VRITA: A Lazy-eye Solution

1. We are committed to solve the issues of low compliance with conventional clinic-based treatment for lazy eye, and save parents travel time, clinical visits which are not possible due to pandemic related lock-down, money, and efforts while providing an effective but fun at-home solution to avoid preventable vision loss in children. 

2. We are proposing the development of a simple, low cost, non-invasive treatment that would be a clinically tested smartphone based affordable virtual reality game that can treat lazy eye in the comfort of home allowing parents to continue treatment even in crisis such as pandemic related lock-down. 

3.Time is crucial for lazy eye management, early detection and timely treatment are the key to avoid preventable vision loss. The pandemic related lock-down differed children from timely treatment and a solution like ours has the potential to replace clinic-based treatment sessions with at-home guided amblyopia management treatment program.

Worldwide 1.4 million children are visually impaired or blind. As per World Health Organization, at least 1 billion visual impairments can be prevented or/and managed, among which uncorrected refractive errors and amblyopia are the major contributors. The pooled prevalence rate of amblyopia worldwide is 1.44% and in India around one to four percent of pediatric population is affected by amblyopia. We are solving the problem related to the management of amblyopia, a visual impairment which affects majorly children and exists even in adulthood. By treating the condition through the newly developed remote affordable digital therapy during this pandemic situation we will be improving the visual functions of amblyopic children.

A low-cost virtual reality-based vision therapy game application for at home guided therapy that a clinician can remotely manage for amblyopia treatment. 

This game application will be scientifically designed in such a way that it trains all those visual functions that are affected in children with lazy eye. The clinician will be monitoring and controlling the app remotely. Based on the performance of the child, the difficulty level will be improvised for the betterment of the visual functional improvement.

The game is designed for an android based smart phone, to be used on any virtual reality head set.

Our solution is targeted as a remote therapy for underserved or for rural paediatric population who otherwise will be left untreated due to the current concerns of Coronavirus infection. 

With the current solution, these children need not step out of their home as its planned remotely and also since the treatment is given on a virtual space with a realistic visual experience, it will be fun for the children to play the game. Through this game play we intend to improve the visual functions like visual acuity, three-dimensional perception, and contrast sensitivity, hence improving the quality of life of children with lazy eye. 

As a first step, we will be conducting community level screening for children with amblyopia,  at rural and underserved population. Once these children with lazy eye are identified, we will be providing them with the  new therapy developed there by improving the quality of vision.

The current pandemic has challenged the health management system in many ways. One of which is the treatment modalities where the patient must come to office on a daily basis. One of such condition is amblyopia, where vision therapy is planned for children daily at office. Even though there are conventional management which can be performed at home, the compliance is known to be very poor from patient’s side. The remote vision therapy modalities available currently are quite expensive and not affordable by low socioeconomic group. So here we are coming up with a solution which can be given as a remote therapy at home and affordable and practical to all categories of people including rural population. 

With the help of structured scientific survey studies, we have established the need for an at-home treatment for lazy-eye management. So we are coming up with a solution for the same through VRITA, virtual reality based application for the treatment of amblyopia. The prototype is designed for a android based smart-phone which can be played with any virtual reality head set. The game application is designed such that it trains all those visual functions which are affected among children with lazy-eye. The prototype will be tested among the clinical population of lazy-eye to understand its efficiency in the clinical practice. We are equipped with over 40 years of cumulative clinical experience in the treatment of amblyopia and have prepared a proof of concept to be tested. Hence, we believe that we are at this step.

Our solution is identifying children with lazy eye at community level and treating them with the most affordable and high-tech fun game application. The new solution is innovative in a way where the treatment is planned based on individual requirement, unlike existing game applications. The training of each visual function affected due to lazy eye takes place at various levels of game application without child’s knowledge. So, children will be trained in an entertaining way for all those poor visual functions through playing the game without their cognisance. We will be utilising the latest technology of virtual reality on a smart phone giving each child the real-world visual experience in a virtual space. 

Our solution VRITA will be better in such a way that it gives a realistic visual experience in a virtual world. So child will be more involved with the treatment modality as compared to conventional treatment. Also since we are working remotely, it solves the problem of travelling, pandemic lock down situations, less official visits having a positive attitude from parents of these children as well. In the past, studies have shown parent's of these children are worried about the bullying of their children from their peers due to the treatment modality for lazy-eye. The VRITA game is played by the child at home and nobody gets to know that the child is having visual problem for which he/she is on treatment. So because of all these reasons the new VRITA game application will have positive impacts on children with lazy eye and even parents who will be monitoring these children.

Virtual Reality based interphase with carefully selected targets on a smart phone screen and simple affordable VR headset. We will be utilising Unity 3D gaming engine to create the models and textures for the virtual reality game. The game application will be developed for android smart phone insuring reach to all socioeconomic group. 

Herbison et al1 in the year 2016 have conducted study on 75 children using a virtual reality game application for the treatment of amblyopia. The treatment was given for six weeks on a head mounted virtual reality game application (VR I BiT) and has shown an improvement of visual acuity. Another study by Ziak et al2 in 2017 has shown 30% improvement in vision post treatment with virtual reality game (VR Vivid Vision TM). The study has also reported an improvement in 3D vision (depth perception) among the lazy eye children. Similar study was performed by Cindy Ho et al3 among pediatric and adult age group amblyopic/lazy eye patients with virtual reality game (VR Vivid vision). The study participants were the patients who had failed in improving with occlusion therapy, the conventional treatment. This study also has shown an improvement in vision (visual acuity of 1.5 lines) along with improvement in depth perception (stereopsis). So, these studies have proven the advantage of having the binocular training with realistic virtual world experience against the monocular visual training (occlusion therapy) done in the past. Although there has been improvement in some of the visual functions, they have not been planned for training all the aspects of vision, on which we are planning to work in our innovative solution.

References:

• Herbison N, MacKeith D, Vivian A, Purdy J, Fakis A, Ash IM,et al. Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system. The British journal of ophthalmology. 2016;100(11):1511–1516. https://doi.org/10.1136/bjophthalmol-2015-307798
• Žiak P, Holm A, Halička J, Mojžiš P, Piñero DP. Amblyopia treatment of adults with dichoptic training using the virtual reality oculus rift head mounted display: preliminary results. BMC Ophthalmology. 2017;17(1):105. https://doi.org/10.1186/s12886-017-0501-8
• Cindy Ho, Yousef M. Shahin, Henry Reis, Stefanie Grenier, Deborah Giaschi. Binocular treatment for amblyopia in adults and children with low-pass filtering when occlusion therapy fails. Posterboard number 218 - A0627. ARVO 2019. https://www.seevividly.com/downloads/Ho_BV_Treatment_When_Occlusion_Fails_ARVO_2019.pdf

We anticipate no immediate risk and a minimal risk of eye-strain with continuous digital viewing among users. This is managed by restricted time period per day, that can be set by the clinician.  

The confidentiality of each patient's data will be maintained always. The patient's data will be accessed only by the doctor treating the patient. The application will be password protected and will be stored on the cloud for the safety purpose. 

The solution is planned such way that it meets the Declaration of Helsinki. 

Currently- we have been treating around 50 amblyopic patients. 

In one year - 200 patients at one centre (Testing phase). 

In 2 years and above- We can treat as many people as possible with our new solution, as it is convenient to use, because it has cloud storage. An estimated 30,000/- reach is expected between 2 to 5 years duration. 

It is estimated that India has around 1.391million children with amblyopia. Though our solution we have plans to screen the children with lazy eye at community level. Once children with lazy-eye are identified, the application has a potential to benefit this target group. 

The project has 5 milestones that are time bound and the team lead would organise timely review meeting to monitor the progress of each goal. We would work dedicatedly to meet the milestones. Progress report would be produced every month.  Actions will be taken to achieve each milestone carefully. The milestones are listed as below:

1. The first milestone will be to test the efficiency of VRITA  among the clinical population lazy-eye as compared to the conventional treatment. 
2. Once its efficiency is proven, we will be conducting the community based screening for lazy-eye among children.
3. Children identified with lazy eye will be given with VRITA- a game application to be played on android based smart phone and virtual reality head set.
4. Children will be assessed for the improvement of visual functions remotely through the game application
5. The final assessment will be done at office to test all the visual functions improved with VRITA at the end of three months.

Our solution team has 20 members

Full time:

Scientific team

1. Two pediatric optometrists 
2. One pediatric ophthalmologist 
3. One research scientist 

Technical team

1. One Technical Project Manager 
2. One App developer (Technical team)
3. One graphic designer and tester (3D and 2D) 

Part time:

1. One public health specialist 
2. Ten volunteers
3. A Medical Psychologist 
4. A biostatistician

Our solution team is having subject experts with experience of more than 10 years in their respective specialties. All the team members are currently working with well-known health management organisations serving the community. The associated organisation has conducted community outreach programme for children and their eye care. Nationwide around 5.8 million children have benefitted in the last two decades through this outreach programme. This association is currently helping us in planning and executing our solution.

We have a team that is equipped with relevant experience and great passion for the project. The team members come from diverse specialties with a common goal. We bring in a cumulative experience of over 100 years in specialty paediatric eye care. The panel consists of a paediatric ophthalmologist, pediatric optometrist, an experienced virtual reality game app developer, public health practitioner and a medical psychologist. So, each one of the team members has equitable role and leadership quality to be intricated to get the best possible solution for lazy eye/ amblyopia among children.

No, we do not have any one with this rare disease. But all of us are involved with the screening and treatment of this condition in our clinical practice. The team leader also has a family member who is suffering from this particular condition, so have seen this condition very closely. 

We are applying for the Horizon Prize as lazy eye/amblyopia is a condition which is usually left undetected and untreated in many children and even adults. This majorly contributes for preventable blindness. As children once get the spectacle correction, parents assume that vision will be improved, but that may not be the case. In children with lazy eye require addition treatment for improving the visual functions. So here we are developing a new VR based vision therapy game application utilising the latest technology and testing it in the clinical practice. This development of game application  will require huge financial support. Once the application is proven to be efficient in treating the amblyopic children, we are planning to have a large-scale school screening and community health screening for amblyopia among children as it may be left undetected otherwise. Based on the number of amblyopic children found with screening, all those children will be provided with the newly developed VR game application in their parents’ smart phone. We will also be providing the VR headset for each child as we are targeting the poor and middle-income population. Due to this we are in requirement of the funding for our solution.

As we require financial support in terms of development of final game application and also for the community eye screening of children at a larger scale, we are in requirement of financial support. Also we are targeting the low socio-economic and rural population, so we will have to provide with the accessories required to play the game application which will be the newer treatment modality for lazy eye.  

The technological support if given by your esteemed institute will be of utmost help in improvising our prototype VRITA into the best possible application for the treatment of lazy-eye. 

We would like to partner with MIT solution team and also the technical support team. From the MIT solution team, we would require the guidance in terms of planning of our solution in a systematic way. Also, the technical team of MIT, can guide us with their expertise in the latest technology of VR game application development.