Amblyopia is a childhood condition where the vision does not develop properly. It’s known as Lazy eye.
If something affects one of the images the eye shows the brain as the brain develops, the signals become disrupted.
The brain starts to ignore the poor-quality images, resulting in an “amblyopia”.
Several eyesight problems that disrupt the development of vision and can cause lazy eye.
A lazy eye ideally needs to be diagnosed and treated as early as possible, preferably before a child is 6 years old.
However, it can oft
en be difficult to know whether a child has a lazy eye as they might not realise anything is wrong with their vision. This means a lazy eye may not be diagnosed until a child has their first eye test. In the UK routine eye tests often diagnose amblyopia before parents realize the child’s problem.
The younger the child is when a lazy eye is diagnosed, the more successful treatment is likely to be.
The 2 main treatment options for a lazy eye are:
•Treating or correcting any underlying eye problems for example, Glasses.
•Encouraging the use of the affected eye so vision can develop properly for example, eye patch, atropine eyedrops
The reason why people need to know about Amblyopia is it affects the vision of children and can have long-term effects on their health and quality of life if left untreated.
Data to the World Health Organization (WHO) 80% of the total health burden is visually impaired. An estimated 45 million people around the world are blind and most of them have lost their sight to diseases that are treatable or preventable.
Despite this, results from much research showed a lack of amblyopia awareness in several countries. This lack of awareness can lead to visual impairment among children.
One of the strategies to address visual impairment is through health promotion. For children, the efficient way of intervention is through parents and their school environment. Thus, addressing childhood blindness effectively requires educating parents and health care providers.
Studies on the education of parents of children with amblyopia show a positive result. Parents’ compliance improved with occlusion therapy by providing parents with written information. Their attitudes toward amblyopia also changed in a better way.
Objective
The target audience of the project is the patient’s caregiver for learning amblyopia.
These aims were accomplished by creating a Physical booklet, a PDF format booklet along with supplemental illustrations, educational animation and interactive 3D model.
Process
Booklet
Pre-Production
Brainstorming and set of objectives
Right after the brief was received from Dr Obaid, the author sent him PowerPoint slides of the booklet idea. At a second meeting, the overall design and contents of the booklet were discussed. He wanted the PDF form of a booklet because it is easy to share with the patient’s guardians. He helped the author to understand the function of the optic nerve and the causes of amblyopia such as long-sightedness, strabismus, child cataract and so on.
Observation of pre-existing booklets
To get a better understanding of current resources ophthalmology booklets from Ninewells hospital were examined. This provided reference material and showed factors that could be improved from which concepts and contents were made. Based on that the booklets were estimated and divided into maintainable factors that the author can reference for the project and some factors that can improve.
Contents design
It was decided to reference NHS Health A to Z (NHS, 2022f). NHS Health A to Z is the webpage for helping people take control of their health and wellbeing. The webpage serves complete guidance on conditions, symptoms and treatments, including what to do and when to get help. The webpage that shows the information on amblyopia is well organized and easy to understand.
While researching amblyopia, it became clear the target audiences need to know the function of optic nerve-related disease to help to understand. However, this part would be much easier to convey in an animation.
First, the contents of the booklet need to focus on the information that is directly related to amblyopia. Knowing the basic anatomical structure of the brain with optic nerve and how visual information reaches the primary visual cortex could be helpful to understand amblyopia. However, too much broad information would disturb readers. Therefore, it was decided to put those contents in a separate place for helping readers to focus on information about amblyopia in the booklet and still provide them with the information that might be useful.
Second, the shape of the optic nerve especially, optic chiasm and lateral geniculate body might be quite hard to understand in two-dimensional illustration, if the audience did not know anatomy. According to a study by A. Haque et al (Haque et al., 2021) three-dimensional viewing of structures led to better academic performance than presentations with two-dimensional pictures. It would be much easier to convey the information in a three-dimensional shape. Therefore, it was suggested to Dr Obiad to contain educational animation too.
The design stage
It was decided to use 2D illustrations with a friendly and warm tone palette in the booklet design. As Dr Obaid desired, the booklet would end up in PDF form. However, for people who cannot access the internet, I am willing to make a physical form of a booklet would be created too.
Contents text and design outline
The project began with the writing of the booklet contents. The target audience's information was adjusted and Dr Obaid was asked to do a final fact check. Whilst writing the booklet contents, it was decided to make an educational animation to inform how vision develops and how amblyopia and the development of the optic nerve are related. This was mostly based on the reference NHS health A to Z (NHS, 2022f). Adobe Illustrator 2022 was used for a brief outline such as page design, font and paragraph style and so on.Production
The majority of work for this project was created using an OMEN by HP 15-ax234tx with an Intel(R) Core(TM) i5-7300HQ CPU @ 2.50GHz 2.50 GHz processor, 15-inch display and NVIDIA GeForce GTX 1050 graphics.
2D Illustration assets production
The majority of the 2D illustrations were created using a combination of Adobe Illustrator 2022, Adobe Photoshop 2022 and Adobe Fresco.
Photoshop and Fresco work well for creating organic shapes and freehand drawings. Therefore, it was used in this project to create the eye anatomy illustrations.
Illustrator works well for creating vector-style illustrations and making use of gradients. Therefore, it was used in this project to create the 2D illustration assets, such as those used for the atropine eye drops bottles, maps, and a graph.
3D asset production
To make an image of an atropine eye drops bottle, reference images were searched for on google. It was decided to make atropine eyedrops bottles realistically. In Illustrator it is possible to create 3D objects from 2D artwork. The appearance of 3D objects was controlled by lighting, shading, rotation, and other properties. This technique was used on the bottle of atropine eyedrops. Revolving sweeps a path in a circular direction around the global Y axis to create a 3D object. The eye drops bottles were mostly made with plastic therefore plastic shading was used for the material texture. 2D artwork was mapped onto each surface of a 3D object. The images of the cover seals were created on the other artboard, and it was converted into PNG. The PNG image was mapped on the 3D objects’ surface. The objects’ lighting was also adjusted to match the overall design of the booklet.
Post-Production
Composition
The process was mostly worked on Adobe InDesign 2022. This software is suited for the project as it needs to create and publish a book, digital documents, and interactive PDF.
While working on this stage the planned outline was mostly followed, however, several changes were applied too. First, the Colour palette was changed depending on each chapter to encourage readers’ interest. Second, eye anatomy illustrations were recreated into vector illustrations from pixel illustrations. A dry texture brush was used for the original illustration to match with other illustrations. However, the eye anatomy illustration looks quite pixelated which was not a deliberated style choice. Therefore, a vector illustration was recreated in Illustrator and imported into InDesign.
Adding hyperlinks and QR codes
There are some hyperlinks and a QR code was added to the final book. First QR codes and hyperlinks to the educational animation and 3D model were added. The process of the animation will be described in the Animating and 3D modelling section.
Previously, a picture book was created by the author. The picture book is for young patients with amblyopia who need to use the patch on their eyes for treatment. A patch covers the healthy eye, so the lazy eye is forced to work. Using a patch to heal a lazy eye can often be an unpleasant experience for the child until they get used to it. This is the reason why children need to be explained the reason for using a patch, and the importance of sticking with the treatment, so that child patients are motivated to do it. A hyperlink to the picture book was attached because the aim of the picture book is highly similar to the aim of the lazy eye booklet project.
Animation
Workflow overview
This educational animation of the amblyopia project is affiliated with the booklet project. This process was branched out from the process of the booklet. This animation was completed in several stages using multiple techniques and both 2D and 3D software. The brief was set concept art, script and storyboard were planned. After that, 2D and 3D assets were created, animated and recorded. Sound effects, editing and voice-over were comprised of 2D and 3D assets. Finally, the animation was rendered to upload on YouTube and the hyperlinks and QR code of the URL were created.
Pre-Production
Storyboard and concept art
The project began with a brief, a set of objectives and a story outline for the animation. The outline was used to establish the key learning points and a generalized sequence of events. The script and storyboard developed and changed over time as 3D animation was added to the animation. The narrator helped to form the narrative of the animation and educate the audience. The storyboard was created using photoshop 2022 to establish an overall flow of the animation. The colour pallet for the animation mainly consisted of friendly, and warm colours which are the same as the colour palette of the booklet. The child character from the booklet appears again in the animation to provide a sense of unity to audiences.
Animatic
After the storyboard was set an animatic was created. This preliminary version of the animation was produced by shooting successive sections of a storyboard and adding a soundtrack. In one scene of the animation, when the brain changes its view from lateral to inferior, a 3D model was needed. Therefore, it was decided to use both 2D and 3D assets to provide a three-dimensional anatomy structure of the brain and optic nerve. However, 3D assets should be tuned to the main style which consists of 2D assets.
Production
The work for this project was created using the same laptop as the process of the booklet.
2D asset production
The majority of the 2D assets were created using Adobe Fresco and often Adobe After Effects 2022 was used to create special effects such as dot lines and plane figures. Once 2D assets were assembled in layers and saved as a separate PNG file (.PNG). This enabled transformations and transitions to be achieved during the animation stage.
3D asset production
The 3D asset was created on Blender for the animation. The process of this will describe on the 3D model chapter.
Voice over
The voice-over was recorded using the Antlion Audio ModMic 4.0 microphone and Audacity which is a free and open-source digital editor and recording application software. The microphone and recording software has resulted in a high-quality voice-over. Andreas Bjørnø who is a master’s degree student in Psychology at the University of Dundee was asked to record his voice for the animation.
Post-Production
After Effects was used to combine assets, motion graphics, and 3D render passes together to create each scene. Since the animation is short and simple, it was possible to do the composition and final edit all in Adobe After Effects.
2D animation and motion graphic
Each 2D scene was set up in After Effects and animated using a combination of the pre-made 2D assets and in-program elements. By importing 2D assets into After Effects using PNG files the layers were separate and directly editable. Many key-frames were used in After Effects to animate the assets or create motion graphics. Key-frames allow for certain properties. Such as position or scale, to be changed over time. When key-frames are used to simulate movement, this is termed motion graphics. There are three noteworthy key-frame effects.
The first is the ‘Turbulent Displace’ effect which is used on eye-wiggling images from 51 seconds to one minute. The ‘Turbulent Displace’ can be found under the ‘Distort’ category and applied to the image. Most of the controls such as ‘Displacement Type’, ‘Offset’, ‘Complexity’ and so on were set as default, however, the value of ‘Size’ and ‘Amount to Not’ were adjusted to make the image dramatically winding.
On the effect, a simple expression which can loop the effect was added. ‘Evolution’ was clicked with alt. <time*1000> was inputted on space for writing a text that appears on the timeline panel. This effect was added on an oval shape from 20 seconds to 41 seconds and, a light effect illustration from 18 seconds to 41 seconds.
Second, the ‘Trim Path’ effect is applied to the abstract image of movement of visual information. The effect is visible from 20 seconds to 41 seconds and from 46 seconds to 1 minute and 11 seconds. A path was drawn with the pen tool and adjusted its thickness and colour. The trim path can be found after opening adds next to subsection which next to Contents. After the trim path is added, the value of the ‘Start’, the ‘End’ and the ‘Offset’ was adjusted to make sure the direction of the dot lines is correct. Additional effects were added such as the ‘Dash’ effects which turn the line path into a dotted line and the ‘Round Cap’ which made the dotted line a smoother shape. Those effects can be found under the ‘Stroke’ category.
Last, is a character effect that rises text from the bottom. This effect was used on the text ‘LAZY EYE’ from one minute and 12 seconds to one minute and 11 seconds. Type the text ‘LAZY EYE’ and make sure the anchor point is the centre of the text box. Open the ‘Position’ which can be found at the ‘LAZY EYE’ text layer. On the ‘Range selector 1’, lower the Y-value to lower the text box position. Down the arrow on the left side of the ‘Range Selector 1’ and add a key-frame of ‘Offset’ (one minute 12 sec: -100%, 1 min 11 sec: 100%). For more natural movement, the shape was changed from the ‘Square’ to the ‘Ramp Up’ and increased the percentage of the ‘Ease Low’. Right-click below the ‘Position’ layer and select the ‘New’ and the ‘Solid’. Lower the solid shape until it can hide the whole text of one minute and 12 seconds. To apply the ‘Track Matte’, press F4 and select ‘Alpha Inverted Matte’.
Editing
Once the 3D animation clips were rendered, they were imported into After Effects where 2D animation and audio were added. The Voice over was edited using key-frames to adjust the volume of the track, therefore clearing the voice. To keep the voice-over consistent no ambient or background sound was added, however, for drawing the interest of the audience, several sound effects were added. Those sound effects were downloaded from FMA (Free Music Archive) and ZAPSPLAT which offers free access to open licensed original music and sound effects.
Upload on YouTube
The final animation was uploaded to the author’s Medical Art YouTube channel. The subtitles were added to provide clarity of scripts, and better user engagement, especially in sound-sensitive environments. YouTube provide an editing tool for subtitle and captions. It was available when the animation was uploaded or after it was uploaded. The ‘Add Language’ need to be selected and select the language wanted to use for the animation. English (UK) was chosen for the animation. The transcript of the animation’s subtitles was copied and pasted to YouTube editor. The animation was published after all of the work processes were done.
A QR code was generated with the published URL link for attaching to the booklet. The QR code was created on Naver QR cord which is the webpage that provides the creation and management of QR codes.
3D modelling
The processes used to create the 3D assets were developed through online research and advice from Sean Yu, the DJCAD support specialist. After the modelling plan sketch was created on Fresco, development moved on to Blender. Blender2.9.3 and 3.2.1 were used to create a 3D model of the optic nerve and brain.
Blender is a free and open-source 3D computer graphics software tool for creating various digital artworks such as animation, visual effects, 3D-printed models, motion graphics and so on. In this instance Blender was mostly used for 3D modelling, UV mapping, texturing, digital drawing, editing, sculpting, animation, rendering, compositing and so on.
Pre-Production
Idea sketch and planning
Before the model was created, idea sketches of the model design were created on Fresco. The concept of the model should anatomically correct and match with overall art style at the same time. After general design was set, planning of production process was planned. For this work. The author needs to search new tools, the ‘Grease Pencil’ and the ‘Toon Shade’. YouTube, Google and Blender manual website were referenced for those tools.
Production
Modelling
The modelling started with a basic sphere which was remeshed sculpting mode for higher resolution and smoother shape. The right side of the cerebrum shape was sculpted with ‘Grab’, ‘Draw’ and ‘Scrape’ brushes. After that, the sulci of the brain were curved with a combination of ‘Draw’, ‘Blob’ and ‘Layer’ brushes.
To match the overall style of the project, which is simplified, stylized and friendly, it was decided to daringly simplify the corpus callosum, midbrain, pons and spinal cord. These parts are also started with a simple sphere, and one more sphere was added to object mode for creating the cerebellum. Both spheres were rotated X-axis 90 degrees and deleted half of it. In the sculpt mode and its shape was adjusted with the ‘Grab’ and ‘Draw’ brush.
The optic nerve was started with the ‘Bezier Curve’ which is a parametric curve used in computer graphics. After the curve was adjusted to the same as the one side of the optic nerve, it was duplicated on the Edit mode and find ‘Mirror’ tool in the ‘Mesh’ menu. The ‘Mirror’ tool in Edit mode is similar to Mirroring in Object Mode, it was exactly equivalent to scaling vertices by -1 around one chosen pivot point and in the direction of one chosen axis, only it is faster and handier. After this tool becomes active, select a Y-axis to mirror. The curves’ thickness and resolutions are controlled on the ‘Object Data’ properties panel. Back to the Object mode, they were converted into Mesh.
On the Object mode, a sphere was added for creating an eyeball and applied a mirror modifier. This modifier mirrors a mesh along its local X, Y and /or Z axes, across the object’s centre. It can also use another object as the mirror centre, and then use that object’s axes instead of its own. Once the modifier was applied, its axis was fixed to the ‘Optic nerve’ object for both eyeballs to put it symmetrically right place.
While 3D objects were building up, Shade Smooth was applied (in the Object mode, select the object and right click and select Shade Smooth) and Auto Smooth with 30degre which is on the Object Data Properties settings category.
Texturing and more
After the modelling was completed, materials were applied to the objects to define the substance that the object is made of its colour and texture and how light interacts with it. These work processes mostly work this process on Material Preview and Rendered Viewport Shading.
I unwrapped the eyeball object on the UV Editing workspace. Save the unwrapped image as PNG. Move to Shading workspace, add a new node named Image Texture and output Color and input to the Base colour of Principled BSDF. Import the unwrapped PNG image to the Image Texture node and move on to the Texture Paint workspace. I used a basic dot brush for painting the iris and a Fill tool for filling the sclera with an off-white colour.
To match with other artworks of the project, Toon Shader on the Shading workspace was applied. Two nodes, Shader to RGB, and Color Ramp, were imported and rearrange the composition of the nodes. I changed the Liner option on the Color Ramp into Constant and adjust the colour and gradient scale to make cartoony-style shading. This node’s composition was added on other objects too except the eyeball because turned out basic shading is better than cartoony shading. For making a cartoon-style outline, I add one more material and named it a border. I deleted Principled BSDF and import Emission. Output Emission of Emission and input Surface of Material Output. Solidify modifier was applied and a few options were adjusted. Drop down Normals and check the Flip. Increase the number of Material Offset which is under the Materials option. Go back to Material Property and drop-down Settings and check Backface Culling.
The most exciting part of the 3D modelling process was using the ‘Grease Pencil’ tool. The ‘Grease Pencil’ is a particular type of Blender object that allows you to draw 2D in the 3D space. Can be used to make traditional 2D animation, cut-out animation, motion graphics or use it as a storyboard tool among other things. It is quite a powerful tool that is great to draw with and add another dimension to the artwork. This tool was used for depicting the sulcus of the cerebrum. To match the illustration style of the booklet, the sulcus was depicted as simple as possible, but at the same time anatomically accurate.
To use the ‘Grease Pencil’, some visibility options that will make drawing with the ‘Grease Pencil’ easier need to be adjusted. The ‘Grid’, ‘3D Cursor’, and ‘Canvas’ which can be found in the Dropdown menu of Overlays were selected. The ‘Stroke Placement’ was designated as the ‘Surface’ and the ‘Drawing Planes’ was designated as the ‘View’. The sulcus on the right cerebrum object were depicted with the ‘Grease Pencil’ and applied the Mirror modifier. Axis was tuned to the Cerebrum object.
Animation clip
To render the animation clips and images, some properties’ options need to be adjusted. On the Render Properties, the ‘Transparence’ option under the ‘Film’ category was selected to get a transparent background of the PNG sequence. On the Output properties, resolution properties were set as 100%, 24 fps, and file format was set as PNG and RGBs colour.
Two animation clips and one image were required for the final animation. The first animation clip is to show the inside anatomical structure of the brain and optic nerve. In the Layout workspace and object mode, the ‘Camera’ was added and adjusted its place. The Right side of the cerebrum object, the cerebellum object, the corpus callosum, the midbrain, pons and spinal cord object and, the ‘Grease Pencil’ object were selected. ‘I’ on the keyboard was pressed to add the keyframe. On the options window, the ‘Location’ was selected and repeated this progress at 25 frames. The selected objects were moved upside at 25 frames while these were fixed to the Z axis. Press Ctrl + F12 to render the animation clip.
The second animation clip is the turn table animation from lateral to inferior. In the Layout workspace and object mode, the ‘Empty Plain Axis’ was added, and the ‘Camera’ was parented to the ‘Empty Plain Axis’. This work Is for the focalization of the ‘Camera’ to the right pivot point. On the Animation workspace and the left side, the 3D viewport was tuned to the camera view for checking real-time rendering. The start of the animation was set at 26 frames and the end of it was set at 40 frames. The keyframe of the ‘Rotation and Location’ was added at the start and the end of frames. On the Object Properties, -90 degrees was inputted to the Y axis of rotation and adjusted the ‘Empty Plain Axis’ location. Press Ctrl + F12 to render animation.
Finally, the images of the optic nerve object and eyeball object were rendered. Unselect the camera icons on the Outliner of the object which do not need to be rendered. Press F12 for rendering a still image.
Post-Production
Upload 3D model on SketchFab
Interactive elements were provided to create an engaging user experience whilst improving the transfer and retention of information. A 3D digital interactive model was added to SketchFab .com. SketchFab is a 3D modelling platform website used to publish, share, discover, buy and sell 3D, VR and AR content. This model was added to educate the anatomical structure of the Brain and optic nerve.
The 3D model object and texture map were exported from the blender (OBJ, MTL and PNG). Those necessary files to upload to SketchFab were combined into one file and reduced file size. On the SketchFab website model was uploaded. After the title and description were added to ‘the Edit Properties’, work continues on the ‘Edit 3D Settings’. In the Scene workspace, turn on the background and change the colour to pale blue. In the Lighting workspace, set the environment as the ‘Studio Soft’ and turn on the ‘Shadow’ and adjust the ‘Light Intensity’ and ‘Shadow Bias’ for better visual. In the Material workspace, cerebrum and eyeball objects were applied texture and other objects were changed its colour manually. An additional option, the ‘Subsurface scattering/ skin’, was applied to the cerebrum object. Every object was changed from the ‘Face Rendering’ to ‘Double Sided’ to the ‘Single Sided’. In the ‘Post Processing Filters’, some options such as Depth of Field, Bloom, Tone Mapping and Color Balance were adjusted for better visual effect. Depth of Field is for blur sliders to simulate a photorealistic depth of field effect on the model. This option is useful when the audience clicks a small part such as a lateral geniculate body because this effect blurs the background and shows a clear view of the structure which needs to be focused. In the Annotation workspace, several important annotations and explanations were added. This model was not planned for AR and VR, therefore options in the ‘Virtual Reality and Augmented Reality’ workspace were not adjusted. After the setting was done the model was published. The URL link was converted into a QR code and attached to the booklet.
Result
The resource outcome for this project included a completed interactive PDF booklet containing hyperlinks and QR codes which can watch the animation and 3D model. Many types of learning tools were utilized in this project such as 3D interactive models, animation, illustrations and interactive Pdf. By presenting all three types, the audiences are given an equal opportunity to become involved and engaged, enhancing their understanding overall.
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