate opponents while facing the everyday difﬁculties

experienced by people with visual impairments in a

simulated way. This unique approach provides an im-

mersive and educational experience, allowing play-

ers to better understand the challenges faced by those

with visual limitations. The game serves as a valu-

able tool to promote empathy and understanding the

importance of accessibility in everyday life.

During the match, players can collect a special

item: glasses. Which temporarily improves players’

vision, conveying the crucial message about the im-

portance of seeing an ophthalmologist and recogniz-

ing the vital role of glasses for those with correctable

eye problems. This game mechanic highlights the rel-

evance of visual health and encourages the search for

ophthalmological solutions when necessary.

The developed game stands out from conventional

games by adopting a unique inverse awareness ap-

proach to accessibility. It challenges people with-

out disabilities to experience ﬁrst-hand the difﬁculties

faced by individuals with visual limitations. This dis-

tinction was proven in tests carried out at events and

in the positive feedback received from players. These

results reinforce the effectiveness of the game in pro-

moting empathy and understanding regarding the ex-

periences of people with visual impairments.

ACKNOWLEDGEMENTS

We thank the anonymous reviewers for their valuable

feedback and the support from PUCPR and CNPq.

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