the problem with BoI is, after like the second update, it was all but unplayable unless you were willing to spend weeks memorizing increasingly similar looking item graphics and their interactions.
9 out of 10 items you find would power you down or interact with your already collected items so negative, you might as well just start over.
most runs, your damage output is so low, you'll spend 15 minutes to whittle away at any boss, leaving you open to so many stray shots hitting you. and its not even the bosses only, there's so many enemies that require too many hits to beat and if they're quick and homing and can only be hit from one direction that's only exposed for a second, its just annoying and idiotic.
coincidentally, while so many items remain basically useless and a waste of treasure room key, others are so absurdly useful (anything that lets you fly over spikes, holes and obstacles, brimstone, that thing that turns your tears into bombs, the half damage hat ...) that you might as well reset your runs over and over until you get one of them.
not to mention the additional randomness of cards, trinkets and pills and with all the additional potential item drops, you're constantly running low on keys, bombs and coins too.