Eyeworld

EW NEWS & OPINION 22 February 2016 Insights by J.C. Noreika, MD, MBA sophisticated optics, powerful pro- cessors to ensure real-time eye track- ing, novel heat sinks and batteries. The hardware is where smartphones were in the mid-1990s, software where apps were in 2006. Its poten- tial is unlimited. VA-ST's Smart Specs uses AR to help the legally blind enhance residual vision for facial recognition, reading, obstacle avoid- ance, even driving. Microsoft's HoloLens will be shipped to developers in this first quarter of 2016. Hundreds attended December's HoloLens Developer Experience Showcase. Wearing the HoloLens, a person can walk over, through, under, and around holo- graphic images. It weaves real and virtual sights and sounds seamlessly. Tactile, proprioceptive and olfactory recognition is in the works. Might this technology realize the nascent promise of telemedicine to resolve the elusive muddle of efficient, cost-effective healthcare for the masses? EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for 35 years. Contact information Noreika: JCNMD@aol.com produces the VeinViewer, a hand- held device using infrared light to locate veins up to 1 centimeter deep. It is done in real time, adjusting for the patient's movements. It paints a vessel's position, valves, bifurca- tions, and patency onto the skin. Luminetx states that finding a vein on the first stick is 3.5 times more likely using its device. Thousands have been sold. AR can improve surgical outcomes by enhancing planning, honing strategy, and truncating learning curves. Innovega's iOptik System uses a "smart" contact lens to overlay graphical images onto real objects; whatever runs on an iPhone can be projected via the lens. Preoperatively, an eye's imaging studies and nomograpic data are captured during the patient's clinical workup. During the procedure, this augmented information directly overlays the operated eye and is seen by the iOptik lens-wearing surgeon in high-definition 3-D. Crazy? VIPAAR (virtual interactive presence in augmented reality) projects an avatar, a spatially remote "expert's" hands, into the microscopic dis- play, guiding the novice to the next movement. Psychological desensi- tization affords a safer transition to "the other side of the table." Drawbacks include the cost of the equipment, which requires Ophthalmology is a player. Vir- tual reality may be a game-changer of training and education. A surgeon could unveil the "holy grail" of pres- byopia correction to an audience of residents and fellows seated in class- rooms an ocean away. They would wear devices over their eyes similar to Samsung's Gear VR for a complete immersion experience; by turning one's head, the view through the operating microscope smoothly transmutes to the assistant preparing the surgeon's next instrumental se- quence. Performed in Germany, the operating room's clock would seem to be 6 hours ahead to observers in New York. Sounds of personnel and technology would be heard, with neither lag nor distortion of the high-definition 3-D scene presented to the viewer's eyes. VR is mainstream, Silicone Valley-speak for old news. It is coming to a symposium near you soon. A creatively destructive inno- vation, it poses a serious threat to medical meetings, those cash cows that are to our organizations what beribboned blue blazers are to their attendees. Why suffer indignities of commercial air travel, 350-square- feet of a grossly overpriced hotel room, and being closed out of courses when you can sit in a re- cliner next to the fireplace sipping a beverage of choice? Far more transformative is augmented reality (AR). True AR is more than showing information on a screen as a heads-up display (HUD) does in attack helicopters and ostentatious cars. Want to know how much energy is discharged into a brunescent cataract's eye? That information is found transparently projected in the periphery of the operating microscope's field. This is HUD. Kyle Samani, cofounder and CEO of Pristine, sniffs that HUD is not augmented reality. True AR su- perimposes imagery on a user's view of the world melding digital with real. It goes beyond "gluing a phone to your face." I was a surgical intern before limitations were set on house-of- ficers' hours. On call every other night, the inevitable 3 a.m. call to restart an IV was the intern's version of the basic trainee's KP. Luminetx Virtual reality's application in ophthalmology will be outstripped by the immense potential of augmented reality I magine: You roam the stage as the "cute" Beatle, Paul McCartney, plays his Steinway while musicians amp the vol- ume to work the thousands in the audience into primeval frenzy. The heat, sound, and smell of the arena confront your senses. How did you score this ticket? A smart- phone, an app (www.jauntvr.com), and Google Cardboard. Since you already have the smartphone, your admission ticket—the Cardboard— costs about $10 on Amazon. This is virtual reality. Virtual reality (VR) puts the viewer into a self-contained environ- ment of artifice. It's all smoke and mirrors. You turn your head to the left and Paul McCartney is singing "Live and Let Die." Turn back to the right and a drummer is feverishly hammering the percussions. Straight ahead are thousands of adoring, gesticulating fans that only athletes, rock stars and demigods know. You are immersed in a highly perceptible yet utterly ethereal experience. Your brain doesn't know that. Initially conceived to create online virtual worlds for Internet gamers and the military, VR com- mandeers corner offices of Silicone Valley giants Google and Apple. Mark Zuckerberg's Facebook paid an astonishing $2 billion for the Oculus Rift even though chosen app developers didn't get their hands on it until late December. Microsoft, Sony, HTC, Samsung, and Toshiba are all in. Private equity and ven- ture capital covet the opportunity to write enormous checks to little known companies such as Atheer, Optinvent, and Meta. The new, new thing augmented J.C. Noreika, MD, MBA

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