# Myopic Bike and Say Hi: Games for Empathizing with The Myopic

Xiang Li  Xi’an Jiaotong-Liverpool UniversitySuzhouChina Exertion Games Lab
Monash UniversityMelbourneAustralia<EMAIL_ADDRESS>,  Xiaohang
Tang  Xi’an Jiaotong-Liverpool UniversitySuzhouChina
<EMAIL_ADDRESS>,  Xin Tong  Duke Kunshan
UniversitySuzhouChina Stanford UniversityStanfordUSA<EMAIL_ADDRESS>,  Rakesh
Patibanda  Exertion Games Lab
Monash UniversityMelbourneAustralia<EMAIL_ADDRESS>,  Florian
’Floyd’ Mueller  Exertion Games Lab
Monash UniversityMelbourneAustralia<EMAIL_ADDRESS>and  Hai-Ning
Liang  Xi’an Jiaotong-Liverpool UniversitySuzhouChina
<EMAIL_ADDRESS>
(2021; 2021)

###### Abstract.

Myopia is an eye condition that makes it difficult for people to focus on
faraway objects. It has become one of the most serious eye conditions
worldwide and negatively impacts the quality of life of those who suffer from
it. Although myopia is prevalent, many non-myopic people have misconceptions
about it and encounter challenges empathizing those who suffer from it. In
this research, we developed two virtual reality (VR) games, (1) ”Myopic Bike”
and (2) ”Say Hi”, to provide a means for the non-myopic population to
experience the difficulties of myopic people. Our two games simulate two
inconvenient daily life scenarios (riding a bicycle and greeting friends on
the street) that myopic people encounter when not wearing glasses. The goal is
to facilitate empathy in people with non-myopia for those who suffer from
myopia. We evaluated four participants’ game experiences through
questionnaires and semi-structured interviews. Overall, our two VR games can
create an engaging and non-judgmental experience for the non-myopic people
that has potential to facilitate empathizing with those who suffer from
myopia.

Myopia; Nearsightedness; Serious Games; Virtual Reality; Accessibility;
Empathy in HCI; Game Design

††copyright: acmcopyright††journalyear: 2021††doi:
10.1145/1122445.1122456††journalyear: 2021††copyright:
rightsretained††conference: Extended Abstracts of the 2021 Annual Symposium on
Computer-Human Interaction in Play; October 18–21, 2021; Virtual Event,
Austria††booktitle: Extended Abstracts of the 2021 Annual Symposium on
Computer-Human Interaction in Play (CHI PLAY ’21), October 18–21, 2021,
Virtual Event, Austria††doi: 10.1145/3450337.3483505††isbn:
978-1-4503-8356-1/21/10††ccs: Human-centered computing Accessibility††ccs:
Human-centered computing Virtual reality††ccs: Software and its engineering
Interactive games

Figure 1. Two VR games facilitate empathising people with myopia: Myopic Bike
and Say Hi. 1-4 and 5-8 simulate four myopic conditions: no myopia, low,
moderate and high myopia (from left to right).

Screenshots of the two games developed to help people empathise with myopic
users. (Top row: 1.1 to 1.4): Myopic Bike; (Bottom row:1.5 to 1.8): Say Hi, in
four myopic conditions: No Myopia, Low Myopia, Moderate Myopia, and High
Myopia (from left to right).

##  1\. Introduction

Myopia (or nearsightedness) is a common vision condition with which people can
see nearby objects clearly but the further-away ones are blurry (Morgan et
al., 2012). Myopia happens when the shape of an eye causes light rays to bend
(refract) incorrectly, focusing images in front of the retina instead of on
the retina (Morgan et al., 2012). In general, low myopia is less than 3.0
diopters (<-3.0 D), moderate myopia is less than 6.0 diopters (-3.0 D to -6.0
D), and high myopia is usually greater than 6.0 diopters (>-6.0 D).

Myopia is one of the most common eye problems worldwide. For example,
approximately 600 million residents in China are suffering from myopia (Zhao
et al., 2018b) and 4% of the population in the United States are suffering
from high myopia (Sia et al., 2014). For non-myopic people, it is often
difficult to empathize with different levels of myopia, and as such, it can be
challenging to feel the distress and discomfort experienced by those who have
it (Benford et al., 2013). We believe that the lack of empathy toward the
population with myopia could result in inadequate considerations when
designing products for myopic people and inadvertently cause accessibility
problems.

Recently, virtual reality (VR) games has shown great potential as a medium to
foster empathy in a non-judgemental but engaging and fun way (Shin, 2018). VR
can offer players an embodied first-person perspective to experience different
severities of myopia throguh the use of a virtual environment (Arnold et al.,
2018). Unlike traditional displays on mobile phones or monitors, VR gives the
user a depth experience, bringing the most visual-based and non-tactile
feedback in such non-existent scenarios (Li et al., 2021), which iempathy with
patients experiencings beneficial for scenario simulation and immersive
experience.

The use of extended reality to study health issues is not new. For example, Xu
et al. (Xu et al., 2020a) designed a variety of VR exergames in seated or
standing postures using head-mounted displays (HMDs). Likewise, Xu and
colleagues (Xu et al., 2020b) designed a high-intensity interval training
(HIIT) boxing VR game that allowed players to achieve high heart rates and
exertion, rapid fat burning, and reduced exercise time with high intensity.

In this research, we explore the design of VR games that are aimed to foster
in non-myopic people empathy toward those around us who suffer from myopia. To
do this, we first collected opinions from eight myopic and two non-myopic
people through a survey. We then investigated and studied the potential risks
encountered by myopic people when not wearing glasses. After, we developed two
VR myopic games, Myopic Bike and Say Hi (Figure 1). We then recruited four
participants with three levels of myopia to evaluate the two games. We
collected their feedback through semi-structured interviews and
questionnaires. These findings suggested that these two VR games represent a
good balance between having an engaging game experience and developing
empathetic feelings toward people with myopia. Overall, the results of our
research suggest that VR games are a promising approach to foster empathy
toward myopic people.

##  2\. Related Work

###  2.1. Facilitating Empathy

One common definition of empathy is ”the ability to perceive, understand, and
respond to the experiences and behaviors of others” (Szanto and Krueger,
2019). According to Davis (Davis, 2018), empathy is manifested in three
aspects: (1) physical sensations, (2) emotional sensations, and (3) cognitive
awareness. As VR can provide users with an embodied and immersive experience
(Bowman and McMahan, 2007), it is a suitable and powerful platform to foster
empathy toward those with physical and visual disorders or challenges (Freina
and Canessa, 2015).

Researchers have been using videogames and VR environments to foster empathy
toward specific populations (Konrath et al., 2011; Kral et al., 2018;
Greitemeyer et al., 2010; Sterkenburg et al., 2019). Their findings suggest
that VR games can elicit a strong sense of embodied empathy because of VR’s
immersive nature (Shin, 2018; Patibanda et al., 2017; ’Floyd’Mueller et al.,
2021; Perez-Marcos, 2018). Furthermore, the immersive features of VR games can
also provide benefits to individuals’ perceptions and behaviors (Herrera et
al., 2018; Slater and Sanchez-Vives, 2016; Lim et al., 2016; Boltz et al.,
2015). Bailenson et al. (Herrera et al., 2018) found that two experiential
aspects of VR, immersion and embodiment, play an essential role in fostering
empathy. Similarly, Tong and colleagues (Jin et al., 2016; Tong et al., 2020)
designed a VR game named AS IF, and found that it promoted empathy toward
chronic pain patients through an embodied avatar and game tasks. They
identified the critical role of embodiment in eliciting people’s empathetic
attitudes. Although previous studies have explored empathy toward vulnerable
populations, our study targets a unique group, people with different levels of
myopia.

###  2.2. Accessibility Designs for Visual Impairments

Figure 2. Four conditions in Myopic Bike. We engaged three groups of users
with different degrees of myopia (low, moderate and high myopia), two from
each group, in a pre-experiment data collection survey to help frame the
design of the games and, based on their feedback, we adjusted the Gaussian
blur parameters to match the real-world myopic situations as much as possible,
which are 0, 1, 2 and 3 (Figures 2.1 - 2.4, respectively).

Four conditions in Myopic Bike. We engaged three groups of users with
different degrees of myopia (low, moderate and high myopia), two from each
group, in a pre-experiment data collection survey to help frame the design of
the games and, based on their feedback, we adjusted the Gaussian blur
parameters to match the real-world myopic situations as much as possible,
which are 0, 1, 2 and 3 (Figures 2.1 - 2.4, respectively).

Prior research on the accessibility design for those with visual impairments
in VR has focused on blindness (González-Mora et al., 2006; Maidenbaum et al.,
2013; Picinali et al., 2014; Sánchez and Lumbreras, 1999), guidance systems
(Seki and Sato, 2010; Torres-Gil et al., 2010; Zhao et al., 2019a, b; Lécuyer
et al., 2003; Schloerb et al., 2010; Tzovaras et al., 2009, 2002), and non-
visual interfaces (An et al., 2020; Shinohara and Wobbrock, 2011). Researchers
also explored haptic interaction techniques for people with visual impairments
(Siu et al., 2020; Zhao et al., 2018a; Jansson et al., 1999). Krosl et al.
(Krösl et al., 2020) simulated the perspective of a person suffering from
cataracts in AR to foster empathy with patients experiencing. Prior work
contributed techniques that are useful for blind people or low vision
populations. Our two games focus on fostering empathy toward people with
severe myopia from those without myopia or with low or moderate myopic
conditions. We believe that it is only by truly experiencing simulated
difficulties of varying degrees of myopia that we can truly achieve empathy
and thus have a deeper awareness of their challenges and ultimately provide
improved accessibility designs for myopic users.

##  3\. Myopic Games

###  3.1. Background

Benford et al. introduced the concept of ”uncomfortable interaction” (Benford
et al., 2012, 2013), which explores the benefits and unexplored potential
interests of uncomfortable user experience in games. Our work falls under the
category of uncomfortable interaction from the perspective of the players’
experience to deliver an entertaining and fun but also enlightening and
socially bonding experience (Benford et al., 2013), specifically in the
context of experiencing how myopic people feel about doing common daily
activities.

We first collected myopic people’s challenges in their daily lives and non-
myopic people’s perceptions of these challenges through an online survey. We
received a total of 10 responses (6 males and 4 females with an average age of
27 years), 8 from myopic people (7 with moderate myopia in both eyes and 1
with low myopia in both eyes) and 2 responses from non-myopic people.

Nine participants had prior some experience with VR devices. Eight myopic
people reported that if they forget to wear glasses in their daily lives, they
would be afraid of riding a bicycle because they could not see any obstacles
on their way. Six thought they would be afraid of greeting people on the
street because they could not recognize them. The other two non-myopic
respondents also mentioned that they thought myopic people would be afraid to
use transportation and greet people because of any embarrassing situation if
they could not recognize them. Based on these initial findings, we decided to
design the two myopia games, one for each scenario, i.e., Myopic Bike and Say
Hi.

###  3.2. Innovations

Our two games have three innovative features. First, our targeted audience are
people and people with low to medium myopia. Second, we provided four game
levels, each mapped to a level of myopia, for players to choose from to
experience different degrees of myopic situations. Third, our two VR games
simulated challenges people with myopia encounter in their daily life.

###  3.3. Myopic Bike

| Myopic Bike | Say Hi
---|---|---
| NoMyopia | LowMyopia | ModerateMyopia | HighMyopia | NoMyopia | LowMyopia | ModerateMyopia | HighMyopia
Competence | 2.65 (.44) | 2.65 (.79) | 2.50 (.48) | 2.70 (.42) | 2.25 (.87) | 1.95 (.10) | 1.85 (.77) | 1.60 (.40)
Sensory and Imaginative Immersion | 2.58 (.22) | 2.83 (.19) | 2.67 (.30) | 2.75 (.22) | 3.04 (.55) | 2.71 (.25) | 2.28 (.35) | 2.79 (.50)
Flow | 2.25 (.19) | 2.40 (.49) | 2.30 (.26) | 2.25 (.30) | 2.10 (.62) | 2.05 (.57) | 2.25 (.70) | 2.05 (.64)
Tension | 1.05 (.66) | .80 (.43) | 1.00 (.52) | 1.10 (.42) | .90 (.50) | .85 (.55) | 1.15 (.25) | .85 (.44)
Challenge | 2.05 (.79) | 1.75 (.94) | 2.75 (.44) | 2.60 (1.21) | 1.80 (1.06) | 2.45 (.44) | 2.80 (.37) | 2.65 (1.25)
Negative affect | .90 (.74) | .90 (.70) | 1.20 (.82) | 1.40 (.91) | 1.50 (.50) | 1.10 (.35) | 1.05 (.44) | 1.55 (.98)
Positive affect | 2.60 (.28) | 2.95 (.72) | 2.30 (.26) | 2.20 (.59) | 2.65 (.41) | 2.15 (.44) | 1.95 (.19) | 2.00 (.40)

Table 1. Players’ component mean (SD) scores for the seven core GEQ modules.

Players’ component mean (SD) scores for the seven core GEQ modules.

Figure 3. Myopic Bike showing (1) Roadblocks and (2) the Scoreboard (current
Game Score = 97).

Screenshots of Myopic Bike showing (1) Roadblocks and (2) the Scoreboard.

####  3.3.1. Game Concepts and Gameplay Mechanics

Myopic Bike offers four levels of myopia for players to choose from (NoMyopia,
LowMyopia, ModerateMyopia and HighMyopia) (Fig. 2). Users play a person with
myopia riding a bike. Players need to reach the end of the route with
roadblocks (Fig. 3.1). There are three levels of difficulty for each of the
four myopia conditions according to the number of roadblocks along the route
(i.e., 40, 60, 80). Thus, players need to be skilled at handling and
maneuvering the bike to avoid hitting the roadblocks and to not losing points.
We also provide sound effects when a roadblock is hit and a scoreboard (Fig.
3.2) to show players their performance when they cross the finish line.

###  3.4. Say Hi

Figure 4. Screenshots of Say Hi showing (1) a virtual character to say hi to
(or not), and (2) the scoreboard (current game score = 14).

Screenshots of Say Hi showing (1) a virtual character to say hi to (or not),
and (2) the scoreboard (current game score = 14).

####  3.4.1. Overall Concept and Gameplay Mechanics

In Say Hi, players take on the role of a pedestrian standing still and
greeting ”acquaintances” who are among other pedestrians. We use four
international famous people as ”acquaintances” for players to choose. Before
starting the game, we show their pictures to the participants to ensure they
know these faces. Groups of pedestrians will walk facing the player at the
same speed, and disappear after 15 seconds. In each group, the game will show
either one or no person from the four faces. Players need to select the one
they know from all pedestrians before they disappear (Fig. 4.1). The selected
pedestrian will provide positive or negative audio feedback after the player
made a choice. Players’ performances will be shown on a scoreboard (Fig. 4.2)
when they complete the game.

We predefined the number of groups in each round and the number of groups
without any acquaintance (i.e., 20 and 4 in our game). Moreover, for each
group, pedestrians’ clothes and faces are randomly allocated. There are three
difficulty levels , the higher the level, the more pedestrians are on the road
(i.e., 1 per level in our game).

###  3.5. Development and Apparatus

We used the Unity111Unity: https://unity.com/ to develop the two myopic games
and Oculus Rift S222Oculus Rift S: https://www.oculus.com/rift-s/ as the VR
HMD. All development and evaluation were conducted at a university’s research
lab.

###  3.6. Playtesting

| NoMyopia | LowMyopia | ModerateMyopia | HighMyopia
---|---|---|---|---
Myopic Bike | 0.25 | 2 | 2.75 | 4
Say Hi | 0.25 | 2 | 3.25 | 4

Table 2. Players’ empathy in the two games with different myopic conditions
collected via 5-likert scale questions, from 0 to 4.

Players’ empathy in the two games with different myopic conditions collected
via 5-likert scale questions, from 0 to 4.

We recruited four participants from a local university, each from a unique
condition of myopia (including the non-myopic condition), i.e., NoMyopia,
LowMyopia, ModerateMyopia, and HighMyopia. We collected their feedback from
pre-prepared questionnaires, i.e., Game Experience Questionnaire (GEQ).
Although some studies have questioned the validity of the GEQ, we hope our
results still depict interesting feedback on our games (Law et al., 2018).
(IJsselsteijn et al., 2013) (Table 1), a subjective emotion questionnaire
(SEQ) using 5-Likert scale questions (Table 2), and conducted semi-structured
interviews to analyze the players’ preferences and empathy in each case (Carey
et al., 2017). We only tested the low difficulty mode of both VR games and
asked each participant to experience all four myopic conditions and collected
the game scores. After each experimental condition, participants were asked to
complete the above-mentioned questionnaires. Participants finished the two
games in about thirty minutes.

All participants had fun playing the two VR myopia games, but all had their
own preferences. For instance, P1 (who does not have myopia) talked about his
VR experience of being a myopic person. P1 said, ”I enjoyed playing both VR
myopic games, [because] I’m not myopic, so this is the first time I’ve felt
the inconveniences experienced by people with different levels of myopia in
their lives. It’s almost impossible for me to see anything else in high myopia
condition…”. P3 (who has moderate myopia) talked about his previous
misconceptions about high myopia, saying that ”I thought before that high
myopia might be nothing [different] [because] I was moderately nearsighted.
But after experiencing these two games I found I was wrong. These two games
have enhanced my empathy [toward people with high myopia].”

##  4\. Limitations and Future Work

We acknowledge that our design work has limitations (Gaver and Bowers, 2012)
and that there are several possibilities to extend it. Our two VR games
represent myopic people’s challenges through two real-life scenarios. Other
scenarios are certainly possible. To help develop these, we think that body
interaction theories in HCI research can complement our future work. For
example, Merleau-Ponty’s ”motor intentionality” (Svanæs, 2013), Mueller et
al.’s concept of limited body interaction (’Floyd’Mueller et al., 2021) and
their theoretical basis about using the body as an interface for games
(Mueller et al., 2018) could enrich our notion of body control for more
immersive myopic simulations (Sauvé et al., 2007). Future work can investigate
how to better utilize the body as a more direct mode of interaction to enhance
the myopic game experience and achieve better empathy in players.

Our study and game design can be further refined and the myopia rendering in
VR could be enhanced. We only blurred the screen without using any other extra
graphics rendering deformations or transformations for players to experience
different cases of myopia. Moreover, moderate to high myopia is usually
accompanied by other ocular diseases such as astigmatism (Gwiazda et al.,
2000), which is difficult to simulate in VR. Given that our main study was
focused on myopia experiences per se, future work could explore the
possibility of simulating the concomitant or superimposed ocular diseases in
VR.

Regarding measuring empathy, we used a self-reported questionnaire to collect
empathy changes. In future work, we plan to add a way of capturing facial
expressions (Ekman and Friesen, 1971; Ekman et al., 2013) and EEG signals,
such as Neo-Noumena (Semertzidis et al., 2020), to record participants’
affective and biological changes.

Further exploration is required to form a framework for developing myopic VR
games. From the perspective of accessible design, only by fully experiencing
different levels of myopia can designers effectively design accessible
products for people with myopia (Shinohara and Wobbrock, 2011). Aside from
product design, the ability to empathize with people with different degrees of
myopia is conducive to making our society more inclusive and understanding
towards those with visual challenges. Therefore, in the future we plan to
include a larger sample size to further evaluate our VR games, extract design
inspirations and recommendations. Our long term plan is to formulate a
framework that can guide the design of VR games aimed at fostering people’s
empathetic attitudes toward people with different degrees of myopia.

##  5\. Conclusion

In this paper, we presented two VR myopic games, Myopic Bike and Say Hi, that
allows players to experience the challenges people with myopia encounter in
their everyday life. that myopic people encounter when not wearing glasses. We
evaluated these two games with four participants and collected their feedback
using questionnaires and semi-structured interviews. Findings suggested that
the two VR myopic games could foster empathy toward people with myopia.

###### Acknowledgements.

We thank all the participants for their time. We also thank the reviewers for
their comments. Xiang Li would like to thank the internship program provided
by the Exertion Games Lab of Monash University. Rakesh Patibanda and Florian
’Floyd’ Mueller thank the Australian Research Council. This research was
supported in part by Xi’an Jiaotong-Liverpool University’s Key Special Fund
(#KSF-A-03).

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