Stepping into the virtual unknown: feasibility study of a virtual reality-based test of ocular misalignment

Abstract

IntroductionDissociated tests of strabismus provide valuable information for diagnosis and monitoring of ocular misalignment in patients with normal retinal correspondence. However, they are vulnerable to operator error and rely on a fixed head position. Virtual reality headsets obviate the need for head fixation, while providing other clear theoretical advantages, including complete control over the illumination and targets presented for the patient's interaction.PurposeWe compared the performance of a virtual reality-based test of ocular misalignment to that of the traditional Lees screen, to establish the feasibility of using virtual reality technology in ophthalmic settings in the future.MethodsThree patients underwent a traditional Lees screen test, and a virtual reality headset-based test of ocular motility. The virtual reality headset-based programme consisted of an initial test to measure horizontal and vertical deviation, followed by a test for torsion.ResultsThe pattern of deviation obtained using the virtual reality-based test showed agreement with that obtained from the Lees screen for patients with a fourth nerve palsy, comitant esotropia, and restrictive thyroid eye disease.ConclusionsThis study reports the first use of a virtual reality headset in assessing ocular misalignment, and demonstrates that it is a feasible dissociative test of strabismus.

Case Report: Visual Rehabilitation in Hemianopia Patients. Home-Based Visual Rehabilitation in Patients With Hemianopia Consecutive to Brain Tumor Treatment: Feasibility and Potential Effectiveness

“…IVR in HMD is an emerging and very promising visual rehabilitation approach using high-technology devices (52)(53)(54)(55)(56). It is developed to provide perceptual learning with better ecological validity due to virtual reality, greater flexibility due to home-based stimulation protocol, and improved efficiency due to patient-tailored protocols (52,53).…”

Usefulness of virtual reality-based training to diagnose strabismus

“…Besides, several studies on amblyopia and binocular vision using VR technology have also been conducted. A study about the improvement of visual acuity in patients with amblyopia through dichoptic training 2 , showed improvements in stereopsis in patients with intermittent exotropia 3 , and reported the assessment of ocular misalignment of strabismus patients through a dissociative test 13 . We have developed a system using HMD, combining the eye-tracking technology and VR, to measure the angle of strabismus with the principle of cover-uncover and alternate cover tests.…”

“…Learning to use the application would be easy for me 3. www.nature.com/scientificreports/ improvements in stereopsis in patients with intermittent exotropia 3 , and reported the assessment of ocular misalignment of strabismus patients through a dissociative test 13 . We have developed a system using HMD, combining the eye-tracking technology and VR, to measure the angle of strabismus with the principle of coveruncover and alternate cover tests.…”

Usefulness of Virtual Reality-Based Training to Diagnose Strabismus

“…Li et al 14 reported that the degree of strabismus and stereopsis improved with dichoptic visual training using a VR platform in patients with intermittent exotropia. Nesaratnam et al 20 reported the rst use of a VR headset in assessing ocular misalignment and demonstrated its feasibility as the dissociative test for strabismus.…”