Applying Augmented and Virtual Reality in Healthcare

December 12, 2022 - Augmented reality (AR) and virtual reality (VR) have been explored and widely adopted in the entertainment industry. The healthcare industry has transformed these technologies and repurposed them for healthcare applications. Understanding the applications, benefits, and potential risks of AR/VR helps providers assess appropriate utilization for their patients.

Defining AR and VR

Virtual reality is an entirely virtual experience. Often, this means wearing a headset to immerse the user in digitally simulated surroundings. According to an FDA executive summary from July 2022, virtual reality is defined as “a set of technologies that can be applied in a number of ways to diagnose and treat several different types of clinical conditions, in different ways, and with varying or as of-yet unestablished success rates.”

Conversely, augmented reality is a real experience that adds simulated digital imagery via a camera or display.

AR/VR in medicine depends on the ability to provide treatment realistically, remotely, and with little cost. The experience may deliver a standard type of treatment in an immersive way from the comfort of a patient’s home. On the other hand, it may offer an altogether new treatment.

Applications of AR/VR

The applications of AR/VR in healthcare are plentiful. Ongoing research explores multiple ways to incorporate technology to enhance patient experiences, widen treatment access, and alleviate burdens on the healthcare system.

Mental Health

AR/VR is most widely used in mental health practices to conduct exposure therapy, specifically for veterans with PTSD. Exposure therapy is when triggering or anxiety-inducing objects are introduced to patients in a safe environment.

VR provides a unique opportunity to present nearly any situation in the comfort of a therapist’s office or another safe setting. Unlike traditional exposure therapy, VR-facilitated exposure therapy has much fewer limitations.

According to the FDA, “studies have found VR exposure therapy may be helpful in treating phobias, anxiety, and posttraumatic stress, and there has been some exploration of its effectiveness in treating psychosis, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD), as well as eating disorders and schizophrenia spectrum disorder.”

Neurological Disorders

The FDA also notes that AR/VR treats neurological disorders by providing rehabilitation assistance. In particular, stroke rehabilitation — which is dependent on the start, volume, and duration of rehab — benefits from AR/VR. By using AR/VR, patients can overcome facility or therapist availability limitations. 

AR/VR may also be used to assess cognitive functions as a diagnostic method. Rather than traditional observational methods, AR/VR can quickly evaluate cognitive impairment, memory, and eye movement. This alleviates the burden on neurologists and allows for a rapid, accurate, and relatively inexpensive diagnostic pathway.

Pain Management

VR is also being explored as a form of pain management to treat chronic pain effectively. Chronic pain management poses a significant challenge for many providers. Assuming there are no treatable underlying causes for the pain, providers must opt for pain management methods such as physical therapy or medications. Opioids, a class of pain management medications, are highly addictive and increase the risk of substance use disorders. Rather than using opioids to manage pain, providers may opt for VR to distract and relax patients, minimizing pain or pain perception.

VR for pain management has been explored for fibromyalgia, phantom limb syndrome, localized pain, surgical procedures, labor, chronic pain, and more.

The FDA states, “in some studies, VR pain-management therapy outcomes are comparable to those of traditional physical rehabilitation approaches, as well as medication options, which can also have adverse side effects.”

Pediatric Healthcare

Pediatric healthcare is a unique space for VR/AR applications. Based on data from the FDA, AR/VR has been used to manage pain and anxiety in pediatric patients. In addition, the organization commented that some therapies have proven to enhance upper extremity function in children with cerebral palsy. It has also been used for mental healthcare in pediatric cancer patients and ADHD diagnosis and treatment. In addition, VR has been used to treat amblyopia in pediatric patients.

Surgery

Another dominant area for VR/AR integration is in surgical settings. Much like 3D printing, VR/AR can provide surgical staff with better visualization and preparedness for a surgical procedure. The FDA states, “these capabilities may better enable surgeons to more precisely identify structures within the surgical field, find alternative approaches to entry, enable less-invasive procedures, and in general to streamline workflow. Benefits may include shortened procedure times, improved outcomes, and decreased complications.”

In addition to pre-operative preparedness, AR can be used during the procedures to visualize progress. Modeling and assistance can improve patients' health outcomes and medical professionals' educational efforts.

Other applications of AR/VR in surgery are for educational purposes to train new surgeons. This technology may replace traditional cadavers and animal models when practicing surgical procedures. Additionally, the ability to simulate a live surgery could produce better-prepared and educated providers. Furthermore, it may broaden access to medical education in areas where cadavers, animal models, or other practice tools are unavailable or limited.

In addition, VR/AR may be used to prepare patients for surgery and alleviate anxiety about surgical procedures.

Benefits and Risks

The impacts and benefits of AR/VR are not perfectly understood, as they are relatively new approaches, and the FDA notes that the benefits of AR/VR may vary from patient to patient. One perceived benefit of AR/VR is the ability to widen access to healthcare. For specific populations unable to relocate for treatment, AR/VR can provide an additional option to seek treatment.

According to the FDA, VR and AR can provide additional comfort to patients by allowing them to participate in specific therapies from the comfort of their own homes rather than in a hospital or other clinical setting. The thought is that VR and AR could widen accessibility to some treatments.

The FDA also notes multiple concerns when it comes to AR/VR. One of the common concerns is cybersickness. Like motion sickness, cybersickness is associated with dizziness, headaches, fatigue, and nausea. Depending on the patient and their condition, they may be more likely to develop cybersickness. Overall, pregnant individuals, children, and elderly patients are typically more susceptible to cybersickness.

Additionally, AR/VR use impedes a person’s ability to see the position of things around them. Immersion in this form of virtual reality for therapy requires caution as patients may run into surroundings, causing injury. Headsets may also contribute to neck and head pain.

The FDA warns against the habitual use of AR/VR because chronic use and addiction to AR/VR — which can occur because the therapies are often engaging — can cause patients to neglect exercise, social engagement, and routine tasks. Beyond pain and habitual use, individuals sensitive to light may have seizures while using AR/VR.

“There is more to learn about the risks and benefits of AR/VR, about how to calculate and weigh those risks and benefits for different devices, software, applications, and populations, and about how best to communicate guidance, warnings, and other information to patients, practitioners, and caregivers. These questions all merit careful study and consideration,” stated the FDA in FDA executive summary from July 2022.