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Changing how we view eye conditions

Growing up we were always told too much TV would make our eyes go square. But fast forward a few years and researchers are increasingly turning to virtual reality headsets as a way of fixing eye conditions.

Internationally, vision scientists are turning to VR to treat amblyopia, sometimes known as lazy eye. Affecting up to 3% of people, one eye is relatively weak compared to the other, and it is historically treated by wearing an eye patch over the stronger eye in an attempt to encourage the weak eye to develop better vision. However, the new approach uses VR headsets which can manipulate the picture sent to each eye, creating a similar effect.

Turn it into a game or something entertaining, and patients are far more likely to persist with the treatment, say the research teams.

One of those teams is based at Deakin University, formed by Professor James Armitage. The Australian team is attempting to take the work one step further, creating a VR system that lets them tailor the treatment to the specific patient.

And they say a similar approach could also be used for treating other eye conditions.

VR for improving vision

The team’s work, led by Amanda Douglass and Geoff Sampson, starts with a similar concept to other VR approaches to amblyopia. A VR headset is worn by the patient, with slightly different images shown to each eye to help encourage the weaker eye to develop.

However, the Deakin team improved the concept, creating masks that can be manipulated and changed depending on the needs of the patient. These masks consist of two circular areas, with the inner and outer areas being able to be adapted and changed in size, brightness, contrast, and other factors.

“Amblyopia generally occurs when something interferes with the ability to use the two eyes as a functional pair, and the brain will often switch information from one off. That avoids it trying to fight to make sense of one being clear and one blurry, or the two eyes seeing different things,” says Sampson.

“Because the information from the amblyopic eye is suppressed, the connections between the eye and the brain do not develop normally and the eye doesn’t learn to see well.”

And that can have implications later in life if something happens to the good eye, and also potentially affects their ability to appreciate the world in three dimensions, or judge distances.

An overview of the VR treatment for amblyopia. Credit: Stefan Greuter, Rose Woodcock, Lienors Torre, Amanda Douglass, Geoff Sampson, Luke Chong, Simon Backhouse, James Armitage, Deakin University

“When you patch one eye, you’ve got a complete image and nothing, and that doesn’t really encourage the eyes to work together. It’s encouraging one eye to get better, but then you need to think about how you get them to work together,” says Douglass.

“We use different aspects of the image, processed through different neural channels. The question is which channels are most important to emphasise when we’re trying to fine tune our vision? The VR gives us the ability to control really well what is being presented to each eye.”

That customisability is the big advantage of their approach to the VR treatment. With different patients having differing levels of amblyopia, the treatment itself can be scaled depending on what is required on a patient-by-patient basis.

However, at the moment the recommendations are standardised. Instead, the way the treatment is applied could be personalised with strength, timing, and tracking of improvements to deliver the best outcomes for each patient.

By fine-tuning different aspects for patients, the amblyopic eye can not only be improved, but the treatment then also aims to get the pair of eyes working together as a functional pair at the same time. And that, say the researchers, is the key to keeping them strong and returning vision to the person close to equivalent to someone without the condition.

Sampson and Douglass even think that, with more development, the idea could be used as an add-on to any VR game. Their experimental set up uses a custom-designed game, created via a strong collaboration with the School of Communication and Creative Arts at Deakin. This helps patients with things like coordination between eyes and judging distances. And that gamification is vital for making the treatment as appealing as possible so that people keep using it.

If they can develop it the way they hope, people could even undertake the treatment while playing a game of their choice – to the point where eye conditions could be treated while playing Forza or GTA. Or, they could apply the technology to videos instead of games – tailoring it to the patient and what works best for them.

Science and arts are stronger working together

The development of this technology shows two important things – the critical collaboration that exists between the arts and science, and the changing face of medical research.

“We couldn’t have done this without the collaboration with the team from the School of Communication and Creative Arts. Their way of thinking and their knowledge has been vital,” says Douglass.

These collaborators include Professor Stefan Greuter, Dr Rosemary Woodcock and Dr Lienors Torre from Deakin.

“Having their creative skillsets has been invaluable. But equally, we’re working on a game and the way they’re thinking about it – how do I make this bunny rabbit interesting, how do I create this change – that’s what they do.”

Screenshot from the Rabbits on the Moon game created for the amblyopia treatment. Credit: Stefan Greuter, Rose Woodcock, Lienors Torre, Amanda Douglass, Geoff Sampson, Luke Chong, Simon Backhouse, James Armitage, Deakin University

“It’s that collaboration between clinical – where we’re taught to think for ourselves but along a straight down-the-line manner, and those people who are taught to think very broadly in their area.”

Interdisciplinary collaborations are hugely valuable for reaching outcomes, says Armitage. “We have ideas and we have questions, but we don’t even know if there is a tool to answer that question. And there are other people who have or can develop the tools but don’t appreciate how valuable the tools are for another discipline.”

The collaboration with artists, technologists and software developers also goes much deeper than just research. The collaboration first began from plans to improve the teaching of vision science.

“We wanted to set up a program that used all available technologies. So not only do we try to teach our students using a broad range of technology – like 3D printed anatomical parts, and augmented reality. We also use eye-tracking to examine where students look when interpreting clinical images” says Armitage.

“We were delighted to connect with the group in the School of Communication and Creative Arts. One of their team was interested in understanding how people’s perceptions of a scene happens, and how they could manipulate that to create sensations, feelings and emotions to increase people’s interaction and enjoyment of art.”

“We started using technology to teach and to learn, and we’re now using that technology with a completely different perspective from having colleagues who are educators and artists involved.

Using the eye to look wider

The team is also interested in taking the same approach to treating other eye conditions.

Binocular vision problems – where patients eyes don’t work effectively together – could also be helped with VR, says Sampson. “We have some plans to investigate training the visual system to work more efficiently and effectively. There are training programs that exist already, but the engagement level of these programs could be improved by gamification. So again, putting that sort of stuff into VR in a gaming environment has a lot of potential.”

There are also questions around the visual perceptual skills of children with learning difficulties. “It’s not so much about how well they see, but how well they draw information from what they see,” says Sampson.

Different changes able to be made to each individual eye to help eye conditions. Credit: Stefan Greuter, Rose Woodcock, Lienors Torre, Amanda Douglass, Geoff Sampson, Luke Chong, Simon Backhouse, James Armitage, Deakin University

Technology like this can also assist rural and remote patients access to treatments without needing to travel long distances, say the researchers.

The nature of vision science and optometry is changing, say the team. Technology is providing the opportunity to not only improve the treatment of eye conditions, but also potentially identify other health issues.

“I think we need to think wider than the eye and think about how we can use the eye as a marker for systemic health. It’s a very accessible organ – you can see into it. We can use what we see in the eye as a way of predicting what might be happening to the blood vessels or nerves in the rest of the body.

“The eye gives you a really unique way of looking at the tiniest blood vessels in the body – and the brain,” says Armitage.

“The eye is an extension of the brain,” adds Douglass.

“It’s got wonderful links to other aspects that change where our visual attention is directed. It has roles with other medical fields when we’re thinking about how these different aspects change as we become sick – dementia, stroke, or something else that’s happened within the brain. We can look at that.”

And the importance of vision science is only going to increase as more technology such as AI plays a role in looking at those changes.

“We still need health practitioners. AI is a really important opportunity for optometry, it’s something we’re going to need to embrace,” says Armitage.

“The AI is always going to assist the clinician, not replace the clinician.”

This article was first published on Australia’s Science Channel, the original news platform of The Royal Institution of Australia.