Feasibility and tolerability of ophthalmic virtual reality as a medical communication tool in children and young people

Abstract

Purpose: Virtual reality (VR) can be useful in explaining diseases and complications that affect children in order to improve medical communications with this vulnerable patient group. So far, children and young people's responses to high-end medical VR environments have never been assessed.

Methods: An unprecedented number of 320 children and young people were given the opportunity to interact with a VR application displaying original ophthalmic volume data via a commercially available tethered head-mounted display (HMD). Participants completed three surveys: demographics and experience with VR, usability and perceived utility of this technology and the Simulator Sickness Questionnaire. The second survey also probed participants for suggestions on improvements and whether this system could be useful for increasing engagement in science.

Results: A total of 206 sets of surveys were received. 165 children and young people (84 female) aged 12-18 years (mean, 15 years) completed surveys that could be used for analysis. 69 participants (47.59%) were VR-naïve, and 76 (52.41%) reported that they had previous VR experience. Results show that VR facilitated understanding of ophthalmological complications and was reasonably tolerated. Lastly, exposure to VR raised children and young people's awareness and interest in science.

Conclusions: The VR platform used was successfully utilized and was well accepted in children to display and interact with volume-rendered 3D ophthalmological data. Virtual reality (VR) is suitable as a novel image display platform in ophthalmology to engage children and young people.

Keywords: children; optical coherence tomography; point-cloud data; ray casting; virtual reality; volume rendering.

Fig. 1

Stereoscopic display of the virtual reality environment (VR) and three VR models from this study (images can be fused for stereoscopic experience). (A) Volume‐rendered OCT data of a peripheral retinal tear in a human eye. The retina model was freely floating in space and could be observed from all sides. It was navigated by the right handle (triangle) and the left handle was freely available inside the VR space in this illustration. The edge of the retina tear was clearly depicted (double arrow heads). Above the VR model, the ray casting light (white arrow head) was positioned for better illumination, and the projection of the shadow below the tear is visible on the yellowish displayed retinal pigment epithelium (RPE). In the background on the wall, the conventional cross‐sectional OCT images (white arrow) were displayed. (B) VR display of a computed tomography (CT) scan of a skull of a skier who presented after a ski accident showing several fractures and dislocated bone fragments in the right skull hemisphere. The ray casting light was centred with the left handle (star) in the direction of the fractures (arrow heads) on the skull. The right handle (triangle) positioned the skull towards the light to improve the representation of the dislocated fractures in 3D. In the area of the teeth, radial artefact signals were visible, typical for metallic tooth fillings (arrow). Conventional CT images were placed in the background. (C) A VR vessel model of a healthy mini‐pig’s eye imaged with micro‐computed tomography after contrast agent was injected into the vessels is depicted. The ray casting light was centred with the left handle (star) on the eye to illuminate it well. The eye model consisted only of vessels, whereby the model was cut using a VR cut plane with the right handle (triangle). This allowed for an inside view to visualize the posterior opening in the area of the optic disc (arrow) and the retinal vessels, among others. At the front right, the cavity in the pupil was made visible.

Fig. 2

Participants’ change in their level of interest in science following their ophthalmology VR experience. The top bar shows this change for the whole sample (159 valid responses), while the four other bars indicate changes as a function of gender and VR experience. Percentages on the left relate to decreases in interest, whereas percentages on the right indicate increases in interest. Large increases/decreases indicate changes between ‘low’ and ‘high’. Small increases/decreases relate to changes between ‘low’ and ‘medium’, or ‘medium’ and ‘high’.

Fig. 3

Responses to the Simulator Sickness Questionnaire. Percentages on the left relate to the number of people who indicated ‘none’ or ‘light’ symptoms, whereas percentages on the right indicate ‘moderate’ or ‘heavy’ responses.

Fig. 4

Participant’s total SSQ scores according to whether they had or had not experienced virtual reality before. Smaller coloured circles represent the scores of individual participants, whereas the larger black circles indicate the means for each group. Error bars indicate standard error, and the data distributions are represented to the right of each mean.

Fig. 5

Responses to the Virtual Reality Reactions survey. Percentages on the left relate to the number of people who answered ‘strongly disagree’ or ‘agree’, whereas percentages on the right indicate ‘agree’ or ‘strongly disagree’ responses. Percentages in the centre relate to ‘neither agree nor disagree’ responses.