Virtual and Augmented Reality Direct Ophthalmoscopy Tool: A Comparison between Interactions Methods

Michael Chan,Bill Kapralos,Michael Jenkin,Alvaro Uribe-Quevedo,Kamen Kanev,Norman Jaimes

doi:10.3390/mti5110066

Abstract

Direct ophthalmoscopy (DO) is a medical procedure whereby a health professional, using a direct ophthalmoscope, examines the eye fundus. DO skills are in decline due to the use of interactive diagnostic equipment and insufficient practice with the direct ophthalmoscope. To address the loss of DO skills, physical and computer-based simulators have been developed to offer additional training. Among the computer-based simulations, virtual and augmented reality (VR and AR, respectively) allow simulated immersive and interactive scenarios with eye fundus conditions that are difficult to replicate in the classroom. VR and AR require employing 3D user interfaces (3DUIs) to perform the virtual eye examination. Using a combination of a between-subjects and within-subjects paradigm with two groups of five participants, this paper builds upon a previous preliminary usability study that compared the use of the HTC Vive controller, the Valve Index controller, and the Microsoft HoloLens 1 hand gesticulation interaction methods when performing a virtual direct ophthalmoscopy eye examination. The work described in this paper extends our prior work by considering the interactions with the Oculus Quest controller and Oculus Quest hand-tracking system to perform a virtual direct ophthalmoscopy eye examination while allowing us to compare these methods without our prior interaction techniques. Ultimately, this helps us develop a greater understanding of usability effects for virtual DO examinations and virtual reality in general. Although the number of participants was limited, n = 5 for Stage 1 (including the HTC Vive controller, the Valve Index controller, and the Microsoft HoloLens hand gesticulations), and n = 13 for Stage 2 (including the Oculus Quest controller and the Oculus Quest hand tracking), given the COVID-19 restrictions, our initial results comparing VR and AR 3D user interactions for direct ophthalmoscopy are consistent with our previous preliminary study where the physical controllers resulted in higher usability scores, while the Oculus Quest’s more accurate hand motion capture resulted in higher usability when compared to the Microsoft HoloLens hand gesticulation.

Highlights

In the context of medical education and training, simulation is defined as “an artificial, yet faithful, representation of clinical situations through the use of analog and digital apparatuses” [1]
The physical virtual reality (VR) controllers resulted in higher system usability scale (SUS) scores than the hand gesticulation required for the augmented reality (AR) simulation during Stage 1 supported by the findings presented in [25]
Stage 2 results are consistent with the findings presented in [25], where the SUS scores were higher for the Oculus Quest controller than the Oculus Quest hand tracking

Summary

Introduction

In the context of medical education and training, simulation is defined as “an artificial, yet faithful, representation of clinical situations through the use of analog and digital apparatuses” [1]. Eye fundus examination training typically focuses on reproducing and mimicking the procedure employing interchangeable images (e.g., printed or digital pictures) [10]. Such an approach has proven to be cost-effective as instructors and trainees can access pictures representing numerous eye conditions that are otherwise difficult to reproduce in the classroom. The EYEsi Direct Ophthalmoscope Simulator (EYEsi DOS) [10] offers a realistic training experience featuring a touchscreen interface that shows the procedure for the instructor to observe while the trainee interacts with an artificial human face that is examined with a special ophthalmoscope replica operated by the trainee. Ltd., Kyoto, Japan) and the EYEsi direct ophthalmoscope simulator (VRmagic, GmbH, Mannheim, Germany) appear to be the two most representative commercially available high-end simulators

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