Healthtech Innovations: Visual-Impairment Assessment Via VR

Cataracts, glaucoma, diabetic retinopathy and age‑related macular degeneration (AMD) are common eye diseases in Hong Kong. Among them, glaucoma is the leading cause of irreversible blindness. Since early signs of glaucoma are not obvious, and most people do not have regular eye exams, the optic nerve in patients with glaucoma can sometimes be seriously damaged with irreversible loss in vision by the time symptoms appear.

The Covid-19 pandemic has not just aroused public‑health awareness but has also made more people realise the positive impact of the development of science and technology on healthcare. Professor Christopher Kai‑shun Leung, CEO of Ace VR Ltd and Professor of the Department of Ophthalmology of the LKS Faculty of Medicine, The University of Hong Kong (HKU), spoke to HKTDC Research about the VR technology developed by his company for assessment of visual disability and discussed the development direction and potential of its applications.

VR Boosts Visual-Impairment Assessment Efficiency

There are more than 170,000 visually impaired people in Hong Kong, according to the Census and Statistics Department. Since many eye diseases do not have obvious symptoms in the early stages, day‑to‑day activities and quality of life can be considerably compromised before disease diagnosis. Leung pointed out that whereas the quality of vision can be adversely affected, visual acuity measurement can be normal. He explained: “This is because regular eye check typically only includes visual acuity testing and measurement of refractive errors such as myopia, hyperopia, astigmatism and presbyopia. Assessment of visual impairment, however, needs to take into consideration other domains of visual function including peripheral visual field sensitivity, contrast sensitivity, color vision, depth perception, and sense of three‑dimensionality. These visual function tests require separate examinations, rendering them difficult to be scheduled on a regular basis in public hospitals and expensive to administer in the private sector.”

The medical world has yet to find clinical tools that can gauge the impact of visual impairment on patients’ day‑to‑day activities. Leung and his team have developed a visual‑impairment assessment system with a VR headset simulating day‑to‑day activities, such as supermarket shopping as well as stair and city navigation in daytime and night‑time simulations, in order to infer the extent of any visual disability. By recording data on the time the user takes to complete the task, the frequency, angle and speed of collision with virtual objects, the size and intensity of colour of the collision objects, the system can produce an overall visual impairment score and thus quantify the impairment.

The VR visual impairment assessment platform can quantify visual disability when users perform simple day‑to‑day activities using a headset.

Although VR assessment of visual impairment cannot replace conventional eye exam by ophthalmologists, VR assessment is particularly suitable for screening of vision. It also allows doctors to judge the specific impact of eye diseases on a patient’s activities of daily living, work out vision rehabilitation programmes, and guide treatment decision. As a non‑invasive tool, VR assessment can also effectively enhance the flexibility and reliability of data collection. As Leung explained: “Through this system, we can integrate different domains of visual function to establish the clinical standard for assessment of visual disability and to quantify the degree of visual disability for early detection of disease deterioration.”

Advantages of University Research Team

Securing funding for clinical research is a major hurdle for many healthcare start‑ups. However, Ace VR Ltd, with its research team from university and the Hong Kong Eye Hospital, is able to clear this hurdle because it has received funding support from different sources. The team has received the Innovation and Technology Fund and Technology Start-up Support Scheme for Universities (TSSSU) provided by the Innovation and Technology Commission. TSSSU has facilitated the spinoff of a start‑up company – ACE VR Ltd to commercialise the VR technology. The company has also been admitted to the Cyberport Incubation Program to advance the R&D and commercialisation.

Leung, explaining that members of the company’s research team have multiple identities, said: “They are postgraduate students, members of the research team of the Hong Kong Eye Hospital as well as employees of Ace VR Ltd. We recruited patients from Hong Kong Eye Hospital to conduct clinical studies. Since clinical data obtained from these patients can also be used in other related research projects, better allocation of resources to reduce the cost and time of data collection and improve R&D efficiency has become possible.”

The team’s achievement has been recognised after more than a year of clinical testing. The clinical study investigating the application of VR technology for assessment of visual disability was published in an international, peer‑reviewed medical journal JAMA Ophthalmology in March 2020. Furthermore, Ace VR Ltd has won several local and international awards including the Hong Kong Information and Communication Technology (ICT) Smart Living Grand Award and Gold Award (Smart Healthcare), the Asia Pacific Information and Communications Technology Alliance (APICTA) Information and Communications Excellence Award, and the Innovative eHealth Solutions Award of the World Information Technology and Services Alliance (WITSA).

Professor Christopher Leung (fourth from left) accepts the Grand Award and Smart Healthcare Gold Award at the 2019 ICT Awards for Ace VR Ltd.

Ace VR Ltd was winner of the 2019 Asia Pacific Information and Communications Technology Alliance (APICTA) Awards (Inclusions & Community Services – Health and Wellbeing).

Serving the Community: Remote Home Monitoring

This technology has already been applied in the Hong Kong Eye Hospital. Leung explained: “We hope to extend the VR technology to community centres, nursing homes, optical shops and general out‑patient clinics to facilitate the screening of vision. In the long run, we hope to provide remote home‑based monitoring services to people diagnosed with chronic eye diseases. Patients may wear the VR headset at home and complete the tasks as required by the system for assessment of visual impairment. Doctors can remotely monitor patients’ conditions and re‑schedule appointments for follow‑up if the condition deteriorates. By contrast, stable patients can be followed up in the eye clinic less frequently. This can reduce the number of follow‑up consultations and make the health service and the entire healthcare system more efficient and cost‑effective.”

Leung admitted that price was the biggest hurdle in the promotion of remote home‑based monitoring. The VR head‑mounted display alone costs several thousand Hong Kong dollars. Also, it takes a high‑performance computer which may cost more than HK$10,000 to accurately simulate the virtual environments. Home‑based monitoring will, however, become more affordable with the rapid advancement and popularisation of high‑performance computing chips.

Market Expansion

On market expansion overseas, Leung said: “The EU and the US are our preferred markets because they are more international in their healthcare service regulatory system. As a next move, we plan to open an office in the US and apply for FDA (Food and Drug Administration) certification.”

Ace VR Ltd is also conducting research on scenario‑based virtual driving, a system that may help determine whether visually impaired drivers are fit to drive. Leung explained: “If a professional driver sustained visual impairment due to a work‑related injury, scenario‑based virtual driving can assess the impact of vision loss on his work so the insurance company can comprehensively assess the amount of compensation to which he is entitled. In future, we will continue to develop more scenarios and try to make use of artificial intelligence and big data to analyse additional data, such as eye movement, collected from the VR simulations for assessment and prediction of visual impairment.”

Hong Kong can develop into an international innovation and technology hub as the Outline Development Plan for the Guangdong-Hong Kong-Macao Greater Bay Area unfurls. The congregation of innovation and technology talent is expected to generate invaluable opportunities for innovation and technology start‑ups.