Contents lists available at ScienceDirect Entertainment Computing journal homepage: www.elsevier.com/locate/entcom Game accessibility guidelines for people with sequelae from macular chorioretinitis Amanda F. Pereira ⁎ , Jonathan Silva, Henrique Hideki, Miguel Rodrigues, Luiza Souza, Michel Martins, Ismael S. SilvaMichel, Glívia A.R. Barbosa, Flávio R.S. Coutinho ⁎ Departamento de Computação, Centro Federal de Educação Tecnológica de Minas Gerais, Brazil ARTICLE INFO Keywords: Game accessibility Macular chorioretinitis Visual impairment Low vision Central vision loss 2010 MSC: 00-01 99-00 ABSTRACT Macular chorioretinitis is an ocular inflammation that may cause the permanent loss of the central vision. Researches indicate that the formation of macular scars, the potential sequela of that inflammation, is the leading cause of low vision in children. As we found no game accessibility guidelines in the literature that were specific to users with central vision loss in a preliminary review, this study thus aimed at surveying guidelines targeted at players with low vision. They were extracted through a systematic literature review conducted on digital libraries. There were some known guidelines that were not in the results of the systematic literature review and therefore we made a manual selection of other relevant sources. We also proposed a new guideline related to the sharpness of images because it was deemed important to improve game accessibility to the public concerned and it had not been presented in the literature. In total, we identified 25 general game accessibility guidelines for people with low vision, plus the one we proposed, and 20 of them were considered applicable to people with macular scars. Afterwards, based on classifications available in the literature and on the experience of the authors as developers, we assessed the feasibility of each guideline according to their impact, reach and an estimation of their implementation cost. The survey also confirmed that no guideline existed that was specific to players with central vision loss. In order to evaluate the new guideline and one of those identified in the lit- erature from the player perspective, we developed a game prototype which implemented both. A qualitative analysis conducted with the game prototype indicated that the evaluated guidelines are applicable to the public concerned. We expect the results of this research to serve as a step towards determining how to make games more accessible to players with sequelae from macular chorioretinitis. 1. Introduction Macular chorioretinitis is an inflammation in the eye [1] that can lead to permanent loss of the central vision [2]. People who do lose their central vision go through several limitations on daily activities, such as a difficulty in recognizing faces not so frequently seen, the need to approach others closer to identify facial expressions and a higher propensity to visual fatigue while reading [2]. There are different causes to macular chorioretinitis, but the most common one is the congenital toxoplasmosis [3], a disease resulting from the infection from a protozoan, transmitted through the ingestion of contaminated food and that can be acquired during gestation, from mother to fetus. A possible sequela is the formation of scars is the eyes’ macula (i.e., an anatomic structure situated in the central region of the retina [4] that is responsible for the vision of details and the perception of colors [5]). The formation of macular scars leads to the permanent central vision loss. Proper treatment with antibiotics when conducted during a child’s first year of life can significantly decrease the damage caused by congenital toxoplasmosis [6], but that depends on the timely diagnosis of the disease, as early as the first days of life [7]. Similarly to other visual impairments, the macular scar caused by chorioretinitis impacts heavily on the gaming experience, as in the case of games not made accessible, players are presented with barriers im- posed by the developers and need to adapt to overcome the artificial conditions that have been implemented. The peculiarity of the presence of macular scars is that players cannot use the central vision [2], which frequently prevents them from having a good gaming experience. Accessibility is a concept that defines the participation of people with some disability in diverse activities [8], and the same notion ap- plies to digital games, such that game accessibility defines that in- dividuals with some impairment have the option of having a satisfac- tory gaming experience independently of their conditions. https://doi.org/10.1016/j.entcom.2018.09.001 Received 28 February 2018; Received in revised form 30 August 2018; Accepted 27 September 2018 ⁎ Corresponding authors. E-mail address: fegemo@cefetmg.br (F.R.S. Coutinho). Entertainment Computing 28 (2018) 49–58 Available online 28 September 2018 1875-9521/ © 2018 Elsevier B.V. All rights reserved. T