A Structured Approach to the Development and Evaluation of a Virtual Reality Eye Examination Simulation

Ophthalmoscopy is a required clinical skill which is difficult to learn. This paper describes the development of a VR ophthalmoscopy app to support learning of this skill. It was developed using the Unity game engine, Google CardboardTM and smart phone. Forty-eight clinicians agreed to evaluate it for system usability (SUS), technology acceptance and knowledge acquisition (pre and post quizzes). Twenty-seven volunteers undertook the quiz. Mean scores improved by all (6.3 ± 1.5 to 8.4 ± 0.8 p < 0.001); medical students (6.2 ± 1.5 to 8.5 ± 0.9 p < 0.001 n:20); doctors (6.4 ± 1.5 to 8.3 ± 0.8 p < 0.05 n:7). Overall, SUS was 74 ± 11 (n:33), medical students rating 72 ± 12 (n:20) and doctors 77 ± 9 (n:13). Forty-eight volunteers provided feedback on technology acceptance. All highly rated its ease of use and how it improved their confidence in being able to perform this diagnostic procedure. Regression analyses emphasized the importance of usability, ability to perform the task and ease of use as predictors of success. Ninety percent of users felt that this type of technology would benefit their clinical training but should not replace other forms of teaching. Owing to the lack of technical-focused development frameworks this study also defines an appropriate framework that ensures clinicians are central to the process.