VRAM

Project Title

VRAM

Project Area of Specialization Augmented and Virtual RealityProject Summary

Ophthalmology is one of the most technology dependent medical specialties that makes use of multiple imaging and electrodiagnostic tools along with software for diagnosis and effective treatment. Amongst the various eye diseases, amblyopia has the most impact on productivity and Disability Adjusted Life Years (DALY) of patients. Amblyopia, monocular or binocular, is commonly acquired during early childhood secondary to multiple ocular conditions, most common being uncorrected refractive error and ocular misalignment. Ocular misalignment is easily recognized by parents and treatment may be sought; hence refractive errors is the most common cause of amblyopia which is not easily recognized without ophthalmic examination. Pakistan and other developing countries with no national screening programs amblyopia remains undiagnosed and untreated becoming permanent resulting in significant cost to the society and its human resource development as loss of DALY.   
Depending on the severity of amblyopia, current treatment such as patching and atropine penalty is only effective up to a certain age with efficacy degrading significantly after age 7 becoming irreversible in young adults. Recent studies have investigated application of Virtual Reality (VR) in treatment for amblyopia in children and possible vision restoration in adults with promising results. More recent reports suggest that use of Virtual Reality (VR) environments with precise and independent control of visual stimulus for each eye may augment and improve current treatment regimens. This may result in decreasing treatment time, improving binocular vision and most importantly may have benefit for adults considered to be untreatable. 
Our proposed project aims to provide a solution that is low-cost and non-invasive VR-based system for recognition and treatment of amblyopia. This research is based on detailed study where we plan to enhance the treatment of amblyopia by projecting real time dynamic contrast and focus differential between the two eyes in form of engaging and fun games and activities. Impact of such low-cost standardized system will have significant benefit for Pakistan. It will augment limited ophthalmology resources, reduce the economic and social burden of vision loss. In additional such systems can be adapted and exported to other markets boosting our exports. 
 

Project Objectives

The objective of the proposal is to develop a low cost scalable VR based system for enhancing treatment for amblyopia in children and developing a new one for adults.  
Specific Aims: 
Aim 1:  
Develop an integrated VR environment with specific games and virtual environment designed to mimic and enhance the principles of amblyopia treatment. 
Aim 2:  
Test the system developed in Aim 1 on patients with amblyopia in a controlled environment to enhance, augment and expedite the visual function recovery in patients with amblyopia. 
Aim 3: 
Design a large multicentre clinical trial comparing the efficacy of VR system augmented treatment with standard of care. 
Aim 4: 
Adapt the system developed to cheaper alternate using a cell phone and google cardboard device. 

Project Implementation Method

1. Design and development of VR environment:  This is main research part of proposed Project. Through thorough research, these environments would be set and designed to compliment therapy procedure properly.  

2. Controlled testing: Initially the VR environments would be tested in a controlled environment with help of ophthalmologists and redesigning of environments would be done if needed

3. Pilot testing and trials: After successful testing under controlled environment,testing would be done at two main locations AFIO, RWP and LRBT, Lahore. Our aim is to at least register 50 children for this whole study and following proper IRB rules we will register our clinical studies. Study coordinator is required for this whole process.  

4. Review of collected data: Once trails are done, then we will perform a complete review of collected data along with statistical analysis to see the significance of proposed research and to develop further games for therapy.  

5. Mobile based therapy: We will also switch to mobile based therapy in order to make a low cost solution where there would be no need of expensive equipment like oculus rift etc

6. Large Clinical trials: This whole research and study would be concluded at design of a large scale clinical trials in future.   

Benefits of the Project

Available literature suggests that the use of VR augments the traditional treatment options in children and may be beneficial in adults 12–14. This is particularly advantageous in adults who may have no benefit from patching or atropine penalty. The interactive nature of stimulus and engagement of non-visual stimuli in VR environments may benefit the learning process and visual perception. This is also an important factor in Pakistan. For one, there is no comprehensive screening program for vision screening in schools, and second a significant number of children do not go to schools. Hence it is possible that the prevalence of untreatable amblyopia in adults is much higher than the published reports from the developed countries. In addition, the cost of implementation will be low and the benefit in terms of improved productivity will be significant.

Impact in Quantifiable terms: 
The use of VR in medicine is continuing to expand. The research conducted on the use of VR system for treatment of amblyopia will spur interest in the academic community in Pakistan in the use of VR. Our own follow up project will be the use of VR in diagnostic testing in ophthalmology from simple vision testing to amblyopia screening and visual fields.  
Lack of nationwide screening programs in schools during the critical period of visual development may have a high impact on prevalence of amblyopia in Pakistan. Even if there is some level of screening, a large proportion of children do not go to school. Hence amblyopia prevalence in Pakistan is likely to be higher than reported. This has a significant impact on human development and DALY resulting in lower productivity and resources of the society.  
Lack of resources is another factor, with only 11 ophthalmologists per million (REF), once diagnosed, the treatment regimens are hard to implement. Once developed we will transition our system to smartphones. Given the high penetrance of mobile phones in Pakistan, our VR solution will be available to urban and rural areas alike.  
The overall increase in productivity will have a significant impact on the economic condition of Pakistan.  

Technical Details of Final Deliverable

1. Occlusion Therapy:

Initially we split the VR environment into two halves. One for the strong eye and one for the weak eye. Then we decrease the signal strength of the scene rendered to the strong eye and increase it for the weaker eye. This way we train both the eyes to function together by balancing the interocular contrast. Each week as the patient progresses, the difference between the vision of both eyes decreases.

 2. Dichoptic Training:

This method presents two independent images to each eye and enhances the ability to use both eyes in conjunction. This technique has shown to improve amblyopic eye BCVA, and in some cases stereo acuity. A mirror haploscope is used in practice to present dichoptic training.  Our VR system will be able to act as a haploscope and create a contrast differential or other parameters to present different stimuli to each eye.  

3. Perceptual learning:

Perceptual learning refers to the ability to improve performance on a sensory task by repeated practice11. It induces plasticity in the normal visual system and thus has been suggested as a potential method for amblyopia recovery in adults. Perceptual learning for amblyopia includes extensive training on a perceptual task with the fellow eye patched. This would be helpful in developing stereoacuity and depth perception. Using the VR controller, the patients will be presented with multiple tasks which will require moving in a controlled environment. This could be in form of hurdles which the patients have to navigate through. This would mostly be in adult patients. 

Final Deliverable of the Project HW/SW integrated systemCore Industry HealthOther Industries Medical Core Technology Augmented & Virtual RealityOther TechnologiesSustainable Development Goals Good Health and Well-Being for PeopleRequired Resources

Item Name	Type	No. of Units	Per Unit Cost (in Rs)	Total (in Rs)
			Total in (Rs)	80000
oculus rift s	Equipment	1	70000	70000
Transport to hospitals	Miscellaneous	1	10000	10000