Thomas Wong, OD, FNAP, is an Associate Clinical Professor at the SUNY College of Optometry serving as both the Director of Clinical Externships and New Technologies focused on innovative ophthalmic technologies improving patient outcomes, ocular disease, contact lenses, bioethics, clinical research, and medical informatics.
Innovative technology is certainly one way to catch a patient’s attention. Most patients will appreciate ODs who are not only current but use state-of-the art technology.
Virtual reality (VR) has been used in health care for decades. Dentistry has utilized VR simulations to relax patients, and ophthalmic researchers have used it to simulate a patient’s vision with both glasses and contact lenses. Optometric institutions have begun using virtual simulation labs to teach procedures, for example, direct and indirect ophthalmoscopy.1
When significant changes in the world occur, it takes a great deal of time. However, when everything is aligned, change hits us at light speed.
Optometry had heard for years in the 1980s and 1990s that the move toward electronic health records (EHR) was coming. While many of us became skeptical it would happen, the changes and movement to EHRs came quickly. For ODs, it is important that we not only provide quality care, but that we deliver a first-class experience to our patients.
How do we differentiate ourselves from other vision care options that patients have?
Previously from Dr. Wong: Using technology, medical informatics in patient education
Innovative technology is certainly one way to catch a patient’s attention. Most patients will appreciate ODs who are not only current but use state-of-the art technology. If we follow the news, we can see that many groups have already made significant investments in virtual and augmented reality, such as, Facebook, Google, Amazon, professional sports, and major universities. Augmented reality refers to applications in which VR is used to overlay 3-D data on live images-such as the images seen through a microscope during surgery.2
How can VR and virtual simulations improve my patients’ experiences, supplement the care I deliver, and integrate into a busy optometric office?
In my opinion, several areas are important for the primary care OD:
• Continuing education and training
• Advanced diagnostic testing
• Patient education and experience
• Innovations in eyecare treatments
At our “SUNY Optometry New Technologies Hackathon I: The Future Eye Exam,” there was much discussion about the use of VR during an eye exam. Some believed that it was integral to the future of eye care, and some believed that it was an expensive way to use technology that is not yet proven to have clinical value.
As optometry advances, virtual and augmented reality serve as important tools to teach students, residents, and ODs important diagnostic and therapeutic skills.
SUNY College of Optometry and other optometry and ophthalmology programs utilize VR simulation laboratories as an integral part of their students’ education.1 While VR simulations will never fully replace wet labs and training on live subjects, it can be readily used to provide the majority of training for many techniques.
Most of us have spent many hours sitting as patients for our classmates as they learn gonioscopy, lid eversion, and binocular indirect ophthalmoscopy (BIO). VR simulations save our test subjects’ valuable hours lost from their work or school schedules, and it reduces potential waste in the use of expensive specimens in wet labs.
Research has shown that BIO training for novice ophthalmology residents can be significantly improved by the use of VR simulators.3
The ability to use VR to track eye movements has existed for some time but has been utilized mostly in sports vision training for elite athletes.4 Applications for visual field testing have been developed by CREWT Medical Systems in Tokyo, Japan.
CREWT’s head-mounted perimeter imo has been shown to obtain visual field sensitivity highly compatible to that obtained by the standard automated perimeter. Furthermore, CREWT’s binocular random single eye test provides an effective non-occlusion test condition without the examinee being aware of which eye is being tested.5
Perhaps the entire concept of VR began with a desire to create a different human experience. Patient education and informed choice selection could be greatly enhanced by the use of virtual and augmented reality.
Clinical applications of wavefront aberrometry may be optimized by its integration with virtual and augmented reality to simulate night driving conditions, vision with premium IOLs, and correction of higher order aberrations.6 Researchers continue to work with VR simulations for glaucoma and low vision patients to improve patient education and to enhance patient life experiences.7
It is impossible to predict the future of virtual and augmented reality in optometric care because it is up to us. Virtual and augmented reality presents an opportunity to differentiate our practices from others.
Google has shown us that less expensive cardboard VR devices can be just as effective as more expensive models that have so far failed to capture a strong market share.8 It is my belief that universities and athletics will lead the way toward the more widespread use of VR.
My alma mater Georgetown University has started to make use of VR applications in creating 360-degree YouTube videos of the Georgetown campus for use with any VR device, e.g. cardboard VR devices.9
In March 2016, Fox Sports broadcasted the Big East men’s basketball tournament in VR format for the first time.10 Perhaps the time is near for optometry to utilize VR to enhance the quality of human interaction for our patients.
1. State University of New York College of Optometry. See the VR Simulation Laboratory in Action. Available at: https://www.sunyopt.edu/news/the-future-is-now-new-simulation-laboratory-set-to-launch. Accessed 6/28/17.
2. Kent C. VR: A New Frontier in Eye Care? Rev Ophthalmology. Available at: https://www.reviewofophthalmology.com/article/virtual-reality-a-new-frontier-in-eye-care. 2015 Jul. Accessed 6/28/17.
3. Rai A, Rai A, Mavrikakis E, Lam WC. Teaching binocular indirect ophthalmoscopy to novice residents using am augmented reality simulator. Can J Ophthalmol. 2017 Apr. Available at: http://www.canadianjournalofophthalmology.ca/article/S0008-4182(16)30295-2/fulltext. Accessed 7/17/17.
4. CogniSens Inc. NeuroTracker. Available at: https://neurotracker.net. Accessed 6/28/17.
5. Matsumoto C, Yamao S, Nomoto H, Takada S, Okuyama S, Kimura S, Yamanaka K, Aihara M, Shimomura Y.Visual Field Testing with Head-Mounted Perimeter 'imo'. PLoS One. 2016 Aug 26;11(8):e0161974.
6. Maeda N. Clinical applications of wavefront aberrometry - a review. Clin Exp Ophthalmol. 2009 Jan;37(1):118-29.
7. Diniz-Filho A, Boer ER, Gracitelli CP, Abe RY, van Driel N, Yang Z, Medeiros FA. Evaluation of Postural Control in Patients with Glaucoma Using a VR Environment. Ophthalmology. 2015 Jun;122 (6):1131-8.
8. Metz C. The Inside Story of Google’s Bizarre Plunge into VR. Wired. 2015 Jun. Available at: https://www.wired.com/2015/06/inside-story-googles-unlikely-leap-cardboard-vr/. Accessed 6/28/17.
9. Soltis P. VR Technology Aims to Enhance Human Interactions. The Hoya. 2016 Apr. Available at: http://www.thehoya.com/virtual-reality-technology-aims-to-enhance-human-interactions. Accessed 6/28/17.
10. Neslon K. Fox Will Broadcast Big East Basketball Tourney in VR. Digital Trends. 2016 Mar. Available at: https://www.digitaltrends.com/virtual-reality/fox-ncaa-tournament-virutal-reality-nextvr. Accessed 6/28/17.