Virtual Reality Vision Therapy VERVE

By OculoMotor Technologies, with funding from New Jersey Institute of Technology, the New Jersey Health Foundation, The Eye Institute at Salus University, EPICS in IEEE, the National Institutes of Health, and the National Science Foundation.

(from left) Tara L. Alvarez, Ph.D., Chang Yaramothu, Ph.D., John Vito d’Antonio-Bertagnolli, M.S.

Tara L. Alvarez, Ph.D., is a difficult woman to find. The door to her “official” office is frequently closed — you can find her down the hall in her Vision and Neural Engineering Laboratory, sitting at an unmarked desk behind half a cubicle wall, with nary a nameplate in sight. Two of her researchers sit at desks behind her, serving as a sort of security from interruptions. If Alvarez is not hunched over her laptop, writing a grant proposal or journal article to the tune of meditation music, she’ll be standing over the shoulders of those two researchers — Chang Yarmothu, Ph.D., and John Vito d’Antonio-Bertagnolli, M.S. Together with Dr. Mitchell M. Scheiman, O.D., Ph.D., these four serve as the founding executives of OculoMotor Technologies (OMT), a medical device company started at New Jersey Institute of Technology, developer of the VERVE vision therapy experience.

VERVE, pictured above, is a novel combination of consumer-available electronics and traditional vision therapy principles. Alvarez developed the idea over the past decade, waiting until the right technology (and the right team) came her way. VERVE is designed to treat a vision disorder known as convergence insufficiency (CI), which affects at least 5% of the general population and over 50% of the brain injury/concussion population. CI causes symptoms including double vision, blurry vision, headaches, dizziness, and nausea, when performing near work — day-to-day tasks that occur close to the face, such as reading a book, or looking at a computer screen. While not a life-threatening condition, CI significantly impacts quality of life in both pediatric and adult patients alike.

Fortunately for CI patients, this vision disorder is highly treatable, as shown by the work of OMT co-founder and Chief Medical Officer. Dr. Mitchell Scheiman led the largest ever randomized clinical trial of CI therapy, and showed that office-based therapy with an optometrist will remediate symptoms in over 75% of patients. However, he also found that patients enrolled in a home-based computerized therapy protocol showed remediation rates of only 33% (lower than even placebo therapy!), and noted that only 67% of these patients were compliant with the therapy program. Clearly, there was room for improvement.

The Team Is Formed

Alvarez and Scheiman have been frequent collaborators on grant proposals and journal papers since they first met in 2012. “At the time,” she recalls, “I didn’t quite realize how famous he was.” She is referring, of course, to Scheiman’s seminal work, Clinical Management of Binocular Vision, a textbook that serves as the bible to many optometrists who practice vision therapy. Connecting with Scheiman gave Alvarez the opportunity to bounce ideas around with one of the most well respected minds in optometry. While Scheiman had access to a large network of clinicians and patients at his home Salus University, Alvarez brought a decade of eye movement data collection and analysis to the table. A classically trained electrical engineer, Alvarez’s custom instrumentation is capable of measuring various aspects of eye movements in a closed experimental environment. The pair’s ongoing National Institutes of Health grant to study the underlying neural mechanisms of CI was the first ever clinical trial at Alvarez’s home institution, New Jersey Institute of Technology. Still, both researchers sought to take their expertise “out of the lab,” where their discoveries can directly help the general public.

In April 2015, the Virtual Reality Vision Therapy officially kicked off with a summer research project led by then-undergraduate researcher John Vito d’Antonio-Bertagnolli. Alvarez’s vision was theoretically straightforward— she wanted a therapeutic video game, playable in a virtual reality headset, that could change in difficulty based on the user’s eye movements. Unfortunately for d’Antonio-Bertagnolli, the hardware to pull off such a project did not yet exist. In a project that served as the foundation for his senior design project, and later his Master’s Thesis, d’Antonio-Bertagnolli cobbled together a system comprised of an Oculus DK2, a pair of Rasperry Pis, infrared LEDs, and a healthy dose of duct tape and prayers.

Alvarez (left) wears the prototype eye tracking VR headset designed by d’Antonio-Bertagnolli (right) as he calibrates the eye tracking cameras.

“The DK2 project was very much a prototype,” d’Antonio-Bertagnolli says. “It was never meant to be commercialized, it was just a test bed for our software ideas while we waited for someone else to take care of the hardware.” Those software ideas were a mashup of a custom eye tracking algorithm and various game prototypes in made in Unity. There was a dungeon crawler, a Halloween-themed game, a butterfly catching simulator, and the team’s favorite — Bug Eyes, a Space Invaders-inspired wave shooter. All these games were designed with therapy in mind, incorporating visual stimuli and patterns that were hypothesized to elicit therapeutic responses in patients. But, testing that sort of hypothesis is an expensive endeavor, and the prototype eye-tracking headset was not particularly robust.

The Hardware Catches Up

Fortunately, money started to roll in to the project. In addition to funds from both Scheiman and Alvarez’s home institutions, an EPICS in IEEE grant allowed the team to purchase some new hardware — the FOVE 0, an eye-tracking VR headset from Japan. Utilizing this new tech, the team was able to take their demos to the next level, and soon found themselves funded by the kind of money that expects results. A pair of $50,000 Innovation Grants from the New Jersey Health Foundation, as well as a $50,000 I-Corps grant from the National Science Foundation, financed ongoing development of therapeutic game ideas, as well as business model development and customer discovery. A pair of NJIT professors, Eric Nersesian and Jessica Ross, joined the project as Game Programmer and Art Director, respectively, just as Alvarez’s then-Ph.D. candidate Chang Yaramothu began to develop the game’s therapeutic difficulty levels. After a busy six months, they had a functional prototype, called VERVE, ready for the first test. Would the game actually work, and give a therapeutic benefit to CI patients?

VERVE gameplay footage

VERVE, short for Virtual Eye Rotation Vision Exercises, is a pirate-themed adventure, playable in the FOVE 0 headset. It’s core gameplay mechanic mimics a common vision therapy exercise, where a visual target is slowly moved towards a patient’s face. Simultaneously the game play environment recreates the effect of prisms routinely used in vision therapy. The end result, shown in the gif above, is a game that caused the player’s eyes to repeatedly cross and uncross. This is a fundamental mechanism of vision therapy for CI. At the end of each therapeutic movement, players sorted the visual target by color into a matching orb, gaining points along the way, and using their eyes to make the selection. No game controllers are used in the entire game — it’s all eye movements!

Next Steps

Yaramothu concluded the first pilot study of VERVE’s effect on CI patients in April 2018. Of nine enrolled research subjects, he observed both clinically significant reductions in symptoms and statistically significant improvements in eye movement speed and accuracy in seven subjects. Spurred by this proof-of-concept data, the OMT team is actively continuing development of the VERVE software into a fully-realized commercial solution.

Alvarez’s enthusiastic leadership as CSO of OculoMotor technologies is uncommon for a tenured professor. She is not comfortable keeping her research confined to the laboratory, and strongly desires to share it with the world. The NJIT Board of Overseers recognized her commitment to translational work by honoring her with the 2017 Excellence in Research Prize, a rare honor given to only one faculty member annually.

NJIT 2017 Excellence in Research Video featuring Tara Alvarez and VERVE prototype

As a startup company, OculoMotor Technologies is still trying to find its way in the world outside of NJIT’s campus. If you have ever participated in vision therapy for convergence insufficiency, and are willing to speak about your experience, please reach out to the OMT team!

Contact John Vito at ceo@oculomotortechnologies.com

VERVE Credits
Director & Producer Tara L. Alvarez, Ph.D.
Game Programmer John Vito d’Antonio-Bertagnolli, M.S.
Clinical Trial Manager Chang Yaramothu, Ph.D.
Clinical Advisor Mitchell M. Scheiman, O.D., Ph.D.
Art Director Jessica Nersesian-Ross, M.F.A.
VR Developer/Programmer Eric Nersesian, M.S.

OculoMotor Technologies
Chief Executive Officer John Vito d’Antonio-Bertagnolli, M.S.
Chief Technology Officer Chang Yaramothu, Ph.D.
Chief Science Officer Tara L. Alvarez, Ph.D.
Chief Medical Officer Mitchell M. Scheiman, O.D., Ph.D.