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Download a PDF of The Wearable Tech Effect.

Once considered the stuff of science fiction, wearable technology in health care—including fitness trackers, smartwatches and other personal monitors—is now mainstream. And the demand is clearly growing. According to a report from Insider Intelligence, consumers’ use of wearable technology to track their health has more than tripled in the past four years, and this year, more than a quarter of the population will be wearing these devices. When it comes to vision care, though, another popular wearable technology, virtual reality, has moved into the foreground. With millions of consumers worldwide now using virtual reality (VR) headsets for online gaming and other forms of entertainment, employing VR devices for diagnostics, vision training for patients and teaching eyecare professionals is becoming a natural extension of the technology.

Wearables are also adding an important new dimension to assistive technology for people who are blind or have low vision. As the Lighthouse Guild, a leading resource for people with vision impairments, noted on its website, “Wearable Assistive Technologies for people who are blind or visually impaired include devices that are developed from the ground up with vision loss in mind. The premise of these devices is to allow increased functionality in activities of daily living. Some can help with reading, watching television or sporting events, computer use and work.

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“Many are head-worn, utilizing AI and computer vision, and gives audio feedback and is used by someone who is blind or has low vision. Others use glasses with LED screens, near the eyes, or virtual reality-like goggles that provide magnification for someone who is visually impaired.”

VM spoke with a number of suppliers and doctors to learn how wearables are being used to diagnose and treat patients for a variety of eye conditions, train eye doctors and increase accessibility for those with vision impairments. (Note: Although smart glasses are considered wearable technology, this article focuses on virtual reality headsets and other vision-related devices.)


Wearables’ New Role in Diagnostic Applications
As with any health condition, early detection and treatment of vision conditions is key to increasing quality of life for patients. Wearable devices and the technology behind them—including VR, which offers wearers an immersive experience in a virtual environment; AR, which lets wearers see their surrounding environment while adding an overlay of data and images, and artificial intelligence (AI)—can help eyecare professionals (ECPs) act on large quantities of different types of data, offering huge potential for early detection, remote diagnostics and more personalized treatments.

One focus of VR technology is visual field testing—augmenting the automated perimeter test that hasn’t changed much in 30 years.

The Olleyes VisuALL S Virtual Reality Platform and Olleyes VisuALL ETS Comprehensive Testing Suite, sold exclusively by Marco, are virtual reality, multi-test systems designed for standardized and mobile assessments of the visual field. In addition to perimetry, these devices offer a myriad of additional tests including pupillometry, visual acuity, color vision, contrast sensitivity and more.

“The Olleyes VisuALL VRPs give doctors flexibility,” said Jocelyn Hamilton, president, Marco Healthcare. “They no longer need a dedicated space to conduct many types of vision tests, as the VisuALL test can be performed virtually anywhere. The patient experience is high-end, and the eye tracking algorithm of the VisuALL ETS pays attention even when the patient loses focus, eliminating fixation loss. Plus, with the full suite of tests available, exams can be completed faster and with more data provided.”

The Olleyes VisuALL platform also comes with “Annie,” a virtual assistant that frees up staff and walks the patient through the testing processes in the headsets, offered in nearly 40 languages.



VisuALL S Virtual Reality Platform
VisuALL ETS Comprehensive Testing Suite
Manufacturer: Olleyes
Key Features:
• Enables testing in any environment.
• Frees up staff with Annie the virtual assistant.
• Improves the patient experience.
Learn more at https://marco.com/product-category/perimeters/

M&S Technologies offers another VR-based visual field testing solution. The company’s VR headset provides a comfortable test-taking experience with an easy-to-use interface and audible instructions making the process as close to autopilot as you can get.

By using Bluetooth technology, tests can be run without depending on unreliable Wi-Fi connections. Each eye can be tested individually while the patient keeps both eyes open for fast, yet accurate results. M&S Active Eye Tracking ensures patients are locked in on the fixation target, pausing the test if fixation is lost and resuming after the headset’s internal cameras detect eyes are again focused on the fixation target. This offers maximum accuracy and reliability for every visual field.

Mark Leipert, OD, Optical Expressions Berlin (Berlin, Vt.) uses the headset daily as another option for automated perimetry and can attest to the benefits firsthand. He said, “I was looking for an alternative visual field that might be easier for some patients to use. For example, we have patients who are in wheelchairs, have mobility problems, or are just poor visual test takers who prefer this modality.”



M&S Technologies Smart System VR Headset
Manufacturer: M&S Technologies
Key Features:
• Includes Surface Pro tablet and two controllers.
• Active Eye Tracking with reliable, fast results.
• Conveniently test anywhere—no Wi-Fi connection is needed.
• Patient comfort, lightweight design with an intuitive interface.
Learn more at https://www.mstech-eyes.com/vr-headset

Other exam systems offer even more versatility. For example, Heru’s multi-modal wearable technology solution delivers nine vision exams, supported with five reimbursable CPT medical billing codes, in a single wearable AR/VR headset. Introduced in October 2021, the platform replaces several legacy diagnostic devices and exceeds traditional standards of care in usability, cost, size and portability. Since the platform’s commercial launch, the Heru platform has passed the clinical milestone of performing over 175,000 eye exams.

“We are thrilled to see the rapid adoption of the Heru platform,” said Mohamed Abou Shousha, MD, PhD, Heru’s founder and CEO. “We started with one application in 2021 and we will soon offer 12 applications—with the collection continually growing.”



Heru Multi-Modal Technology
Manufacturer: Heru
Key Features:
• Delivers 12 vision exams, supported with reimbursable CPT billing codes, in a single, wearable AR/VR headset.
• Enables eyecare providers to easily fit a multitude of eye exams into their practice workflow.
• Born out of the University of Miami’s Bascom Palmer Eye Institute, a well-known incubator of novel, disruptive technologies.
Learn more at https://www.seeheru.com/

Another company, Xenon Ophthalmics, is focused on addressing the skyrocketing global demand for vision exams through the world’s first medical-grade ophthalmic diagnostic technology. The company’s soon-to-be-released XO Exam system provides a comfortable headset for conducting vital ophthalmic examinations, enabling practitioners to see more patients than ever before while providing a very high level of care, even remotely. The exam system performs a visual field test and an aberrometry test.

“Vision care needs to be brought to the people who need it, especially in remote areas of the world,” said Zeshan Khan, CEO, Xenon Ophthalmics. “A trained technician with several of our XO Exam units could work with an optometrist located remotely, or perhaps a teacher in a small village, to extend access to vital eyecare exams.”

Using XO Exam, patient wait time, exam time and overall appointment time are reduced, providing greater comfort and convenience, while maintaining a high standard of care. In addition, ECPs can expand their practice without investing in additional conventional and often outmoded diagnostic equipment.



XO Exam System
Manufacturer: Xenon Ophthalmics
Key Features:
• Consists of the XO Exam VFT (Visual Field) and XO Exam ABT (Aberrometry) detachable and interchangeable system.
• Covers vital, ophthalmic diagnostic examinations on a comfortable headset, enabling practitioners to see more patients efficiently, even remotely.
• Reduces equipment, maintenance, labor, training and office space costs associated with ECP practice expansion.
Learn more at https://xophthalmics.com/

IrisVision is another leader in digital vision technologies. It offers an FDA registered Class-I medical device that harnesses the power of a Samsung Galaxy smartphone mounted in a VR headset. IrisVision’s easy-to-use system enables people who have impaired visual acuity due to conditions such as macular degeneration, diabetic retinopathy and RP see clearly again.

The lifestyle-friendly devices are available in two platforms—the original IrisVision Live and the newer IrisVision Inspire, a low-profile wearable device currently only available in the U.S.

In 2022, IrisVision co-founder and CEO Ammad Khan introduced a new company, Radius XR, at the American Academy of Ophthalmology (AAO) meeting. Radius XR builds on the therapeutic legacy of IrisVision by introducing diagnostic capability to the proprietary VR/AR assistive device.



IrisVision Live
Manufacturer: IrisVision
Key Features:
• Combines leading-edge software lens technology with robust connectivity tools.
• Clinically validated, award-winning voice-controlled technology.
• Wi-Fi and cellular connectivity for media features and remote support.
Learn more at https://irisvision.com/irisvision-live/

The company’s Radius XR is a portable vision diagnostic system combining medical-grade diagnostics, business management and patient education tools in a single wearable AR/VR device. Using a single Radius XR headset, patients can self-perform a range of vision tests that are clinically equivalent to gold standard exams. The exams currently performed with the Radius XR testing platform are visual field, visual acuity, contrast sensitivity, Amsler grid and color scheme.

Designed to look and feel like a pair of fashionable sunglasses, Radius XR weighs less than 6 oz., and features all-day battery life. Its portable design allows exams to be conducted anywhere, even in the waiting room. The multi-modal platform enables patients to perform self-guided vision exams with minimal supervision.

“I’m convinced that Radius represents the future of office-based visual field testing,” said Stephen Montequila, OD, West Bay Eye Associates in Warwick, R.I. “It’s lightweight, accurate and adaptable. And Radius offers us so much more. The customizable video library allows us to educate patients on various topics, freeing up staff and giving us more time to provide a better patient experience.”



Radius
Manufacturer: Radius XR
Key Features:
• Medical-grade, 6 oz. perimeter featuring all-day battery life with validation study proving average testing time is 10 percent faster than bowl perimeters.
• Validated exam strategies for 24-2 RATA Standard/Fast, 10-2 Standard, 30-2 Standard.
• Patient education library featuring Drs. Radcliffe, Bacharach, Thimnons, Donnenfeld and Zhu.
Learn more at https://radiusxr.com/

Vivid Vision is another company using wearable technology as a platform to deliver powerful tools for vision care professionals. The company’s Vivid Vision Perimetry (VVP) is a mobile VR-based visual field test designed for at-home visual field monitoring. VVP is designed along proven principles from cognitive psychology to be easier to take. By taking visual field tests at home, patients can collect more data so that changes in their vision can be detected in months rather than years.

“We’ve solved the fundamental problem in visual field testing, which is actually a mathematical problem,” said Benjamin Backus, PhD, chief science officer, Vivid Vision. “The real problem with conventional perimetry is variability. You can always overcome variability just by collecting more data, and that’s what we do. People are used to thinking of visual field tests as being inherently unpleasant, so they never think of trying to make the test 10 times as long.

“But we can do that with our test by combining three essential ingredients: at-home testing, use of a mobile VR headset, and the essential secret sauce that sets us apart, which is modifying the test using proven principles from cognitive science and vision science to make it easier to take.”

The device is currently being used in academic and pharmaceutical research. Because the Vivid Vision system is accurate, precise, customizable, and the data easily accessible, it’s able to provide research organizations a powerful tool that accelerates their scientific research.



Vivid Vision Perimetry
Manufacturer: Vivid Vision
Key Features:
• Affordable, mobile, visual field testing.
• Familiar test patterns such as the 24-2, as well as novel test patterns for monitoring, screening and more.
• Designed for clinical use, as well as research—easily performs custom test patterns and accesses raw data.
Learn more at https://www.perimetry.seevividly.com/


Transforming Progressive Lens Design and Dispensing
The mimesys universe (from Horizons Optical) includes several disruptive technologies focused on meeting the needs of ECPs and users, optimizing retail processes, improving the product mix and giving users new experiences when purchasing progressive lenses.

One is mimesys Lens, an ecosystem of technologies able to offer a totally tailored progressive lens through the study of gaze dynamics and morphing technology. Through the use of VR, gaze analyzer technology collects information about each patient’s unique way of looking. From there, it makes an accurate and replicable diagnosis that’s used to obtain the ideal progressive solution for each user.

Once the patient gets their mimesys progressive lenses, Horizons Optical also teaches them how to use their new lenses properly. mimesys Coach is a VR-based simulation tool that offers the patient the experience of wearing a progressive lens, allowing the practitioner to engage and convince those presbyopes who have not yet used progressives.

Not only does it help break the taboos of progressive lenses—by helping patients experience the lens as if they were actually wearing it—it helps practitioners tap into opportunities of a huge potential market, drive sales, improve their product mix and reduce non-adaptation.



The universe of mimesys
Manufacturer: Horizons Optical
Key Features:
• mimesys Lens learns by studying the visual needs of patients, providing quality aggregate data to create a progressive lens from scratch.
• mimesys Glasses provide a VR multi-sensory environment that simulates reality and evaluates the patients Gaze Dynamics for all distances of vision.
• mimesys Coach virtual progressive lens simulator tool offers patients the experience of wearing a progressive lens.
Learn more at https://horizonsoptical.com/us/mimesys-universe/


An FDA-Approved Treatment for Amblyopia and An Eye-Tracking System
Thanks to VR technology, wearable devices are also making big strides in vision treatment for children with strabismus (crossed eyes) and amblyopia (lazy eye).

Amblyopia, a condition which affects 3 percent of all children, is conventionally treated with glasses combined with eye-patching or blurring (atropine) eye drops that prevent usage of the stronger eye and force usage of the weaker eye, but these approaches don’t train the eyes to work together. Poor patient compliance and social stigmas also present significant challenges with these existing treatment options.

Luminopia is the first FDA-approved digital therapeutic for a neuro-visual disorder in children, indicated to improve vision in children with amblyopia. With Luminopia, patients choose TV shows and movies to watch from a selection of 700+ hours of popular, engaging and educational content. Proprietary algorithms modify the selected videos in real-time within a virtual reality headset to promote weaker eye usage and encourage patients’ brains to combine input from both eyes.

“The FDA approval of a new digital therapy with robust clinical evidence for children affected by amblyopia was a major development,” said David G. Hunter, MD, PhD, opthalmologist-in-chief, Richard Robb Chair in Ophthalmology, Boston Children’s Hospital and advisor to Luminopia. “The idea of prescribing TV shows and movies to treat amblyopia in children instead of eye patches or eye drops is an exciting prospect.”



Luminopia
Manufacturer: Luminopia
Key Features:
• The first FDA-approved digital therapeutic for children with amblyopia (commercially available by prescription only).
• At-home treatment allows patients to watch therapeutically modified TV shows and movies within a VR headset to improve their vision.
• Validated through a series of clinical studies, including a prospective, randomized controlled trial.
Learn more at https://luminopia.com/

Optics Trainer offers yet another approach for using a wearable device for targeted vision therapy. Its Optics Trainer VR and the Optics Trainer eye tracking system effectively treat a wide range of vision problems, such as amblyopia, strabismus and convergence insufficiency.

The Optics Trainer eye tracking system detects the gaze and fixation of its user—providing instant biofeedback to both the patient and the therapist on the patient’s eye movements and where they are aiming. The Optics Trainer VR system uses cutting-edge VR hardware and 12 immersive games and activities that make visual and sensory training fun and engaging. Games are designed to improve eye-hand coordination, reaction time, visual memory, visual discrimination, peripheral awareness, sports vision, pursuits, depth perception and vergences.

“We recognize that traditional therapy methods can be mundane and repetitive, often resulting in low compliance rates,” said Joshua Li, founder of Optics Trainer. “Our systems are designed to transform the patient experience by making therapy enjoyable, engaging and highly effective.”



Optics Trainer Eye Tracking System
Manufacturer: Optics Trainer
Key Features:
• Cutting-edge eye tracking hardware to detect user gaze and fixation.
• Games designed to make vision therapy fun and engaging while remediating visual information processing problems.
• Activities for developing accuracy and control of fixation, saccades and pursuits.
Learn more at https://www.opticstrainer.com/eye-tracking/


Non-VR Assistive Technology for Low Vision and Blind Patients
While virtual reality (VR) plays a big role in many wearable tech devices, it’s not the only technology in play. There are also non-VR assistive technology options—devices that are specially designed to enable better eyesight and enhance quality of life for people with vision loss.

One provider is eSight, which makes versatile, low-vision devices that help people with over 20 different serious eye conditions causing visual acuity from 20/60 to 20/800, and in some cases up to 20/1400. The company said that its current model, eSight 4, offers “best visual acuity, unmatched mobility, ease of use, and new mobile and cloud-based capabilities.” A new model, eSight Go, will be released in Fall 2023.

“I learned about eSight five years ago when I had a diabetic patient with substantial vision loss,” said Dr. Andrew Jordan, ophthalmologist, Sanford Health Park Rapids Clinic in Fargo, N.D. “Many times, I’m trying to prevent vision from getting worse. eSight helps fill that void to help these patients. It gives our patients a sense of independence and the ability to enjoy their hobbies, including watching TV and reading a book, without using a 15x magnifier.”



eSight 4
Manufacturer: eSight Eyewear
Key Features:
• A best-match camera and lens technology projects a superior image onto two high-resolution screens for full binocular vision. Adjustable pupillary and screen distance ensures the perfect view for the wearer.
• The wireless device has rechargeable batteries and built-in controls that work with users’ natural peripheral vision for 100 percent mobility retention.
• With support of TeleHealth training programs, eSight is efficient, reduces travel time and offers a seamless, patient-centered experience from referral to usage to help change lives for the better.
Learn more at https://www.esighteyewear.com/esight-4/

Another assistive tech option is OrCam’s MyEye, an AI-driven wearable, gesture-and-voice-activated visual impairment solution that uses an advanced smart camera to capture an image of the user’s surroundings and articulates visual information out loud in real-time.

“OrCam MyEye is futuristic ‘personal AI’ accessibility that is already in use by tens of thousands of people in the blind and visually impaired community—in 25 languages and in 50 countries,” said Rafi Fischer, director of public and media relations. “This intuitive wearable assistive companion seamlessly attaches to virtually any pair of glasses to help users read any printed or digital text, recognize faces, identify consumer products, and verify the denominations of paper currency to help them shop and perform other daily activities more independently.”



OrCam MyEye
Manufacturer: OrCam
Key Features:
• An intuitive AI wearable assistive companion that seamlessly attaches to virtually any glasses.
• Advanced optic sensor (smart camera) captures an image of a user’s surroundings and articulates the visual information out loud and in real-time.
• Helps users instantly read text from any book and digital screen, seamlessly recognize faces of family and friends, accurately identify products and more—all communicated audibly in real time.
Learn more at https://www.orcam.com/en-us/low-vision

Envision Glasses articulate visual information into speech. These smart glasses provide an enhanced user experience by being hands-free and mobile, with an added sense of safety from the Ally video call feature. The latest game-changer is Ask Envision, a powerful new feature that leverages GPT-4 by OpenAI to understand and answer natural language questions through virtual assistance. A benefit to the Envision platform is the ability to be used solely through the app or paired with Envision Glasses, allowing for more choices and options.

“Many patients enjoy the freedom of a wearable device and respond well to Envision Glasses as it provides them with increased mobility and functionality while on the go,” said Bryan Wolynski, OD, chief technical officer at Lighthouse Guild, who often recommends Envision Glasses through his nonprofit organization. “Moreover, some of our patients’ family members reacted favorably to the Ally video call feature, especially parents of children with vision impairment.”



Envision Glasses
Manufacturer: Envision
Key Features:
• Features range from real-time text recognition to voice controls and hands-free video calls to friends, family or professionals through the Envision Ally feature or AIRA app.
• Ask Envision is a virtual assistance feature that utilizes GPT-4 by OpenAI to improve accessibility and understanding of the world around us.
• Empowers people who are blind or have low vision to access everyday visual information for themselves.
Learn more at https://www.letsenvision.com/