A rare disease robbed me of my sight. VR brought it back

Playing L.A. Noire in virtual reality, Alex Lee found himself able to see clearly for the first time in five years

Slipping the HTC Vive VR headset over my head, I wasn’t really sure what to expect. The last time I played a video game, it was 2013, throwing red shells in Mario Kart on the Wii. I was mostly apprehensive for one simple reason: I’d lost my central vision to a rare genetic disease later that year.

So when L.A. Noire booted up on the HTC Vive, my expectations were pretty low. Normally, everything in a video game is an indecipherable blur, and I assumed it would be the same in virtual reality. Instead, I was met with a surprise: I could actually see more in this 1940s virtual world than in other games. More than that, I could see more in VR than I could in real life.

According to Gary Rubin, professor of visual function and rehabilitation at UCL, the reason is actually pretty simple: “The closer something is, the more magnified it is. Placing two screens inches from your eyes is essentially making things larger by filling your field of vision.

“Additionally, the device will have automatic gain control, which will adjust and boost the contrast of the scene. Contrast is very important in making things visible.”

Virtual-reality systems fill the wearer’s entire field of vision, utilising a combination of near-eye displays and high-colour contrast. This is one of the reasons why some people with low vision, like myself, can see better when wearing a VR headset.

(Above: L.A. Noire. Credit: Rockstar)

Dr Michael Crossland, specialist optometrist at Moorfields Eye Hospital NHS Foundation Trust, agrees: “Virtual reality often incorporates big, bright and bold text and images in its games and environments, which helps some people with low vision see better while experiencing it.

“The screens are positioned very close to the face, which makes objects appear bigger, and the bold images and vivid colours that are often used in virtual environments help to distinguish objects more clearly.”

This isn’t the first time colour contrast and magnification have been used to aid people with central vision loss. A 1999 study conducted by researchers at the University of Bristol, for example, tested whether a head-mounted camera that boosted image enhancement and colour contrast would help people recognise images of objects. The participants went from recognising 40% of the objects to a huge 87.5%.

In another review of 37 studies from the University of Manchester, conducted in 2015, researchers found that image enhancement was, on the whole, effective for helping people with central vision loss see better.

Sound and vision

While it may seem like VR could be revelatory for visually impaired people, Ian Hamilton, a games accessibility specialist and advocate with more than ten years’ experience in games accessibility, sees it a little differently.

“As with VR for sighted people, it’s really not about a new paradigm that is going to replace all before it. What it is, though, is something different: an alternative way of interacting that offers new kinds of experiences and types of immersion.

“One way that [VR] is currently less accessible [to screen-based experiences] isn’t in fact to do with the tech or games at all, it’s about attitudes and misconceptions. There’s a strong assumption among many blind people I’ve discussed VR with that there would be nothing for them to gain from it; that it is a visual medium, something you wear on your eyes to improve the visuals. Of course this isn’t the case – audio is a core aspect of the experience.”

Indeed, immersive audio in virtual reality can also add a sense of presence for those with partial sight. Many blind gamers use sound design to enable them to play fighting games such as Killer Instinct, Mortal Kombat, Street Fighter and Tekken on traditional gaming consoles, learning the sound cues of moves and the audio feedback from characters. One of these audio-only gamers is Sightless Kombat, a completely blind player from the UK, who climbed to the “Killer” rank in Killer Instinct on the Xbox One back in 2016.

“The amount of audio that can be packed into VR headsets through spatialised sound means that even more immersive experiences can be opened up,” Sightless Kombat explains to me. “I do feel that VR has potential as a medium for immersive gaming, even to players without sight, if handled correctly by developers.”

(Above: Alex Lee)

In addition to 3D sound, there’s also scope for head-tracking to make it easier for those with low vision to find objects or text on the screen. UCL’s Professor Rubin tells me that, in 2008, he and his colleague Antonio Macedo tested whether eye stabilisation would improve sight.

“Some people with low vision have a problem holding their eyes still,” Rubin says. “If your eyes are in motion or jittering, it interferes with your ability to read and see things. If you use VR to stabilise movement, which we’ve tested in the lab, you can read a bit faster. If your eye moves, the VR system knows where you’re looking, so it can move your eyes and move the target to cancel out the movement of your eyes.”

In another study, conducted in 2012, researchers from the University of Toronto used virtual-reality glasses to stabilise video of text in real-time. The participants went from being able to read an average of 2.77 lines of text without the VR glasses, to 6.14 lines of text with the VR image stabilisation activated; a significant jump.

Between the potential benefits to visual recognition and the power of immersive audio, a new paradigm is perhaps opening up for those with partial vision. Visually impaired YouTube VR gamer, Jesse Anderson – who goes by IllegallySighted on YouTube – tells me head tracking is crucial, giving him the ability to physically lean in and examine text or help position himself in a space because of 3D sound: “When combined with a button to recalibrate the centre view, head tracking can often make the difference between me being able to effectively use a VR app or game or being unable to use it completely.”

A new frontier?

Virtual reality has plenty of tools that can help those with visual impairment, but it’s far from being a panacea. While image enhancement using contrast adjustment and magnification can help people with central vision loss, Rubin tells me that VR systems that are close to the eyes, such as the HTC Vive, may not work for people with tunnel vision or little peripheral vision.

“Magnification for people with tunnel vision can be a bad thing. They only have a small area they can see through, and if you magnify it, you see less of the subject,” he says. “You lose the context of what you’re looking at. So it’s a tricky business with tunnel vision. In fact, sometimes it can go in the opposite direction: they don’t magnify, they minimise, because if their central vision is still good, then they can cram more in if they minimise.”

And there are still more hurdles to cross with VR game accessibility itself. Mainstream gaming consoles have been slow to adopt inclusive accessibility functions that make gaming more playable for people with visual impairments. There’s also the fact that in VR you lose things such as aiming crosshairs, something relied upon by people with low vision or limited vision in one eye when playing FPS games.

(Above: Give Vision’s SightPlus wearable headset. Credit: Give Vision)

But VR doesn’t just have to exist in the realm of video games and narrative experiences. “As much as I like games in VR, I’m almost more excited about the potential of non-gaming uses of virtual reality,” Anderson says. “One of my early favourites is called Apollo 11 VR. This experience took you through the whole mission, from hearing it on your living-room TV screen, through the launch, landing on the moon, to the trip home. You even got to walk on the moon and explore the landing site, which was amazing!”

Virtual reality is also helping people with low vision to better see the real world around them. Moorfields Eye Hospital, for example, has been working with Give Vision to bring a portable VR system called Sight Plus to the market. With Sight Plus, the wearer can magnify their surroundings, change the contrast and even the colour of the environment. Then there are apps such as Super Vision Cardboard and Relúmĭno, developed by Samsung, which are designed to magnify whatever the user is looking at.

All of this technology still has a long way to go before it’s widely adopted by visually impaired people, but the early indications suggest there’s a great deal of uncharted potential in using virtual-reality systems such as the HTC Vive and Oculus Rift to combat visual impairment. The hope is that, one day, assistive VR solutions will be as ubiquitous as any other aid out there today. For now, I’ll make do with transporting myself to a virtual recreation of 1940s Los Angeles thanks to L.A. Noire.