JMIR Publications

ABSTRACT

Background:

The ability for extended reality to create, augment and present environments otherwise impossible in the real world has practical applications in the medical discipline. In ophthalmology, virtual reality simulators have become increasingly popular as a tool for surgical education. Recent developments have also explored diagnostic and therapeutic uses in ophthalmology.

Objective:

This systematic review aims to identify and investigate the utility of extended reality applications in ophthalmic education, diagnostics and therapeutics.

Methods:

A literature search was conducted using PubMed, Embase and Cochrane’s Register of Controlled Trials. Publications were included from January 1956 to 15 April 2020. Inclusion criteria were studies evaluating the use of extended reality in ophthalmic education, diagnostics and therapeutics. Eligible studies were evaluated using the Oxford Centre for Evidence-based Medicine (OCEBM) Levels of Evidence. Relevant studies were evaluated for evidence of validity using Messick’s validity framework. Findings and relevant data from the studies were extracted, evaluated and compared to determine the utility of extended reality in ophthalmology.

Results:

We identified 12,490 unique records in our literature search; 87 met the final eligibility criteria, comprising studies evaluating the use of extended reality in education (n=54), diagnostics (n=5), and therapeutics (n=28). Of these, 79 studies (90.8%) achieved an OCEBM evidence level of 2b to 4, indicating poor quality. Of 22 relevant studies, only 2 (9.1%) addressed all five sources of validity evidence. In education, we found that ophthalmic surgical simulators demonstrated efficacy and validity in improving surgical performance and reducing complication rates. Ophthalmoscopy simulators demonstrated efficacy and validity evidence in improving ophthalmoscopy skills in the clinical setting. In diagnostics, studies demonstrated proof-of-concept in presenting ocular imaging data on extended reality platforms and validity in assessing the function of patients with ophthalmic diseases. In therapeutics, heads-up surgical systems demonstrated no significant differences in complication rates, procedural success and outcomes in comparison with conventional ophthalmic surgery.

Conclusions:

Extended reality has promising applications in ophthalmology, but more comparative and higher quality studies are needed to assess their role amongst incumbent methods of ophthalmic education, diagnostics and therapeutics.