Applications and implications for extended reality to improve binocular vision and stereopsis

Naked eye three-dimensional teaching assistant system applied to undergraduate medical imaging education: A pilot study

The traditional approach of using PowerPoint (PPT) presentations in medical imaging theory classes hinders the spatial thinking ability of most students. Consequently, the learning outcomes are often unsatisfactory. This article proposes a naked eye three-dimensional (3D) medical imaging teaching assistant app based on augmented reality (AR) technology to enhance learning interest, teaching interaction, and effectiveness. The control group consisted of 50 undergraduate students from the 2018 clinical medicine major who receive traditional teaching, while the experimental group includes 52 undergraduate students from the 2019 cohort who utilize an AR-based naked eye 3D teaching assistant app in addition to traditional teaching methods. Based on Bloom's cognitive learning taxonomy (Remember, Understand, Apply, Analyze, Evaluate, and Create), corresponding teaching curricula and assessment methods were designed in order to achieve more in-depth learning of the curriculum. The evaluation of the teaching effectiveness between the two groups relied on exam scores and student satisfaction questionnaires, with statistical analyses conducted using t-test and Mann-Whitney U-test in SPSS. The experimental group and control group showed statistically significant differences in the theoretical examination scores (62.06 ± 3.06 vs. 59.82 ± 3.38), practical testing scores (22.90 ± 2.35 vs. 21.06 ± 2.65), and total scores (84.96 ± 4.58 vs. 80.88 ± 6.01). Likert scores showed the experimental group scored significantly higher in enjoyment, satisfaction, participation, efficiency, and understanding. They also reported high convenience scores for the app and desired continued use. The naked eye 3D teaching assistant system is an innovative and effective teaching model for undergraduate medical imaging education, enhancing student interest, student interaction, and teaching effectiveness and promising future applications.

Diagnostic accuracy of a modularized, virtual-reality-based automated pupillometer for detection of relative afferent pupillary defect in unilateral optic neuropathies

Purpose

To describe the construction and diagnostic accuracy of a modularized, virtual reality (VR)-based, pupillometer for detecting relative afferent pupillary defect (RAPD) in unilateral optic neuropathies, vis-à-vis, clinical grading by experienced neuro-ophthalmologists.

Methods

Protocols for the swinging flashlight test and pupillary light response analysis used in a previous stand-alone pupillometer was integrated into the hardware of a Pico Neo 2 Eye® VR headset with built-in eye tracker. Each eye of 77 cases (mean ± 1SD age: 39.1 ± 14.9yrs) and 77 age-similar controls were stimulated independently thrice for 1sec at 125lux light intensity, followed by 3sec of darkness. RAPD was quantified as the ratio of the direct reflex of the stronger to the weaker eye. Device performance was evaluated using standard ROC analysis.

Results

The median (25th - 75th quartiles) pupil constriction of the affected eye of cases was 38% (17 - 23%) smaller than their fellow eye (p<0.001), compared to an interocular difference of +/-6% (3 - 15%) in controls. The sensitivity of RAPD detection was 78.5% for the entire dataset and it improved to 85.1% when the physiological asymmetries in the bilateral pupillary miosis were accounted for. Specificity and the area under ROC curve remained between 81 - 96.3% across all analyses.

Conclusions

RAPD may be successfully quantified in unilateral neuro-ophthalmic pathology using a VR-technology-based modularized pupillometer. Such an objective estimation of RAPD provides immunity against biases and variability in the clinical grading, overall enhancing its value for clinical decision making.

Can viewing a 3D movie improve visual function in children with a history of amblyopia and neurotypical children?: A pilot study

PURPOSE

The aim of this pilot study was to determine whether viewing an immersive 3D movie with large disparities in a cinema resulted in improved visual acuity (VA), stereoscopic depth perception (ST), and improved eye alignment in residual amblyopic children and children without amblyopia.

METHODS

A total of 24 children aged between 5 and 12 years with a history of anisometropic and/or strabismic amblyopia, that had been previously treated and who currently have residual amblyopia (N = 14), and in children with typical development without amblyopia (N = 10) viewed the movie in 3D Sing 2 in a cinema for 110 minutes. Visual acuity, stereoacuity and ocular deviation were assessed before viewing the movie, and three months later. Stereoacuity and ocular deviation were also measured immediately after viewing the movie.

RESULTS

We observed an improvement in visual acuity in the non-dominant (amblyopic) eye 3 months after viewing the movie in the amblyopic group (P<0.001). Stereopsis improved immediately after viewing the movie (P = 0.02), and after 3 months by ≈ 40% (P = 0.01). Moreover, improvements in stereopsis were also observed in children without amblyopia (P = 0.04). No significant changes in ocular deviation were observed in either group.

CONCLUSIONS

These pilot results suggest that brief exposure to large disparities by viewing a 3D movie in a cinema can help to improve stereopsis and visual acuity in children aged 5‒12 years with previously treated amblyopia, and provide a rationale for a randomized clinical trial.

Distinct rich and diverse clubs regulate coarse and fine binocular disparity processing: Evidence from stereoscopic task-based fMRI

While cortical regions involved in processing binocular disparities have been studied extensively, little is known on how the human visual system adapts to changing disparity magnitudes. In this paper, we investigate causal mechanisms of coarse and fine binocular disparity processing using fMRI with a clinically validated, custom anaglyph-based stimulus. We make use of Granger causality and graph measures to reveal the existence of distinct rich and diverse clubs across different disparity magnitudes. We demonstrate that Middle Temporal area (MT) plays a specialized role with overlapping rich and diverse characteristics. Next, we show that subtle interhemispheric differences exist across various brain regions, despite an overall right hemisphere dominance. Finally, we pass the graph measures through the decision tree and found that the diverse clubs outperform rich clubs in decoding disparity magnitudes. Our study sets the stage for conducting further investigations on binocular disparity processing, particularly in the context of neuro-ophthalmic disorders with binocular impairments.

PTVR - A software in Python to make virtual reality experiments easier to build and more reproducible

Researchers increasingly use virtual reality (VR) to perform behavioral experiments, especially in vision science. These experiments are usually programmed directly in so-called game engines that are extremely powerful. However, this process is tricky and time-consuming as it requires solid knowledge of game engines. Consequently, the anticipated prohibitive effort discourages many researchers who want to engage in VR. This paper introduces the Perception Toolbox for Virtual Reality (PTVR) library, allowing visual perception studies in VR to be created using high-level Python script programming. A crucial consequence of using a script is that an experiment can be described by a single, easy-to-read piece of code, thus improving VR studies' transparency, reproducibility, and reusability. We built our library upon a seminal open-source library released in 2018 that we have considerably developed since then. This paper aims to provide a comprehensive overview of the PTVR software for the first time. We introduce the main objects and features of PTVR and some general concepts related to the three-dimensional (3D) world. This new library should dramatically reduce the difficulty of programming experiments in VR and elicit a whole new set of visual perception studies with high ecological validity.

Efficacy of Amblyopia Treatments in Children Up to Seven Years Old: A Systematic Review

Amblyopia is a neurodevelopmental disorder of the visual system that impairs the vision of millions of children worldwide. Amblyopia is best treated within the sensitive period of visual development when a child is up to seven years of age. Currently, the gold standard for early treatment of childhood amblyopia is patching, with new treatments emerging in recent years. We aim to evaluate the effectiveness of these newly developed treatments for amblyopia in children aged seven years and younger while comparing them to the current industry standard of patching. We searched online databases including PubMed, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs), systematic reviews, meta-analyses, and narrative reviews relating to amblyopia treatment in children aged seven and younger. We only included articles and studies completed within the last five years and those written in the English language. After compiling a list of 297 articles, we removed duplicates, articles without an available full text, and those not relevant to our topic. Of the remaining 51 articles, we were left with 22 after reading abstracts and removing further irrelevant articles. We did a quality assessment on the remaining 22 articles and were left with 14 articles for our systematic review after removing eight low-quality articles. Of the 14 articles, we had eight RCTs, two systematic reviews, one comparative interventional study, and three narrative reviews. Seven of the articles contained data reinforcing the effectiveness of patching while comparing it to other treatment modalities. Three of the articles had data supporting spectacle correction, including a novel form called alternative flicker glass which delivers occlusion therapy via a spectacle frame with unique lenses, and ultimately deemed it at least as effective or more than patching. Data from three articles supported the use of surgery to successfully correct the angle of strabismus. Findings from five articles backed the use of pharmacologic therapy, specifically atropine when used alongside patching as a more effective alternative to patching solely. However, levodopa plus patching had no advantage over patching alone. Additionally, seven articles addressed the use of virtual reality (VR) and dichoptic therapy as prospective treatments for childhood amblyopia. VR therapy proved beneficial when used within one week after strabismus surgery. Dichoptic training was also effective in improving amblyopic-eye visual acuity when used on its own or in conjunction with spectacles. Furthermore, dichoptic movie therapy was found to be more effective than patching. Thus, we found multiple highly effective treatments for childhood amblyopia that are as effective or more than patching. Future studies should consider prescribing these treatments to larger cohorts while also performing a cost-benefit analysis for each treatment. In addition, more needs to be learned about the potential adverse side effects of these treatments, especially for pharmaceutical therapy.

Spatial perception in stereoscopic augmented reality based on multifocus sensing

In many areas ranging from medical imaging to visual entertainment, 3D information acquisition and display is a key task. In this regard, in multifocus computational imaging, stacks of images of a certain 3D scene are acquired under different focus configurations and are later combined by means of post-capture algorithms based on image formation model in order to synthesize images with novel viewpoints of the scene. Stereoscopic augmented reality devices, through which is possible to simultaneously visualize the three dimensional real world along with overlaid digital stereoscopic image pair, could benefit from the binocular content allowed by multifocus computational imaging. Spatial perception of the displayed stereo pairs can be controlled by synthesizing the desired point of view of each image of the stereo-pair along with their parallax setting. The proposed method has the potential to alleviate the accommodation-convergence conflict and make augmented reality stereoscopic devices less vulnerable to visual fatigue.

Binocular rivalry under naturalistic geometry: Evidence from worlds simulated in virtual reality

Binocular rivalry is a fascinating, widely studied visual phenomenon in which perception alternates between two competing images. This experience, however, is generally restricted to laboratory settings where two irreconcilable images are presented separately to the two eyes, an implausible geometry where two objects occupy the same physical location. Such laboratory experiences are in stark contrast to everyday visual behavior, where rivalry is almost never encountered, casting doubt on whether rivalry is relevant to our understanding of everyday binocular vision. To investigate the external validity of binocular rivalry, we manipulated the geometric plausibility of rival images using a naturalistic, cue-rich, 3D-corridor model created in virtual reality. Rival stimuli were presented in geometrically implausible, semi-plausible, or plausible layouts. Participants tracked rivalry fluctuations in each of these three layouts and for both static and moving rival stimuli. Results revealed significant and canonical binocular rivalry alternations regardless of geometrical plausibility and stimulus type. Rivalry occurred for layouts that mirrored the unnatural geometry used in laboratory studies and for layouts that mimicked real-world occlusion geometry. In a complementary 3D modeling analysis, we show that interocular conflict caused by geometrically plausible occlusion is a common outcome in a visual scene containing multiple objects. Together, our findings demonstrate that binocular rivalry can reliably occur for both geometrically implausible interocular conflicts and conflicts caused by a common form of naturalistic occlusion. Thus, key features of binocular rivalry are not simply laboratory artifacts but generalize to conditions that match the geometry of everyday binocular vision.

The status of binocular visual functions among Taiwan high-tech industry engineers and its correlation with computer vision symptom

To analyze the status of binocular visual functions, the relationship between binocular visual function and computer vision-related symptoms in the high-tech industry group. The study sample was comprised of 33 participants aged between 20 and 40 years of age. After completing basic information and the Computer Vision Symptom Scale (CVSS-17) questionnaire, the participants underwent a comprehensive examination of binocular visual function. All data were statistically analyzed with SPSS V26.0 software. The value of the binocular vision function of the Taiwan high-tech industry group was significantly different compared with the Scheiman and Morgan standard value. Study subjects were generally found to exhibit larger exophoric at distance, which in turn might lead to a lower ability to maintain binocular fusion to a single image, or recover from fusional disruption at distance. Subjects also experienced accommodation and convergence problems at near at the same time. Age, gender, and refractive errors had no significant impact on CVSS-17 scores, only the duration of computer usage showed a significant effect, particularly for internal symptom factor (ISF) dimensions. In addition, the interaction between the ISF and external symptom factor resulted in more severe visual symptoms. Long-term use of electronic devices may lead to an imbalance in binocular vision function, thereby increasing or exacerbating visual symptoms. If the use of electronic devices is an unchangeable trend, interventions in prescription, visual training or the visual design of electronic products become worthwhile topics for development.

Amblyopia Treatment through Immersive Virtual Reality: A Preliminary Experience in Anisometropic Children

The use of digital devices provides a wide range of possibilities for measuring and improving visual function, including concepts such as perceptual learning and dichoptic therapy. Different technologies can be used to apply these concepts, including, in recent years, the introduction of virtual reality (VR) systems. A preliminary experience in treating anisometropic amblyopia through an immersive VR device and using prototype software is described. A total of 4 children were treated by performing 18 office-based sessions. Results showed that distance VA in amblyopic eyes remained constant in two subjects, whereas the younger subjects improved after the training. Near VA improved in three subjects. All subjects showed an increase in the stereopsis of at least one step, with three subjects showing a final stereopsis of a 60 s arc. A total of three subjects showed an increase of approximately 0.5 CS units for the spatial frequency of 3 cpd after the training. Results from this pilot study suggest that visual training based on perceptual learning through an immersive VR environment could be a viable treatment for improving CS, VA, and stereopsis in some children with anisometropic amblyopia. Future studies should support these preliminary results.