New Technologies Help Extend the Potency and Reach of Vision Therapy – Part 2
The goal of any new tech tool in clinic should be to build on the foundation of known successful in order to improve it either by extension of utility and therapeutic range, by improving on its potency, and/or by rendering it more accessible. It is a truism that new tools should not be implemented simply because they are new or built on a particular platform such as a tablet.
In the first part of this series, we considered how geo-boarding principles elaborated by Dr. Jerome Rosner and adapted and expanded by VisionMechanic, Inc. in the game GeoBee! is an example of the synergy possible between tried and true technique and today’s new tech. While traditional geo-boarding is a better choice for building gross manual skills, paper geo-tracing and GeoBee! are more oriented to fine motor control, and manipulation of spatial constructs through visualization and motor planning – with the added benefits of rapid cycling of stimuli and tasking and much greater portability and accessibility. As it is presented to the user as a game, GeoBee! has proven to be a much more engaging form of practice than the more traditional approaches.
Geo-boarding and geo-patterning remain popular take-home tools for many reasons including persisting value in training perceptual and motor skills, and the fact that they are low risk. GeoBee! falls into this category of potent but safe therapeutic adjuncts for distributed or remote use.
Case 2: Vivid Vision – Immersive and Engaging Amblyopia Training
On the other end of the spectrum are tools in development by Vivid Vision (https://www.seevividly.com/). Vivid Vision uses cutting edge virtual reality and gesture tracking technologies. Virtual reality allows accurate control of visual input to the brain in a way that is more like real life. When you are using it you are inside of a virtual world, where you can look any direction and even stand up and move around. The gesture tracking technology allows patients to interact intuitively with their virtual environment. The head-mounted hardware sends data back on the position of the patient’s head and body, so the software can present visual stimulus and measure different aspects of the player’s response including many different aspects of the patient’s binocular vision including degree of suppression, contrast sensitivity, acuity, stereo acuity, fusional ranges, angle of deviation, and more.
Similar to VisionMechanic’s GeoBee!, Vivid Vision designed their system initially as a platform to do distributed research. They are now working with UCSF on a clinical study with 50-60 patients, and are helping universities all over the world set up their own studies for amblyopia treatment. They collect data from testing and have a patient management interface to analyze it, mask certain researchers, and randomize patients into separate arms.
Currently Vivid Vision’s platform targets in-clinic use for modern amblyopia and strabismus treatments. Like Vision Mechanic’s approach with GeoBee!, Vivid Vision focuses on two things: Core principles of vision science research, and ease of use. To that end, Vivid supplies everything the clinic needs, with software preinstalled and ready to go on hardware that’s already set up and tested. According to Vivid, much time was spent testing the user interface (UI) and usability of the software, making it as easy to use for clinics as possible while still giving the vision therapists flexibility and control over the patient experience.
Both Vivid Vision and Vision Mechanic are incorporating strategies in their products to lead potential patients to clinics offering vision therapy services in their area. While Vision Mechanic tools are designed for wide distribution through therapeutic practices, Vivid Vision’s platform is currently only available for use in optometry clinics. They are developing a home version that optometrists can offer for their patients which connects to the clinical version. When using the home version, the optometrist can have the patient come into the clinic as often as needed, and configure and monitor their home version remotely. This remote monitoring and management of play parameters will be critical elements in any successful venture in this field.
As with any leap forward, some might view this new wave of products as a threat to traditional vision rehabilitative practice, but this has never been a problem with emerging technologies in the clinic. Most vision rehabilitation clinics implement at least a few computer-based elements in therapy. HTS, the wonderful Sanet Visual Integrator, and visuo-motor skills monitoring tools such as Readalyzer and Visagraph are strong examples. No single worthwhile tool or activity has ever been presented this way by any credible source; all tools are part of a complete array of options, and these should be combined by knowledgeable therapists to the best advantage of the client.
These new smart tools serve to extend the reach of therapists, while dramatically improving impact of time in therapy through intelligent game design and play. These tools are at the same time arguably much more palatable to many clients, such as where electronic play seems to be more engaging than traditional geo-board or geo-pattern exercises, or when we can leverage principles of dichoptic viewing in an adventure game to assist in breaking down suppression.
It is a wonderful time to be involved in vision rehabilitation given we are now seeing only the tip of the iceberg in what is possible in software and remote monitoring, reporting, and management. All these companies mentioned are worth watching as they stand to have a significant and positive impact on the efficacy and accessibility of vision rehabilitation.