Development Of An Eye Movement Training System Based On Virtual Reality Technology And Its Application In Orbital Blowout Fractures Patients After Reconstruction Surgery

Objective:This study aimed to develop an eye movement training system based on virtual reality(VR)technology and further evaluate its clinical efficacy in targeting orbital blowout fractures(BOFs)patients after reconstruction surgery.Methods:The VR-based eye movement training system was designed to promote the recovery of diplopia.Patients with diplopia who visited the Department of Orbital Diseases and Oculoplastic at the Second Hospital of Jilin University were prospectively recruited from August 2021 to October 2021.Cohen’s Kappa was used to assess the consistency for detecting the type of diplopia between the VR-based eye movement training system and the red glasses test.Intraclass correlation coefficient(ICC)was used to assess the stability of the hit rate of VR-based eye movement training system.Furthermore,we continued to recruit patients diagnosed with BOFs-related diplopia(excluding neurogenic)and treated with reconstruction surgery by the same operator from October 2021 to October 2022 at the Second Hospital of Jilin University.All subjects were divided into experimental and control groups according to the random number table.12 weeks VR-based and traditional eye movement training were given to the experimental and control group,respectively.Hess area ratio(HAR)and the field of binocular single vision(BSVF)scores of experimental and control group patients were compared before and after(2 weeks,6 weeks,and 12 weeks)training.Repeated measurement ANOVA was used to assess the variability of HAR,BSVF scores,and hit rate before and after training.Student’s t-test was used to contrast the compliance of patients between the experimental and control group.Spearman’s rank correlation coefficient(r_s)was used to evaluate the correlation between the hit rate and the severity of diplopia.A p-value<0.05 was considered to be statistically significant.Results:(1)The accuracy and stability of the VR-based eye movement training system:A total of 25 subjects(39.00±12.42 years,range:19-58 years)were recruited,with 16males and 9 females.There was reliable agreement in detecting the type of diplopia between VR-based eye movement training system and the red glasses test(Kappa=0.808,P<0.001).In addition,the hit rate of VR-based eye movement training system was stable(ICC=0.893,P<0.001).(2)Comparing the clinical efficacy of VR-based and traditional eye movement training in BOFs-related diplopia patients:A total of 31 subjects(41.45±13.42 years,range:19-69 years)were recruited,with 21 males and 10 females.Patients who used the VR-based eye movement training system had faster increased HAR and BSVF scores than patients who used traditional eye movement training(P<0.05).It is notable that the subjects who used VR-based eye movement training had higher compliance(P=0.024).After training,individuals who used the VR-based eye movement training system demonstrated a significant improvement in hit rate(P<0.05),and the hit rate had a negative correlation with diplopia severity(|r_s|>0.6,P<0.05).Conclusion:(1)The results showed that the VR-based eye movement training system has high accuracy and stability.(2)The recovery of diplopia(non-neurogenic)in patients with BOFs were significantly improved by using VR-based eye movement training compared with traditional eye movement training.Compliance may the reason which contributes to this discrepancy.(3)The hit rate of VR-based eye movement training system can be used to assess the recovery of diplopia.(4)This study provides the first and key step in the digitization of diplopia treatment,as well as possibility for its application in telemedicine.