M&S Technologies News
Be Part of the Technology Revolution in Optometry
Paul Harris, OD, FCOVD, FACBO, FAAO, FNAP
Professor, Southern College of Optometry
My colleague Chris Johnson, PhD said, “The transition from manual to automated visual field testing dramatically improved clinical patient flow and standardization of procedures. The Smart System® VR Headset provides further enhancement and creates the possibility of a single device being able to perform a wide variety of test procedures.” There is a lot packed into this one statement that looks back at where we were as a profession not too long ago, where we are now, and what our future holds.
During my optometric training, I learned how to perform visual fields using a tangent screen. In fact, when I took the New York State licensing exam in 1979, it was one of the stations we rotated through and had to pass to get that ticket punched to begin practice. The first few years of practice I used a B+L Auto-plot, which I kept handy even after purchasing my first automated visual field unit from Dicon. For many years, candidates coming to Maryland to practice would stop by my office to see the device and try it out because they heard it was used on the boards. There were patients for whom this open functional field device was far better than automated perimetry. But that is enough time reminiscing about the good old days!
We as a profession evolved away from these manual devices to automated fields that we could delegate to staff to perform. At first, we thought any person could be trained up to do the testing but over time we learned to value an expert perimetrist. We have lived in the age of automated perimetry, run by our staff, which we review on computers in our consultation rooms after the test is run.
But now we have reached an inflection point where we must decide whether to take the leap into new methods for virtual field tests. The world of Virtual Reality (VR) is the newest technology that can give us the best of both worlds – reliable data with a positive patient experience.
A side observation here. The profession did a similar transition over the past 20 or so years from the projection charts to computerized charts, such as the Smart System® by M&S Technologies. The first versions of these systems all believed they had to replicate the old “Snellen” targets faithfully and replicated exactly the charts the eye care field knew. We, Doctors of Optometry, have never been known as a whole group to be all that adaptable. Always taking one small step at a time forward, usually kicking and screaming and demanding things stay the same. We believe ourselves to be unique in this way, but other fields suffer from the same reluctance to change.
Over time, we realized that we had the full power of a computer at our disposal. We implemented continuously changing size optotypes with search algorithms that allowed one to find threshold acuities to fine levels more quickly than showing replicas of ancient runes like the standard Snellen lines at lock step sizes like 20/30, 20/40, 20/50 etc. Now we can get visual acuities of 20/33 or 20/11 while crossing thresholds multiple times in both directions very quickly. All because the application of new technology allowed us to approach visual acuity tests in a different way.
Now that VR headsets are available for visual fields, we revert to beating the same drum, “Don’t move my cheese,” even after seeing the benefits of technology over the last 20 years. We engage in the same behavior of resistance to change that is a normal part of who we are. However, some have realized that we do not have to build replicas of the large cubes that take up full rooms and need to be kept in the dark, triggering anxiousness in some of our patients. No, some of the brightest minds have provided a way, using the power of the computer and the natural freedom to view the world in the VR setup, to allow patients to do a visual field test in fully lit rooms without the constraint of their head having to remain still in a large device. These developments also allow a practice to utilize one staff person to test multiple patients simultaneously. The evolution in the testing protocols and the insights that can be gained to identify progression earlier than ever before will empower us to raise the bar for the level of care we are giving for progressive diseases such as glaucoma and beyond.
We are just scratching the surface of what can be done inside the VR headsets which have been difficult to do in the traditional 20-foot lanes of our offices. In fact, the 20-foot lane is a relic, with many offices already adapting to smaller lanes using optical folding. In some places, as the projectors were removed and Smart Systems were put up, decisions were made to remove the mirror systems and put the screens a scant 6-8 feet in front of the patient. With the VR headsets, we can indeed simulate all distance along the Z-axis, and this is opening the possibility of testing things like stereo acuity and stereo volume at different distances.
The next article in this series will look at testing of stereo acuity in the Smart System VR Headset with a population of elite athletes. Change is upon us and those who adapt using new technologies in our practice will thrive.