Virtual Reality Check

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In the century before Oculus Rift and Pokemon Go there were dozens of visually-immersive products, several of which focused on clinical applications. What can the history of VR teach us about the technology’s future?

by Nicholas Genes, MD, PhD

Virtual reality is experiencing a resurgence in interest, including renewed attention toward medical applications. New VR research shows promise for applications like physical therapy, pain control and distraction, cognitive-behavioral therapy for phobias and PTSD, and new frontiers in medical training. While VR technology is already in use for laparoscopic surgery and colonoscopy training, enthusiasts hope VR will eventually help students and residents manage resuscitations, and improve skills in performing invasive procedures.

Today’s apps and devices for VR mostly focus on entertainment – but it wasn’t always this way. An early underpinning of VR, the stereoscope, was developed for research purposes by Charles Wheatstone to aid his depth perception research. By holding two slightly different images, aligned side-by-side, stereoscopes let viewers feel an immediacy and stronger sense of depth than traditional photographs (see illustration). This proved immensely popular through the 1800s – more than half of photos taken during the Civil War, for instance, were stereoscopic.

Even as photography (and later, film and television) displaced stereoscopic imagery in popularity, interest in VR-like technology persisted.  Morgan Heilig unveiled Sensorama in the mid-1950s, where a customer would stick his or her head into a special box and experience changing perspectives, as well as stereo sound, blowing winds and specific aromas triggered by events in the film – even a vibrating chair. Heilig later invented the first head-mounted display, called Telesphere, to watch stereoscopic films.

None of these stereoscopic or shifting-perspective viewing devices were interactive at this point; computer technology just wasn’t developed enough. But the idea of simulators had already taken hold, without computers or screens. The Link Trainer, for instance, was a flight simulator of the 1930s whose motors could simulate pitch and roll, as pilots controlled a rudder in a mockup fuselage.

VR, as we recognize it, wasn’t demonstrated until 1968, when Ivan Sutherland introduced the “Sword of Damocles.” This computer-powered headset earned its nickname because of the wires, piped from the ceiling to the head-mounted display, which hung over the user and followed him or her around the room. While the computer powering the headset was huge and the stereoscopic images it produced were primitive, today’s gaze-tracking interactive VR goggles are direct descendants of this technology.

The term “virtual reality” wasn’t coined until the 1980s. Jaron Lanier popularized it, though he was referring to his tactile gloves and not the increasingly sophisticated headsets. His company, VPL, made virtual surgery an early priority.

By the 1990s, companies like Virtuality were making stereoscopic VR arcade games, and movies like “Lawnmower Man” were advancing the concept of people gaining new abilities, or seeking escape, through the technology. But even with more powerful gear, the public failed to adopt VR in large numbers. Nintendo’s Virtual Boy was a commercial flop, and Sega’s VR console never made it to market. With the rise of the web, then mobile phones and smartphones, VR development took a backseat.

Oculus Rift’s successful crowdfunding campaign rekindled interest in VR, in 2012 – and the company was snatched up by Facebook two years later for $2 billion. But nothing has done more to introduce people to the potential of VR than Google’s cheap and kitschy Cardboard headset. Cardboard simply cradles a modern smartphone over one’s eyes,  and app makers have rushed to design smartphone apps that respond to head movements and use the screen as a stereoscope. As simple as it is, Cardboard creates an immersive environment and should be lauded for making the ubiquitous smartphone seem magical again.

In recent years, hundreds of trials of VR have been published in the clinical domain – for medical training, rehabilitation medicine and psychiatry to name three. A few medical schools have made high-profile changes to anatomy curricula, incorporating VR glasses and displays from zSpace to allow lifelike rotation and manipulation of anatomic models. Studies often show benefit to learners – or patients – whether it’s planning complex surgeries with VR, or using the technology to practice resuscitation and managing trauma teams. But the studies are small and the technology is still maturing – and still expensive.

It’s certainly possible that VR – whether through Oculus, Cardboard or other up-and-coming headsets – never becomes more than a niche entertainment device. In a world where Google Glass was polarizing, VR headsets remain socially isolating. But with VR, seeing makes believers: folks who’ve tried the early apps for education and simulating procedures tend to evangelize the experience. The way I see it, there’s likely a bright future ahead for VR in medicine.


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