Extended Reality in Ophthalmology: An Overview

Definitions

Virtual Reality - A computer-generated virtual environment that can be interacted with and completely surrounds the user.

Augmented Reality - A computer-generated virtual environment that is integrated with real world surroundings (e.g., a virtual table in a real room) Mixed Reality - Also integrates virtual and real worlds but requires more processing power. Sort of like an upgrade to augmented reality.

Introduction

Ophthalmology is the field of study relating to the eyes. From 2016 to 2026, The job market of ophthalmology is expected to grow by 11.4%. However, something else is growing and it is the use of extended reality in this field. Extended reality is an umbrella term for virtual, augmented, and mixed reality. In this blog, I will outline on some ways extended reality is applied to ophthalmology. (CareerExplorer by sokanu) (Ong, C, et al., 2021)

Patient Monitoring

Patient-doctor interactions are necessary to have a healthy body and relationship. Virtual Reality helps monitor patients from a long distance, because of its portability. For example, Virtual Reality headsets can provide home testing. The home testing detects signs of visual disorders like glaucoma. This information gets sent to the doctor, and they decide whether to alter their approach towards the patient. The application of VR is crucial because patients don't need to travel a potentially long distance that could hamper their appointment. (Levin, et al., 2019)

Surgery

If you read my previous blog posts, you might've already known this. That's beside the point though. Virtual Reality technology allows eye surgeons to see the eyes in a 3d surface. Surgeons can see the inside anatomy of the eye in a much clearer way because it is interactable. This allows eye surgeons to pinpoint specific areas of the eyes more accurately. Furthermore, the technology allows surgeons to practice specific steps in operations to refine their skills and reduce error. Error is a HUGE issue in healthcare, so improved approaches to training definitely helps! (Levin, et al., 2019)

More Specific Examples of Implementation

Binocular Vision

According to (Mandal, 2021), "AR displays possess the capability to auto-adjust the specifics of an image, a technological feature which can help it to substitute the [use of] prescription glasses." This can be important because patients wouldn't need to constantly buy new prescription lenses each time their vision alters.

Color Blindness

The uproar of Augmented Reality allowed for additional features in colorblind glasses such as a better identification of different colors. This is important because some types of color blindness have less contrast between each color (e.g., Tritanopia vs Achromatopsia), so distinguishment is crucial for the patient's sight. (Mandal, 2021).

Augmented Reality

Even though virtual reality seems almost infallible for use in ophthalmologic training and monitoring, augmented reality is just a step ahead. Here's why.

Extra: The Pros and Cons VR and AR

Virtual Reality:

Pros:

- Fully Immersive 3D rendered environment

-Portable

-Reduces cost for medical training

-May cause dizziness or other symptoms with prolonged use (VR Sickness)

-Cheaper than AR

Cons:

-More dated than AR

-Supply may diminish from time to time

Augmented Reality:

Pros:

-Brings an immersive 3D rendered environment to the real world (Huge plus)

-Portable

-Reduces cost for medical training

-Usually much lighter than a VR headset

-Reduces likelihood for VR sickness compared to VR

-Newer than VR

Cons:

-Supply may diminish from time to time

-Pricier than VR

(Azurdy, 2020)

References

Aydındoğan, G., Kavaklı, K., Şahin, A., Artal, P., & Ürey, H. (2021). Applications of augmented reality in ophthalmology [Invited]. Biomedical Optics Express, 12(1), 511-538. doi:10.1364/BOE.405026

Azurdy, J. (2020, June 5). Virtual and augmented reality: Pros and cons. Encora. Retrieved September 5, 2022, from https://www.encora.com/insights/virtual-and-augmented-reality- pros-and-cons#:~:text=Augmented%20Reality%201%20Pros%3A%20AR%2C%20when%

20used%20properly%2C,Use%20Case%204%20VR.%20...%205%20AR.%20

CareerExplorer by sokanu. (n.d.). The job market for Ophthalmologists in the United States.

Retrieved August 21, 2022, from https://www.careerexplorer.com/careers/ophthalmologist/

job-

market/#:~:text=The%20ophthalmologist%20job%20market%20is%20expected%20to%20grow,provide%20great%20employment%20opportunities%20for%20the%20foreseeable%20future.

Cipresso, P., Giglioli, I. A. C., Raya, M. A., & Riva, G. (2018). The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature. 9(2086). doi:10.3389/fpsyg.2018.02086

Hwang, A. D., & Peli, E. (2014). An augmented-reality edge enhancement application for Google Glass. Optom Vis Sci, 91(8), 1021-1030. doi:10.1097/opx.0000000000000326

Jones, P. R., Somoskeöy, T., Chow-Wing-Bom, H., & Crabb, D. P. (2020). Seeing other perspectives: evaluating the use of virtual and augmented reality to simulate visual impairments (OpenVisSim). npj Digital Medicine, 3(1), 32. doi:10.1038/s41746-020-0242-6

Levin, A. M., & Pettey, J. H. (2019, August 16). The future of virtual reality in Ophthalmology is

here. American Academy of Ophthalmologists. Retrieved September 5, 2022, from

https://www.aao.org/young-ophthalmologists/yo-info/article/

future-of-virtual-reality-in-ophthalmology

Mandal, A. (2021, August 1). Virtual and augmented reality: Applications in ophthalmology. Vision

Science Academy. Retrieved September 11, 2022, from https://visionscienceacademy.org/

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Moon, H. S., Yoon, H. J., Park, S. W., Kim, C. Y., Jeong, M. S., Lim, S. M., . . . Heo, H. (2021). Usefulness of virtual reality-based training to diagnose strabismus. Sci Rep, 11(1), 5891. doi:10.1038/s41598-021-85265-8

Ong, C. W., Tan, M., Lam, M., & Koh, V. (2021). Applications of Extended Reality in Ophthalmology: Systematic Review. Journal of medical Internet research, 23(8), e24152. https://doi-org.proxy.library.vcu.edu/10.2196/24152