Hello everyone, and welcome to another episode of Access-Ability, it’s a show on Youtube where I, LauraKBuzz, talk about the video game industry, accessibility, and representation. Basically, how can we help more people to play games, and more people to see themselves in the games they play?

When it comes to Epilepsy and video games, most of you watching will probably have a certain idea in mind of the problem and its cause. It seems simple right? People with Epilepsy have seizures if you show them flashing lights. If a game turns off any scenes where it repeatedly flashes back and forth between two colours, problem fixed right?

Well, no. It’s actually a lot more complicated than that. There’s a lot of myths and misunderstandings in the gaming community around what Epilepsy is, what the potential triggers are for the condition, and what steps can be taken to work towards increased safety for players with the condition.

So, today we’re going to spend some time talking about what Epilepsy actually is, how we can make games safer for those with the condition, and why you should never put an “Epilepsy Safe” setting in your options menu.

So, before we get started, I want to give a special shout out to Indie Gamer Chick on Twitter, a gamer with epilepsy who took some time to help educate me on epilepsy as a condition before I started to tackle this video. She definitely helped me to dispel some of my own misunderstandings, so you should definitely give her a follow @IndieGamerChick on Twitter.

So, what actually is Epilepsy? Well, it is a condition where a person is prone to having seizures, which can manifest in a couple of ways. While you might picture someone having a seizure moving around erratically and falling to the floor, seizures can take other forms, some of which are much less pronounced to the outside world. A seizure might for example see someone walking around with a vacant stare, confused and unable to process their surroundings.

To be diagnosed with Epilepsy, a person generally needs to have had repeated seizures, a one off seizure may not be a sign of epilepsy. Additionally, epilepsy is a rare condition that can have either genetic or environmental causes. Some people are born with epilepsy, while some people develop it later in life after a head injury. Some people have epilepsy as a child, but eventually stop having seizures as they grow older.

However, one important thing to know about Epilepsy up front is that most people with epilepsy don’t have the kind where their seizures are triggered by flashing lights, the kind you may default to thinking about. While one 1% of the general population has some form of Epilepsy, only 3% of those people have photosensitive epilepsy. For the other 97%, other triggers are involved in their seizures.

The kinds of triggers involved in epilepsy are wildly varied, and not easily summed up. For some players it might be triggered by eye strain. For some it may be caused by gaming while tired. For some the trigger may be stress. For some, the trigger may be loud or intensely changing sounds. For some, the trigger may be over exertion and too much exercise. While it’s easy to picture epilepsy only impacting games with flashing lights, a motion controlled game that pushes you to move around intensely could just as easily be a trigger for someone’s seizure.

However, as photosensitive epilepsy is in many cases the type of epilepsy that developers have the highest ability to develop fixes for in their games, that’s the one we’re going to focus on for now.

So, another myth that frequently pops up around epilepsy is that only people who have photosensitive seizures are at all photosensitive. That is simply not the case. Everyone in the world has some degree of photosensitivity. If you were subjected to a strong enough strobing effect, for a long enough period of time, your brain would start to struggle with the sensory input. For people with photosensitive epilepsy, the threshold for what will cause issues is simply lower than the general population. It’s all on a curve. I might get a headache if I look at a strobing light for too long, whereas someone else may have a stronger reaction to a shorter burst of that same stimuli.

Additionally, even within those who have photosensitive epilepsy, the triggers can vary wildly as to what sets off triggers. Around 40% of those impacted are set off by screen wide white strobes, or screens where so many smaller effects are happening that it almost becomes full screen strobes, but photosensitive triggers can vary in numerous and unpredictable ways. Anything from the speed at which colours change, to the colours being changed between, to a player’s distance from the TV at the time of a bright flash can potentially play into seizures being triggered. For some it’s moving patterns. For some it’s gradually shifting colours. There’s too many specific triggers to ever hope to explain them all.

The reason I bring all this up is I want to make something really clear to future game developers who want to make games safer for players with epilepsy. There are certainly things you can do to make games safer. You can have settings that tone down visual effects, turn off strobe effect scenes, reduce the amount of flashing when an attack connects or when points are scored. But, you need to be really careful not to label those settings as an “epilepsy safe mode”.

Why? Well, because as said earlier in this video, there are so many varied triggers for epileptic seizures, even just focusing on photosensitivity, that there is basically no way to know for certain you have made your game 100% perfectly safe for every photosensitive gamer with epilepsy. You can do things you know will help a lot, reducing full screen strobe effects, shifting colours, and moving patterns will make your game safer for around 55% of Photosensitive epileptic gamers, but you’re never going to make a game you can promise players is 100% safe. That’s not a guarantee you are in a position to make as a developer.

So, what should you call a mode that aims to help photosensitive gamers? Well, Indie Gamer Chick advocates for the term “Effects Intensity”. It describes what most games are likely to be actually changing, without making any promises about the end result. Gaming will always be a risk for gamers with photosentive epilepsy, but knowing they can turn down the intensity of visual effects can let them know the game might be on the safer end of their options. Even better, explain to players exactly what kinds of visual effects you are reducing, and what is now in their place, if possible. Give players information on exactly what was there, and what replaced it.

Additionally, Indie Gamer Chick recommends that developers who do put these kinds of modes into games should put a warning with them, warning players to consult their doctors still before playing any games. Don’t assume a game is safe just because it has attempted to reduce triggers. Don’t let the presence of these settings imply that a game is guaranteed totally safe.

It would be great to see more developers make the effort to put options modes in games to reduce the most common photosensitive epilepsy triggers in games, even if they need to be careful not to over promise their level of medically approved safety.

Photosensitive epilepsy may impact a fairly small percentage of the global population, but that small percentage is still a lot of gamers worldwide, and the more we can do to increase the odds games are safe for them, the better. However, if developers need to be sold more on the value of visual intensity removal settings, bear in mind they have a positive impact for a much wider percentage of gamers than just those who get seizures. A lot of people worldwide get headaches, nausea, dizziness, and other unpleasant side effects when exposed to photosensitive triggers. Allowing players to dial back the intensity of those settings can reduce discomfort for a wide number of players, as well as helping players have a lower risk of potential seizures.

We need to improve support for epileptic gamers, but we need to be really careful how we label those settings.