Open letter to the BioShock creative team

Posted: 04/18/2013 | Author: | Filed under: Photosensitive Seizure Prevention, Results of safety testing, Seizure Warnings, Video Game Companies | Tags: , , , , , , , | Leave a comment

BioShock Infinite logo largerCongratulations on last month’s successful launch of BioShock Infinite. The reviews are extraordinary. BioShock Infinite is said to set a new standard for what the video game experience can be. Players are moved and enthusiastic about many aspects of the game and speak effusively about their unprecedented degree of involvement with the story and characters. With all the creative energy, care, and respect for players that went into developing BioShock, though, the game–like so many others–exposes players to visuals that can cause seizures.

I examined several BioShock launch trailers and some other “footage” – a total of eight clips of a few minutes each – and assessed them using an application that identifies video sequences that can trigger seizures. Most of the material was fine, but three of the clips contained brief flashing sequences that don’t meet criteria for safe viewing. It doesn’t take more than a brief exposure to trigger seizures in those who are vulnerable.

This BioShock scene uses safe levels of flash

This BioShock scene uses safe levels of flash.

Contrary to what many gamers assume, eliminating seizure triggers doesn’t make a game boring to look at or play. Irrational Software created a visually stunning, highly engaging experience in which most of the scenes don’t pose a seizure risk. Reports of video game-induced seizures began surfacing in 1981 in newspapers and medical journals. A great deal is known about what types of images and sequences can provoke seizures.

Guidelines for seizure-free video sequences were developed in the UK more than 20 years ago. Since 1991 all television programming and commercials there are required to pass a seizure-safety test. Japan put in place a similar measure following the 1997 Pokémon broadcast that led to hundreds of seizures. In 2005 the International Telecommunication Union published recommended universal guidelines for reducing photosensitive seizures from televised material.

While all these efforts were made to reduce the risk to consumers of photosensitive seizures, video game publishers took their own action—providing printed seizure warnings. The warnings began appearing in the early ‘90s, after a few consumers filed personal injury lawsuits. Putting a seizure warning on video games has thus far provided legal cover for your industry, but offers little protection for customers.

Flash in this scene is safe, too.

Flash in this scene is safe, too.

The warnings all state that photosensitive seizures happen to “a very small percentage of people.” Seizures from flashing images are not rare, but people believe they are because that’s what the warnings say! The wording of these warnings is based on researchers’ estimates that were made decades ago, before today’s sophisticated graphics and before more recent studies that suggest that many photosensitive seizures could be going completely unnoticed. Many doctors continue to think these seizures are rare because that’s what they were taught.

If you haven’t heard many reports of seizures happening while playing BioShock, don’t assume the seizures aren’t occurring. They’re just not being identified. A person experiencing seizures is likely to lose awareness and not even realize what’s happening, or notice that a bit of time has passed that they can’t account for. Furthermore, most seizures don’t involve convulsions, and the only sign others might see could be as subtle as a short period of staring.

Whether or not a seizure is noticeable, it’s a serious event with real risks to health. It can impair health, thinking, and behavior for days afterward. Sometimes a seizure results in permanent disability.

This scene failed seizure safety guidelines.

But this screen capture from the Harding Flash and Pattern Analyzer shows that flash in the BioShock sequence shown at upper left failed seizure safety guidelines.

It’s not reasonable to expect parents to continually monitor their kids for possible signs of a seizure, particularly given that video games are played while people face a screen. So let’s turn to older teens and adults in the midst of a game, who might theoretically be more self-aware and responsible for their own well-being. Will they be vigilant for seizure symptoms such as odd sensations or altered consciousness?

Just last month in a New York Times interview your creative director Ken Levine said, “We work really hard to wear down the audience’s ability to even process. If players are immersed enough, they stop treating it as a piece of artifice and just start experiencing it.” Do you see the problem here? In this ideal game experience, how can players be expected to “immediately stop playing and consult a doctor” as the warning advises, if they develop symptoms consistent with a seizure?

With BioShock Infinite now brought to market, people are asking what your company will do next. You could easily raise the bar further for the industry by publicly committing to developing seizure-safe games. I live in the Boston area and would welcome the chance to begin a conversation about this at your headquarters in Quincy.

Today the sound, tomorrow the picture?

Posted: 01/20/2013 | Author: | Filed under: Photosensitive Seizure Prevention, Political Action & Advocacy, TV, Video Game Companies | Tags: , , , , , , | 9 Comments

too loud2Have you noticed that watching TV is less annoying lately? Commercials are now required to be no louder than the programming surrounding them. On December 13 an FCC regulation went into effect that was designed for just that. The CALM Act, approved by Congress in 2010, directed the Federal Communications Commission to make it possible to watch TV without constantly turning down the volume of advertisements.

Since the introduction of television in the 1950s, many consumers have complained to the FCC  about the loudness of commercials. What prevented the FCC from doing anything in response was that the issue was technically complicated. Multiple factors can contribute to the perceived loudness of a broadcast, including the strength of the electrical signal, the degree to which the sound signal is compressed. In addition, there was no standard method for content creators and broadcasters to measure broadcast volume.  

In 2006, the International Telecommunication Union–the same UN-affiliated standards body that has published specifications for protecting TV viewers from photosensitive seizures–proposed a new technique for measuring broadcast volume that allows uniform evaluation across national boundaries. In addition, the ITU proposed a numerical “target loudness” using the new loudness gauge. Thanks to the ITU, it became possible to define, comply with, and enforce limits on loudness.

Four years later the United States Congress passed the CALM Act with little debate, by unanimous vote in the Senate and by a voice vote in the House. California Congresswoman Anna Eshoo, who introduced the bill, said it was by far the most popular bill she’d ever sponsored. She said the bill “gives consumers peace of mind, because it puts them in control of the sound in their homes.” She was quoted saying, “If I’d saved 50 million children from some malady, people would not have the interest that they have in this.” By that time the UK, France, Norway, Italy, Japan, Brazil, Israel, Germany, Austria, Switzerland, Poland, and the Netherlands were already limiting the loudness of commercials or had begun action on the issue. 

These days even the video game industry is paying attention to some kind of audio standards, if only for consistency across products. According to an July 2012 interview in Designing Sound, Sony Computer Entertainment Europe is looking at smoothing out the volume among their own game titles.

Unfortunately, in this country making TV safer to watch for the visually sensitive–or making video games safer to play–isn’t on the legislative agenda. Consumers and policy makers aren’t aware of the need. The technical groundwork is already in place for regulations to prevent screen-induced photosensitive seizures, thanks to ITU specifications (and similar versions developed by the UK and Japan), and to similar guidelines adopted by the World Wide Web Consortium for web-based content.

Here’s where things stand at the moment in making US electronic screens safe for those with photosensitive epilepsy: Photosensitive epilepsy protection standards now apply to all federal agency websites. The Photosensitive Epilepsy Analysis Tool (PEAT) downloadable from the PACE Center at the University of Wisconsin at Madison makes available to website designers and software developers a free tool that tests screen content for compliance with seizure safety guidelines. The tool is not intended for entertainment industry developers, however; these companies need to buy commercially available assessment tools.

I’ve written previously about some of the complexities of bringing new screen safety standards to the American telecommunications industry. I”m going to learn more about the legislative process in coming months. My State Representative filed a bill last week to create a commission to study the issue of video game safety for minors at home and in school here in Massachusetts. It will take considerable time to even bring the bill to a public hearing, but as I’ve recently learned, all bills filed in the Massachusetts legislature receive a public hearing at some point in the two-year session. The two years just began this month. Stay tuned.

Top First-Person Shooters Fail Safety Test

Posted: 12/17/2012 | Author: | Filed under: Photosensitive Seizure Prevention, Seizure Risk | Tags: , , , , , , , , | 4 Comments

FPS screen captureA while back, I looked at some MMORPGs (massive, multi-player, online role-playing games) and found that they typically don’t pose a high risk of triggering photosensitive seizures. Their appeal lies in the social world of collaborative missions, the acquisition of skills and material goods, and immersion in a detailed narrative.

First-person shooter (FPS) games are a different story. They offer continuous combat with lots of vivid, brightly flickering sequences, a scenario that is much more likely to bring on visually induced seizures. Because players watch from the shooter’s up-close perspective, the flashes from explosions brightly illuminate much of the entire screen. When more of the field of vision is exposed to flashes, more neurons are activated for visual processing, raising the seizure risk. Lots of quick scene cuts are typical while the shooter races and maneuvers through territory at top speed. In addition, the rapid fire of high-caliber weapons causes shaking and vibrating of the scene that adds to players’ visual processing load.

I don’t offer an opinion about the content, value, message, or age- appropriateness of video games. My purpose  is to provide information on their potential to induce photosensitive seizures in people who may have this genetic vulnerability. But I will confess that I turned my attention to FPS games after the recent news that that Navy SEALS had shared classified information with the developer of  Medal of Honor: Warfighter. I was curious as to whether the game was also likely to provoke seizures. In fact Warfighter does fail the test for seizure safety, and it also received poor reviews and didn’t sell well. My testing showed that two blockbusters in this game genre, Halo 4 (with launch day sales of $220 million) and Call of Duty Black Ops 2 ($500 million during its first 24 hours), released last month, violate international guidelines for preventing photosensitive seizures.

Given their huge popularity and the high ranking of many FPS games on reviewers’ best-of-the-year lists, it seemed like an appropriate time to look at the seizure safety of FPS games as a category. I tested the 14 games on GameSpot’s list of the most popular FPS games (which includes all gaming platforms). To obtain representative scenes from each game, I downloaded official trailers and user-submitted video  from YouTube. Most were less than 5 minutes long. If the first clips I tested for a game didn’t fail the safety test, I tested several more clips for each game, since it was possible that failing sequences weren’t included in a particular clip. In all I tested several dozen video segments on the Harding Flash and Pattern Analyzer. As shown in the table below, the visuals in every game either exceeded the limits for photosensitive seizure safety or came close to the limits, a result that received a “Caution” grade from the analyzer software. Note that any game that didn’t actually fail cannot be deemed seizure-safe, since it could easily have unsafe sequences I didn’t locate.

PlanetSide 2, Far Cry 3, Halo 4, Warface, S.T.A.L.K.E.R: Call of Pripyat, Call of Duty: Black Ops Declassified, ZombiU, Call of Duty: Black Ops 2, Borderlands 2, Natural Selection 2, Metro 2033, Team Fortress 2, Borderlands, Call of Duty: Black Ops

FPS games from GameSpot’s “best games by popularity” list

The Caution designation by the analyzer software recognizes that every individual’s vulnerability to seizures changes in response to internal factors (such as fatigue, illness, alcohol, menstrual cycle, stress) and environmental conditions (proximity to/size of screen, screen brightness, duration of play). The risk of seizures for any individual using the same game on different occasions varies depending on  these circumstances.

So caution when playing shooter games is certainly appropriate. Take breaks, don’t play when sleep-deprived, and don’t sit too close to the screen. A game that’s never triggered seizures before may trigger a seizure another time, even in people who’ve never had a seizure in their lives because photosensitivity is a latent trait until it is activated. Sometimes seizures are so subtle people may not realize they are happening, but even small seizures can affect mental and physical functioning for a day or two.

Canaries, autism, and sensory overload

Posted: 06/07/2012 | Author: | Filed under: Health Consequences, Medical Research, Photosensitive Seizure Prevention | Tags: , , , , , , , , | 3 Comments

Like canaries in a coal mine, people with autism are the first to be affected by hazards in our environment that may in time affect everyone. 

“I believe that when the science is in, we will see that people with autism are ‘canaries in the coal mine,’ the most susceptible, who are affected first by problems that may eventually reach us all.”

–from The Autism Revolution by Martha Herbert, MD, PhD, with Karen Weintraub (Ballantine Books, 2012)

Martha Herbert reasons in her remarkable book that the rapidly increasing prevalence of autism indicates the disorder can’t possibly be due to genetics alone. She makes the case, based on findings in diverse fields of medical research and on her own clinical experience, that autism is not a genetic trait destined to be lifelong. Instead, she’s suggesting that the rise in autism is a consequence of the environment we live in, and that many autism symptoms can be reduced by making environmental changes. It’s compelling reading whether or not someone you love has autism, because, Herbert contends, many of the environmental influences that probably contribute to autism will likely affect all of us in time.

While the development of autism may begin with genetic vulnerability, she argues, the emergence of the disorder begins after a tipping point is reached following a multitude of modern-day environmental exposures. The cumulative effects of these environmental stresses influence the expression of genes associated with autism, leading to a cluster of brain and body dysfunctions typical of this spectrum disorder. Autism rates are sharply rising because the biological systems of growing numbers of young people are running out of the resilience required amid burgeoning environmental challenges.

Sensory overload as environmental stressor 

Dr. Herbert explores environmental influences including toxins, emotional stress, infection, diet, and sensory overload. She cites many cases where people with autism got a lot better when specific changes in these environmental factors were made, thereby reducing assorted stresses on the brain and body. Eliminating the right stressors, which may require considerable trial and error, can allow some children to become significantly higher-functioning, healthier individuals.

city-night-explosion-fireworkIn any individual, whether or not autism is present, identifying and avoiding environmental seizure triggers can produce big improvements in a range of physical, cognitive, and emotional difficulties associated with seizure activity. Dr. Herbert suggests that seizures, which are not uncommon in people with autism, can cause or exacerbate some problem behaviors in this population.

The only study done to date on autism and photosensitivity indicates children on the autism spectrum have much higher rates of photosensitive epilepsy. Given the high rate of other types of epilepsy in those with autism, this is not surprising. To be quite clear, I’m not suggesting that video games cause autism, nor does Dr. Herbert. But preventing seizures that exacerbate autism symptoms can be a major stepping-stone to wellness.

Dr. Herbert outlines many steps parents can take, beyond seizure reduction, to limit exposure to things that can magnify autism symptoms and may contribute to its emergence. While not every approach works for every child with autism, she provides a range of additional strategies such as eliminating gluten, dairy, and food additives, regulating sleep, getting rid of toxic household chemicals, and reducing sensory overload.

“Too much sensory stimulation, trouble being coordinated, not enough sleep, seizures, not being able to say what you want—all can contribute to frustration and stress. Looking for solutions at each of these levels can help reduce the stress and increase the time spent truly learning and enjoying life.”

“Gray zone” electrical activity

Dr. Herbert does not assume that a finding of “no seizures” on an EEG means that visual stimuli are not affecting the brain’s normal electrical firing. The consequences of brain waves that are “somewhere between ‘normal’ and ‘disease,'” she contends, could be “subtle but still important”–even if no actual seizures are triggered. In other words, even mildly abnormal rhythms in the brain, which can be provoked in some individuals by exposure to visual overstimulation, may result in impaired neurological functioning. Even if your child has not been experiencing actual seizures, Dr. Herbert says these abnormal rhythms due to excessive sensory stimulation from visual media may actually affect the brain’s ability to process information.

“…A lot of kids with autism might be having ‘gray zone’ electrical problems—too mild to meet the formal definition of seizures, but enough to interfere with their quality of life.”

These “gray zone electrical problems” are not limited to those with autism. Other populations likely to be in this gray zone include people with learning disorders, intellectual disabilities, or psychiatric conditions—the more vulnerable among us. In other words, it may not make sense to dismiss as irrelevant any observed EEG abnormalities that don’t clearly indicate seizures.

Reducing overload

If your child is on the autism spectrum, you probably already know to reduce your child’s sensory overload. One way to do that is to limit screen time and avoid overstimulating content. Try eliminating video games for a few days and see if your child begins to feel better and struggle less with learning, attention, emotions, and behavior. (Your child may be initially quite resistant to this experiment, which will temporarily make things more stressful. To get a fair reading on the effect, you need a few days free of any withdrawal symptoms.) During this video-game-free time, all visually overstimulating media should be avoided, including fast-paced cartoons, movies, and music videos.

Those whose children aren’t on the autism spectrum should also take note. By applying the canary-in-the-coal-mine model, we may yet learn that visual overstimulation can profoundly affect the functioning and health of many people, including those without autism. When the visual system of a person with photosensitivity is no longer overloaded by video games, daily life for that person and their family can be transformed.

Could anyone in your family be affected? It’s something to think about.

Kanye West loves strobe lights

Posted: 05/07/2012 | Author: | Filed under: Health Consequences, Music Videos, Photosensitive Seizure Prevention, Political Action & Advocacy, Results of safety testing, Seizure Warnings | Tags: , , , , , , , , , | Leave a comment

The Harding Flash and Pattern Analyzer shows flash levels in “Lost in the World” fail seizure safety guidelines by a wide margin. At upper left is a screen grab from the new video.

“Kanye West loves strobe lights,” cooed the Huffington Post the other day, reporting the release of the performer’s most recent flash-filled music video. “…the Chicago rapper…seemingly earns an epilepsy warning with every new project. His new video for the not-so-new song ‘Lost in the World’ certainly doesn’t deviate from the pattern.”

Apparently he loves strobe lights so much that–despite being informed, two music video releases ago–that his flashing visuals provoke seizures in some viewers, he is determined to use these effects anyway. Wow, you have to really respect a man who refuses to let the health of the viewing public get in the way of his artistic freedom. The Huff Post article continues in the same admiring tone: “…the rapper is known for his emphasis on quality videos (his half-hour ‘Runaway’ short film was perhaps the biggest statement of the rapper’s visual aesthetic).”

The rapper’s acknowledgement of a potential seizure problem has followed a strange path. In February 2011, accounts of seizures triggered by West’s “All of the Lights” video spurred UK-based Epilepsy Action to request that the video be removed from YouTube. In response, the video was temporarily removed and a warning was placed at the beginning:

This video has been identified by Epilepsy Action to potentially trigger seizures for people with photosensitive epilepsy. Viewer discretion is advised.

A year later the “N—-s in Paris” video was released with this same warning, although Epilepsy Action was never contacted about it.

And now there’s a warning at the beginning of the “Lost in the World” video that doesn’t even explain why the warning is important for viewers. All it says is:

Warning:  Strobe effects are used in this video.

I expect Epilepsy Action will probably make a statement regarding the risks of viewing this latest release, and perhaps take issue with the less-than-explicit warning that was provided. How about some advocacy in the US? It’s time to confront the very preventable public health problem created by strobe effects in entertainment media.

Seizure protection in a bottle!

Posted: 04/27/2012 | Author: | Filed under: Photosensitive Seizure Prevention, Protective Lenses | Tags: , , , , | 40 Comments

With this blue tint, opticians can apply effective photosensitive seizure protection to plastic lenses.

If your local optician can tint eyeglasses, it’s now possible to get protection from visually triggered seizures without ordering therapeutic Zeiss lenses. Lenses tinted using the new Deep Blue Zee lens tint are nearly the same color and appear to be just as effective as Zeiss Z1 F133 lenses.

Brain Power Inc. of Miami, and its UK arm, Brain Power Ltd. of Warwickshire, England, have introduced a cobalt blue optical tint that, according to the company, is nearly identical to the color-filtering specifications of the Z1 F133 lenses used in Capovilla’s photosensitivity studies. Brain Power, which supplies optical tints and laboratory equipment to opticians, optometrists, ophthalmologists, and lens manufacturers, developed the Deep Blue Zee tint specifically for photosensitivity protection. BPI describes itself as the world’s largest manufacturer of optical tints, chemicals, and instruments.

My daughter has been wearing a locally tinted pair for the past week and is finding them quite effective. She actually prefers them to the Zeiss because they aren’t quite as dark and therefore don’t darken her entire view as much. Because they’re not as dark, she is still able to see when watching DVDs from farther away from the screen.

The therapeutic properties of the Z1 F133 lens are due to its color and the way it blocks out shades of red. The amount of light a lens lets in across the color spectrum is measured by a spectrometer and shown in a spectrum curve (see graphs below), and each lens color has a unique spectrum curve. Capovilla and colleagues tried many colors and lens types before settling on the cobalt blue shade that lets in very little light in the red part of the spectrum. The big dip in this graph, excerpted from Capovilla’s 2006 study, shows that very little light is transmitted through the lens in the range of red wavelengths, measured in nanometers.

This is the Z1 spectrum curve from the Capovilla studies:

BPI set out to make a tint with the same light transmittance properties.  As the spectrum curve of Deep Blue Zee shows, it’s very close to the Z1 specifications in keeping out red wavelengths:

For the tint to be absorbed properly by the lens, the lens needs to be made of a particular plastic lens material, a plastic called C-39. If you have existing lenses you’d like tinted, they need to be made of CR-39 and can’t already have a hard coating that would prevent the lens from absorbing tint. BPI recommends that the lens be kept in the dye solution for at least 30 minutes to achieve the proper color. According to BPI, after half an hour of immersion in the dye, the absorption process goes more slowly.

As we’ve discovered in the past week, although the locally tinted ones weren’t as dark as the Zeiss lenses, it doesn’t seem to matter. If the lenses turn out not as dark as you’d like, your optician can make them darker by returning them to the dye solution for a little while. The price for tinted lenses will vary depending on the brand/quality of lens that your optician uses. And the quality and effectiveness may vary as well, depending on the optician’s skill, judgment, and choice of lens manufacturer.

The optician who tinted Alice’s blue lenses is:

Paul Dimos, owner

Eye Look Optical
1760 Massachusetts Ave
Lexington, MA 02420

email: eyelookoflexington@gmail.com
phone: 781-862-4510
fax: 781-674-0366

The same day we got the new clip-ons, I had the idea that Alice might be able to watch certain DVDs (no anime!) on a small screen without needing to take so many breaks. She is doing well watching DVDs on a portable 7-inch DVD player. She sits several feet away from it so that the screen doesn’t take up too much of her field of vision. If she sat very close, that would cancel out the advantage of a small image that by its size minimizes the impact of video on her brain.

We now have a spare pair of cobalt blue clip-ons, allowing us the opportunity to compare the two side by side. Can you tell which is which?

One pair from Zeiss and the other tinted by our optician.

Teaching about photosensitive and “regular” epilepsy together: 1+1=3

Posted: 04/17/2012 | Author: | Filed under: Health Consequences, Photosensitive Seizure Prevention, Political Action & Advocacy, Protective Lenses | Tags: , , , , , , , , | Leave a comment

Click image for 4/12/2012 editorial at epilepsy.com on including photosensitivity in epilepsy awareness campaigns.

The American epilepsy community makes information available on photosensitive seizures but in general doesn’t go out of its way to advocate for protecting consumers from visual media that can provoke seizures. Our epilepsy community doesn’t want to want to call too much attention to the risk of seizures from brightly flashing, visually overstimulating products and experiences. The priorities for public education and advocacy don’t include teaching the public about why video games contain those warnings.

But everybody wins–the “mainstream” epilepsy population, those with exclusively photosensitive seizures, and members of the public with a need to know–when epilepsy public education campaigns raise awareness of both types of epilepsy, in the context of the other.

Epilepsy doesn’t deserve its stigma and the notion that it’s an affliction exclusively of the seriously disabled. Raising awareness of epilepsy as a spectrum of seizure disorders that includes visually triggered seizures in otherwise healthy individuals could help engage the public and change misperceptions. And, much-needed photosensitivity education and advocacy can be most effectively delivered by established, well respected epilepsy organizations, as part of an overall public education program.

Here’s how I envision this:

  • Part of photosensitivity education is making people aware they could already be having visually induced seizures they have never identified. People who learn about subtle, undetected seizures experienced with or without a visual trigger can seek medical assessment and treatment. People with undetected photosensitive seizures might come to understand the source of  their unexplained symptoms during or shortly after being exposed to video games, TV, music videos, and other visual media.
  • Those with no history of seizures and no idea they might be photosensitive would realize they should be mindful of unusual sensations and actions while exposed to lots of flash and pattern motion. Parents would be more vigilant about observing their children who are engaged in screen-based activities, and about asking them about possible symptoms of subtle seizures.
  • Doctors would routinely inquire about patients’ exposure to visual media and about any unusual aftereffects, and they would recognize from patient histories when suspicion of photosensitivity is warranted.
  • People who learn they have photosensitive epilepsy would know how to protect themselves and their families from triggering stimuli–through avoidance, the use of dark glasses, and limiting problem images to a small portion of the viewing field.
  • The isolation and stigma endured by those with “regular” epilepsy will ease when people learn that seizures are a common disorder. The general public will understand that seizures are experienced by a broad spectrum of individuals, some who have other disabilities as well, and many who don’t. Some have seizures provoked by visual triggers, and others have seizures due to other, often unknown, triggers.
  • On the strength of the advocacy of  well-established epilepsy organizations, public health policy makers will become aware of the need for greater consumer protections, such as those in the UK, that require or encourage games, TV, online content, and movies to meet international guidelines for seizure-safe visual media. None of this is even under discussion in the US.

I’ve considered things from both the typical epilepsy and the exclusively-photosensitive-seizures perspectives. After discovering my daughter’s photosensitivity, we saw dramatic gains in her health and functioning after she gave up video games, her main visual trigger. But her wellness didn’t last and she went on to develop “regular” epilepsy. Daily life today is affected by unpredictable seizures and by the need to always be vigilant for visual triggers in the environment. I believe people with mainstream epilepsy–and the general public–have a tendency to assume that reflex seizures are simple to prevent and therefore the disorder is less burdensome than spontaneous seizures.

I wrote an editorial proposing that photosensitivity play a central role in a new type of awareness campaign about epilepsy. You can read “A Different Public Education Campaign” in this week’s epilepsy.com Spotlight newsletter, where I’m addressing the mainstream epilepsy community, and making the case for bringing photosensitivity under the epilepsy awareness umbrella, as it were.

Life with Zeiss Z1 F133 protective lenses

Posted: 03/11/2012 | Author: | Filed under: Health Consequences, Medical Research, Photosensitive Seizure Prevention, Protective Lenses | Tags: , , , , , , , | 37 Comments

The Zeiss F133 lenses are a deep cobalt blue. They filter out a lot of light, and block out the color red, the most seizure-provoking color.

I promised to share information about my daughter’s experience with the blue Zeiss Z1 F133 lenses that I’ve written about previously. In the past we got prescription glasses made with these lenses. But her prescription has changed every year and that meant ordering them all over again. So this last time we got her a new pair, we went with clip-ons. Here’s what I can tell you:

They absolutely do prevent seizures while Alice watches TV! They also prevent the seizures that happen when she reads uninterrupted for very long periods. And they’re handy for unexpected events out in the community—emergency lights, flash photography, and flickering fluorescent bulbs.

  • Alice can feel that her eyes are under less stress as soon as she puts the glasses on. I guess it’s similar to feeling less uncomfortable when putting on regular sunglasses in bright sunlight.
  • No hard data, but we suspect that even with the lenses, there is still some effect on her brain that sneaks through. We can’t say for sure, but we have a hunch that she has more unprovoked seizures in the day or days after watching TV. So we currently limit TV to a couple of half-hour sessions per day.
  • I can’t report on the lenses’ effectiveness for preventing seizures from video games because we aren’t going there. Alice cannot be around video games, period, because she very quickly becomes intensely addicted. If left unsupervised with a computer, she will find a game site. If left alone to play video games with blue glasses on, she invariably removes the glasses when no one is around. There is something about that pre-seizure trance that her brain finds irresistible, even though her mind knows she’ll regret bringing on a seizure.
  • The world looks kind of eerie all in the dim blue light that gets through the lenses. You can’t really discern color very well except for yellow, blue, and green.
  • As expected, clip-ons are hard to keep track of when they’re not attached. (This is especially true for people with the attention and memory issues that often are associated with seizures).  I just ordered another pair!
  • If you get prescription glasses made from the Zeiss lenses, you’ll be switching off with your non-tinted regular prescription glasses–one pair on top of your head or hanging around your neck or at large and at risk of getting lost.

About the lenses

Z1 is the name of a filtering lens, made by Zeiss in Germany, that blocks out 80 percent of light. (I’ve previously said they are cross-polarized, which is incorrect.) These are the lenses used in the Capovilla studies. F133 refers to the particular shade of blue that was found in clinical tests to be most effective for photosensitive patients. Zeiss does the tinting. It’s a lens that was already commercially available in Italy, where the study was done. Researchers have looked at some other lenses as well, and I hope to learn more about those and pass along what I find out. Given how effective the Zeiss lenses are, though, there hasn’t been a lot of other investigation.

Like everything else having to do with seizures, what works for one person may not help another. Before investing in these you might want to just try polarized sunglasses to see how helpful those are. For some people that may be good enough protection.

How to obtain/order F133 lenses ***

In the past we were able to order them via Canada, but last year our optician said the Canadian supplier he was using couldn’t provide these lenses anymore. Through this blog I became aware of Antonio Bernabei, an optician in Rome who sells these. Contact him via email at info@otticabernabei.com. He responds quickly, and his email English is quite good. You can order these lenses from him in any of several ways:

If you don’t wear prescription glasses, order blank F133 lenses and pick out a pair of eyeglass frames from an optician who will fit them for you. The optician can cut and insert the non-prescription F133 lenses when they arrive.

Cost for blank F133 lenses (like the two round lenses above):

  • Plain lenses, for clip-ons: 99 Euros (as of this writing, approx. $130) plus shipping and insurance.
  • Fee to cut blank lenses to fit into (most) sunglasses frames that you send: 20 Euros (as of this writing, approx. $26).

If you wear prescription eyeglasses and want a pair of prescription glasses made with the Zeiss lenses:

Send Antonio your eye doctor’s prescription and a pair of frames. Antonio will make tinted prescription glasses for you. Wear them as needed as you would wear any prescription sunglasses.

OR

Send him your prescription and provide the designer name, color, and model number of a pair of frames you’ve chosen from your optician, and purchase the frames and lenses together from Antonio. He’ll send the assembled glasses, and this way you don’t need to ship him the frames first.

Cost:  Varies according to the prescription, whether you need bifocals, etc.

If you  want to wear the Zeiss lenses as a clip-on for your prescription glasses:

These clip-ons attach magnetically to your eyeglasses at the top. Tiny screws visible on the lower half of the frame allow standard shades to be replaced with the Zeiss lens.

Order blank F133 lenses that your local optician can insert into a clip-on frame that attaches magnetically or hooks on to to your prescription glasses. Note that because Z1 F133 lenses are 2mm thick, most clip-on sunglasses frames cannot accommodate them. Typical custom clip-ons that match your eyeglass frame are made with a thin plastic lens that can’t be replaced without breaking either the lens or the frame. Ask your optician about clip-ons that have a tiny screw that allows the Zeiss lens to be inserted. We ended up buying an EasyTwist frame for the prescription glasses, which comes with a matching magnetic clip-on like the dark green one shown above.

Cost: see costs for non-prescription, blank lenses above

Antonio Bernabei
Ottica Bernabei
Via Del Corso, 4
Rome
Italy
Phone:  +39 06.3610190
www.otticabernabei.it 
 
info@otticabernabei.com

Our optician replaced the standard green shade with the F133. The next time Alice needs new prescription lenses, we can still use the same clip-ons.

Please send in comments to share your experience! I’ve learned a lot from some of you (especially L.H.) who also have been tracking these down. Have you been able to order the lenses from an optician closer to where you live? How well do the lenses work?

Additional sources

There are 2 sources I’ve recently heard about in North America. I believe they both have contacts with Canadian Zeiss representatives. Both optometrists can order the lenses and mail them to you.

Richard L. Silver, O.D.
Professional VisionCare Associates
14607 Ventura Blvd.
Sherman Oaks, CA, USA 91403
Office: (818) 789-3311
Fax: (818) 789-1047

drsilver@provisioncare.com

Dr. Silver charges $400 for a pair of lenses, either blank or corrective. Thanks to L.L. for locating him and sharing contact information

Norm Johnson, manager
Optometrists’ Clinic Inc.
12318 Jasper Ave.
Edmonton, Alberta
Canada T5N 3K5
Phone: 800-661-9976

njohnson@optometristsclinic.com

The clinic provides the lenses for $250 (March 2012 price). You can order them as uncut lenses or, with a prescription and frame (or frame information), make up a pair of prescription glasses. In December 2013 Larra H. reports that you can also order them in a fit-over, standalone frame that covers the field of view more thoroughly. Cost for the Zeiss lenses has apparently dropped, so the plain Zeiss lenses in a fit-over frame is now down to $165. 

*** January 7, 2020–A reader alerted me to the effectiveness of MigraLens glasses that are designed/marketed to prevent migraine. Because migraine and epilepsy are related conditions, this makes sense. The flash and glare that provoke photosensitive seizures can also provoke migraine. According to the MigraLens site, migraine can be triggered by red or blue light. One online customer review of these glasses said they were not helpful for computer/video games. 

*** May 5, 2012–After posting this, I found out about another way to get blue lenses that work just fine. You can work with your local optician and a blue tint they can use. See https://videogameseizures.wordpress.com/2012/04/27/seizure-protection-in-a-bottle/

Block flashing and animation in your browser

Posted: 02/11/2012 | Author: | Filed under: Photosensitive Seizure Prevention | Tags: , , , , , , , | 5 Comments

Solar flare photographed by NASA January 22, 2012

If the flashing images in video games have given you seizures, chances are that other on-screen viewing experiences are potential seizure triggers, too. By making some adjustments to your monitor and browser, you can limit the visual stimulation delivered by computer images.

This list is hardly comprehensive, but it includes some basic approaches to protection against unwanted flashing and animation in the Windows environment. Please contribute additional suggestions!

Monitor adjustments

You can lower the brightness settings on your monitor to reduce contrast and effects of flash. This setting is different on each device/monitor—on my Dell laptop, to lower the screen brightness I hold down the Function key while pressing the up arrow on my keypad.

Desktop and color scheme

In Windows, go to the Settings menu, Control panel > Display.

  • Don’t select one of those constantly moving designs as a screensaver
  • Choose default or low-contrast color schemes

Block unwanted Flash videos

Firefox: Download the extension Flash Block at https://addons.mozilla.org/en-US/firefox/addon/flashblock/?src=search

Flash Block prevents automatic display of moving sequences that are powered by Macromedia Flash or Shockwave. When you load a page containing these images, a placeholder appears on the screen in the spot where the image would be displayed. To view a blocked image, just click on the placeholder.

Internet Explorer 8: instructions on how to disable Flash video graphics:

http://www.winhelponline.com/blog/disable-flash-all-but-whitelist-sites-ie8/ or

http://www.neowin.net/forum/topic/754934-ie8-has-its-built-in-flash-block-its-called-per-site-activex-control/

Internet Explorer 7: http://downloadsquad.switched.com/2008/04/07/toggle-flash-add-on-to-disable-flash-in-ie-7/

Chrome:  Click on the wrench icon for customizing Chrome. Select Options > Under the Hood > Content Settings > Plug-ins. Choose Disable individual plug-ins and select Flash.

Block ads

Unclutter the page, reduce intrusive distractions, and avoid the attention-seeking graphics in advertisements. Read about the options for preventing the display of ads on your screen:

Firefox: http://www.ehow.com/info_12146801_there-adblock-addon-ie8.html

Internet Explorer: http://www.ehow.com/info_12146801_there-adblock-addon-ie8.html

Chrome:  http://www.ehow.com/info_12059584_adblock-vs-adblock-plus-chrome.html

For more detailed directions on blocking ads, see http://dottech.org/tipsntricks/17516/

Stop animated images from moving, as needed for individual screens

Unless you disable them, animations that blink or automatically cycle through images will stay animated for as long as you stay on any page. To prevent graphics from animating in your web browser window, once the web page has stopped loading and the images start to animate, just hit the ESC key on your keyboard.

That will immediately disable all the GIF animations on that webpage. In order to replay the animated images, reload the page by pressing F5 or Ctrl+R. This feature is already available in most browsers, but not in Google Chrome.

To activate the ESC key option for blocking animation in Chrome, download a browser extension at http://userscripts.org/scripts/show/80588

Prevent animated images from moving, automatically for all screens

Firefox: Download  AniDisable extension. See

https://addons.mozilla.org/en-US/firefox/addon/anidisablehacked/

Internet Explorer:  Tools > Internet Options > Advanced. Uncheck the box in the Multimedia list that says “Play animations in web pages”

Chrome:  This option is not currently available.

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