Gamified virtual reality training and ocular vergence: evidence from a randomized controlled study with rehabilitation perspectives
DOI:
https://doi.org/10.47197/retos.v77.117780Keywords:
Gamification, ocular vergence, randomized controlled trial, rehabilitation, virtual realityAbstract
Background: Alterations in ocular vergence are linked to balance and visual coordination; few studies have examined the role of gamified virtual reality (VR) in modulating these functions in healthy adults.
Objective: To assess the effects of a VR-based game on ocular vergence through a randomized controlled trial and explore its potential for rehabilitation.
Methods: 32 university students were randomly assigned to an intervention group (24 sessions of VR training) or a control group. Near Point of Convergence (NPC) and Near Point of Break (NPB) were measured at baseline, after one session, and after 12 weeks. Finally, 27 participants completed the protocol and were included in the final analysis
Results: Participants in the program saw noticeable improvements quickly, with their NPC distance decreasing by about 1.01 cm early on (p=0.001). At the same time, their NPB distance also improved, decreasing by around 1.29 cm (p=0.002). After 12 weeks, these changes became even more noticeable, with NPC decreasing by 1.92 cm (p=0.014) and NPB dropping by about 1.86 cm (p=0.040). The study also found strong links between NPC and NPB measurements, with correlation coefficients over 0.6. Interestingly, it showed differences in how men and women responded to the program.
Conclusions: Playing engaging VR training games can help improve eye coordination in the short and medium term. This promising early evidence suggests that they could be useful additions to rehabilitation or performance routines. Bigger studies are needed to back up these findings and to understand what factors might influence how well they work.
References
Alahmari, K. A., Sparto, P. J., Marchetti, G. F., Redfern, M. S., Furman, J. M., & Whitney, S. L. (2014). Com-parison of virtual reality based therapy with customized vestibular physical therapy for the treatment of vestibular disorders. IEEE Transactions on Neural Systems and Rehabilitation Engineering: A Publication of the IEEE Engineering in Medicine and Biology Society, 22(2), 389-399. https://doi.org/10.1109/TNSRE.2013.2294904
Aoyagi, K., Wen, W., An, Q., Hamasaki, S., Yamakawa, H., Tamura, Y., Yamashita, A., & Asama, H. (2019). Improvement of Sense of Agency During Upper-Limb Movement for Motor Rehabilitation Us-ing Virtual Reality. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Con-ference, 2019, 118-121. https://doi.org/10.1109/EMBC.2019.8856796
Aramaki, A. L., Sampaio, R. F., Reis, A. C. S., Cavalcanti, A., & Dutra, F. C. M. S. E. (2019). Virtual reality in the rehabilitation of patients with stroke: An integrative review. Archivos De Neuro-Psiquiatria, 77(4), 268-278. https://doi.org/10.1590/0004-282X20190025
Campo-Prieto, P., Cancela-Carral, J. M., Tejerina Peña, S. M., & Rodríguez-Fuentes, G. (2025). Una expe-riencia de ejercicio terapéutico gamificado en un paciente con síndrome Wernicke- Korsakoff . Retos, 72, 117-127. https://doi.org/10.47197/retos.v72.116820
Chan, H. S., Tang, Y. M., Do, C. W., Ho Yin Wong, H., Chan, L. Y., & To, S. (2023). Design and assessment of amblyopia, strabismus, and myopia treatment and vision training using virtual reality. Digital Health, 9, 20552076231176638. https://doi.org/10.1177/20552076231176638
Chen, J., Or, C. K., & Chen, T. (2022). Effectiveness of Using Virtual Reality-Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Me-ta-analysis of Randomized Controlled Trials. Journal of Medical Internet Research, 24(6), e24111. https://doi.org/10.2196/24111
Cornwell, B. R., Overstreet, C., Krimsky, M., & Grillon, C. (2013). Passive avoidance is linked to impaired fear extinction in humans. Learning & Memory, 20(3), 164-169. https://doi.org/10.1101/lm.028902.112
Damasceno da Rocha, Y., Virgínia Viana Cardoso, K., & Ferracioli Gama, M. D. C. (2025). El volumen de práctica en la realidad virtual sobre el rendimiento motor de niños con parálisis cere-bral. Retos, 70, 1-10. https://doi.org/10.47197/retos.v70.113511
de Amorim, J. S. C., Leite, R. C., Brizola, R., & Yonamine, C. Y. (2018). Virtual reality therapy for rehabili-tation of balance in the elderly: A systematic review and META-analysis. Advances in Rheuma-tology (London, England), 58(1), 18. https://doi.org/10.1186/s42358-018-0013-0
Erhardsson, M., Alt Murphy, M., & Sunnerhagen, K. S. (2020). Commercial head-mounted display virtual reality for upper extremity rehabilitation in chronic stroke: A single-case design study. Journal of Neuroengineering and Rehabilitation, 17(1), 154. https://doi.org/10.1186/s12984-020-00788-x
Ha, S.-G., Na, K.-H., Kweon, I.-J., Suh, Y.-W., & Kim, S.-H. (2016). Effects of Head-Mounted Display on the Oculomotor System and Refractive Error in Normal Adolescents. Journal of Pediatric Ophthal-mology and Strabismus, 53(4), 238-245. https://doi.org/10.3928/01913913-20160511-01
Hagströmer, M., Oja, P., & Sjöström, M. (2006). The International Physical Activity Questionnaire (IPAQ): A study of concurrent and construct validity. Public Health Nutrition, 9(6), 755-762. https://doi.org/10.1079/phn2005898
Lai, B., Davis, D., Narasaki-Jara, M., Hopson, B., Powell, D., Gowey, M., Rocque, B. G., & Rimmer, J. H. (2020). Feasibility of a Commercially Available Virtual Reality System to Achieve Exercise Guidelines in Youth With Spina Bifida: Mixed Methods Case Study. JMIR Serious Games, 8(3), e20667. https://doi.org/10.2196/20667
Lin, R.-C., Chiang, S.-L., Heitkemper, M. M., Weng, S.-M., Lin, C.-F., Yang, F.-C., & Lin, C.-H. (2020). Effec-tiveness of Early Rehabilitation Combined With Virtual Reality Training on Muscle Strength, Mood State, and Functional Status in Patients With Acute Stroke: A Randomized Controlled Tri-al. Worldviews on Evidence-Based Nursing, 17(2), 158-167. https://doi.org/10.1111/wvn.12429
Mangone, M., Agostini, F., de Sire, A., Cacchio, A., Chiaramonte, A., Butterini, G., Martano, A., Paoloni, M., Bernetti, A., & Paolucci, T. (2022). Effect of virtual reality rehabilitation on functional outcomes for return-to-work patients with Parkinson’s disease: An umbrella review of systematic re-views. NeuroRehabilitation, 51(2), 201-211. https://doi.org/10.3233/NRE-220029
Maranesi, E., Casoni, E., Baldoni, R., Barboni, I., Rinaldi, N., Tramontana, B., Amabili, G., Benadduci, M., Barbarossa, F., Luzi, R., Di Donna, V., Scendoni, P., Pelliccioni, G., Lattanzio, F., Riccardi, G. R., & Bevilacqua, R. (2022). The Effect of Non-Immersive Virtual Reality Exergames versus Tradi-tional Physiotherapy in Parkinson’s Disease Older Patients: Preliminary Results from a Ran-domized-Controlled Trial. International Journal of Environmental Research and Public Health, 19(22), 14818. https://doi.org/10.3390/ijerph192214818
Mestre, C., Bedell, H. E., Díaz-Doutón, F., Pujol, J., & Gautier, J. (2021). Characteristics of saccades during the near point of convergence test. Vision Research, 187, 27-40. https://doi.org/10.1016/j.visres.2021.06.001
Micarelli, A., Viziano, A., Micarelli, B., Augimeri, I., & Alessandrini, M. (2019). Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display. Archives of Gerontology and Geriatrics, 83, 246-256. https://doi.org/10.1016/j.archger.2019.05.008
Minoonejad, H., Barati, A. H., Naderifar, H., Heidari, B., Kazemi, A. S., & Lashay, A. (2019). Effect of four weeks of ocular-motor exercises on dynamic visual acuity and stability limit of female basket-ball players. Gait & Posture, 73, 286-290. https://doi.org/10.1016/j.gaitpost.2019.06.022
Molina Heredia, M. N., Cepero González, M. de M., & Rojas Ruiz, F. J. (2025). Diseño e implementación para mejorar la Actividad Física Escolar con gamificación y pulseras digitales en niños de 11-13 años. Retos, 69, 580-601. https://doi.org/10.47197/retos.v69.114002
MPT, V. K., Amarnath, R., Nusarath jaha, G., Katiyar, P., Rangaswamy, R., & Sinha, A. (2025). Evaluación de la eficacia de los programas de rehabilitación basados en realidad virtual para la recupera-ción de deportistas adolescentes tras lesiones: un estudio de métodos mixtos . Retos, 65, 1184-1192. https://doi.org/10.47197/retos.v65.111674
Nesaratnam, N., Thomas, P., & Vivian, A. (2017). Stepping into the virtual unknown: Feasibility study of a virtual reality-based test of ocular misalignment. Eye (London, England), 31(10), 1503-1506. https://doi.org/10.1038/eye.2017.97
Pétursdóttir, D., Holmström, G., & Larsson, E. (2022). Strabismus, stereoacuity, accommodation and convergence in young adults born premature and screened for retinopathy of prematurity. Acta Ophthalmologica, 100(3), e791-e797. https://doi.org/10.1111/aos.14987
Prasertsakul, T., Kaimuk, P., Chinjenpradit, W., Limroongreungrat, W., & Charoensuk, W. (2018). The effect of virtual reality-based balance training on motor learning and postural control in healthy adults: A randomized preliminary study. BioMedical Engineering OnLine, 17(1), 124. https://doi.org/10.1186/s12938-018-0550-0
Qu, J., Cui, L., Guo, W., Ren, X., & Bu, L. (2022). The Effects of a Virtual Reality Rehabilitation Task on Elderly Subjects: An Experimental Study Using Multimodal Data. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 30, 1684-1692. IEEE Transactions on Neural Systems and Rehabilitation Engineering. https://doi.org/10.1109/TNSRE.2022.3183686
Ramírez-Moran, L. P., Zapa-Cedeño, J. K., Hidalgo Arce, C. J., Suárez-Lima, G. J., & Gutiérrez Cruz, M. (2025). Realidad virtual y supervisión profesional: efectos en la movilidad articular y el equili-brio de adultos mayores masculinos. Retos, 70, 575-587. https://doi.org/10.47197/retos.v70.114437
Rutkowski, S., Adamczyk, M., Pastuła, A., Gos, E., Luque-Moreno, C., & Rutkowska, A. (2021). Training Using a Commercial Immersive Virtual Reality System on Hand-Eye Coordination and Reaction Time in Young Musicians: A Pilot Study. International Journal of Environmental Research and Public Health, 18(3), 1297. https://doi.org/10.3390/ijerph18031297
Sano, Y., Wake, N., Ichinose, A., Osumi, M., Oya, R., Sumitani, M., Kumagaya, S.-I., & Kuniyoshi, Y. (2016). Tactile feedback for relief of deafferentation pain using virtual reality system: A pilot study. Journal of Neuroengineering and Rehabilitation, 13(1), 61. https://doi.org/10.1186/s12984-016-0161-6
Seo, N. J., Arun Kumar, J., Hur, P., Crocher, V., Motawar, B., & Lakshminarayanan, K. (2016). Usability evaluation of low-cost virtual reality hand and arm rehabilitation games. Journal of Rehabilita-tion Research and Development, 53(3), 321-334. https://pmc.ncbi.nlm.nih.gov/articles/PMC6710625/
Szpak, A., Michalski, S. C., & Loetscher, T. (2020). Exergaming With Beat Saber: An Investigation of Vir-tual Reality Aftereffects. Journal of Medical Internet Research, 22(10), e19840. https://doi.org/10.2196/19840
Truijen, S., Abdullahi, A., Bijsterbosch, D., van Zoest, E., Conijn, M., Wang, Y., Struyf, N., & Saeys, W. (2022). Effect of home-based virtual reality training and telerehabilitation on balance in indi-viduals with Parkinson disease, multiple sclerosis, and stroke: A systematic review and meta-analysis. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 43(5), 2995-3006. https://doi.org/10.1007/s10072-021-05855-2
Yaman, F., Akdeniz Leblebicier, M., Okur, İ., İmal Kızılkaya, M., & Kavuncu, V. (2022). Is virtual reality training superior to conventional treatment in improving lower extremity motor function in chronic hemiplegic patients? Turkish Journal of Physical Medicine and Rehabilitation, 68(3), 391-398. https://doi.org/10.5606/tftrd.2022.9081
Yang, H. K., Kim, D. H., Kim, J. H., Whangbo, T. K., & Hwang, J.-M. (2025). Virtual reality head-mounted display game for intermittent exotropia in a randomized controlled trial. Scientific Reports, 15(1), 4317. https://doi.org/10.1038/s41598-024-78088-w
Zhang, H., Yang, S.-H., Chen, T., Kang, M.-X., Liu, D.-Y., Wang, D., Hao, J., Wang, M., Yang, Z., Han, X., & Su, H. (2023). The effect of virtual reality technology in children after surgery for concomitant strabismus. Indian Journal of Ophthalmology, 71(2), 625-630. https://doi.org/10.4103/ijo.IJO_1505_22
Zhou, Z.-Q., Hua, X.-Y., Wu, J.-J., Xu, J.-J., Ren, M., Shan, C.-L., & Xu, J.-G. (2022). Combined robot motor assistance with neural circuit-based virtual reality (NeuCir-VR) lower extremity rehabilitation training in patients after stroke: A study protocol for a single-centre randomised controlled tri-al. BMJ Open, 12(12), e064926. https://doi.org/10.1136/bmjopen-2022-064926
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Sergio Gómez Doctor, Manuel Garcia San Emeterio, Jordi Esquirol Caussa

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.