Can virtual reality headsets save vision in people with lazy eye?

Luminopia amblyopia virtual reality
IDHA’s Matt Murphy tries out Luminopia’s VR headset with Dean Travers (photo: Greb Weintraub)

Three to five percent of the population has amblyopia, a.k.a. lazy eye, in which a healthy eye never “learns” to see because isn’t used. This usually happens because of a focusing problem or subtle misalignment of that eye. The brain learns to ignore input from that eye, and unless this is noticed early, it weakens and can slowly go blind.

“When I can diagnose amblyopia early enough, I can treat it with an eye patch or eye drops to block the ‘good’ eye,” says David Hunter, MD, PhD, chief of ophthalmology at Boston Children’s Hospital. “This gives the eye with amblyopia time to catch up.”

Unfortunately, eye patching doesn’t work well at older ages, and kids hate the socially stigmatizing patches, which often need to be worn for more than a year. As Dean Travers, cofounder of Luminopia, put it at Boston Children’s Hospital’s Innovators’ Showcase last week, “Being a pirate isn’t cool for very long.”

Training an amblyopic eye

A former professional ski racer, Travers had a concussion in a large jump that destroyed vision in one of his eyes. While he doesn’t have amblyopia, he became interested in it and left his undergraduate studies at Harvard to find a way to treat it, sans eyepatch. He wanted something that would be more fun, more efficient and applicable to older kids — perhaps even adults.

Luminopia VR headset amblyopia strabismus
Eye misalignments are a common cause of amblyopia.

Travers was joined by fellow Harvard students Alex Wendland, a skilled coder, and Scott Xiao, a chemical/physical biology major. They came up with the idea of a virtual reality headset, and reached out to Hunter via email. The headset would train the amblyopic eye to see by rebalancing the visual input to both eyes.

“They came to me to see how plausible I thought the idea is,” Hunter says.

Hunter found it plausible enough to act as a clinical advisor to their startup, Luminopia. He also agreed to facilitate a small clinical trial of the VR goggles at Boston Children’s. “Clearly, they need data to show that this works,” he says.

It’s a blur (in one eye)

In the randomized trial, led by Jason Mantagos, MD, 50 patients ages 5 to 38 are watching videos through VR goggles. (Children younger than 5 have trouble using the currently available goggles.) Enrollment is still underway for children ages 5 to 7, says study coordinator Srishti Kothari, MD.

Luminopia amblyopia virtual realityDuring the first four weeks, the treatment group gets Luminopia’s goggles, which blur the images shown to the normal eye. This compels children to use their amblyopic eye. The other group uses goggles that show normal video to both eyes. During the second four weeks, both groups use the Luminopia goggles.

“The normal eye might be shown a clear view of Mickey Mouse’s ears, but blurry images of his face, while the amblyopic eye receives crisp images of both,” explains Hunter. “Children can choose whatever video they want to watch on YouTube, PBS or other sites, and the software processes it automatically to do the blurring.”

Before the pilot began, there was some concern that “waking” an amblyopic eye might cause children to start seeing double. So far that hasn’t been a problem, Hunter says.

The trial is still in progress, but the results seem promising enough that a multi-site trial is planned to open this summer, according to Travers.

The Luminopia team is also being advised by Edward Buckley, MD, chair of ophthalmology at Duke Medical School, Mark Bear, PhD, of MIT, Marguerite McDonald, MD, who performed the first excimer laser eye treatment in 1987, and Peter McDonnell, MD, chair of ophthalmology at Johns Hopkins. The startup was a 2016 Silver Winner of the MassChallenge and one of two 2017 winners of SXSW’s Impact Pediatric Health startup pitch competition.

Travers and his cofounders hope the VR approach will prove to work in adults, as well as in other neurologic disorders that affect sight. “You can watch Sponge Bob or Game of Thrones, and the entire time you’re being treated,” he says.

For information about enrolling in the clinical trial, contact eye.research@childrens.harvard.edu.