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Virtual Clinical Classroom - Ophthalmology Student VR Training

Updated: Aug 10, 2021

CUSTOMER: Michael Williams

DATE OF PROJECT: Sep – Nov 2020

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Dr Michael Williams is a Senior Lecturer and Consultant Ophthalmologist at Queens University Belfast, and has a special interest in evaluating the use of technology, including virtual reality, in healthcare education. He advocates the important of recognising abnormalities in pupillary reactions, and the need for healthcare practitioners to be confident in managing ophthalmologic conditions. Often students do not have the opportunity to carry out pupillary exams, and may merely observe eye exams, rather than carrying them out.


Lack of opportunity to practice, as well as restrictions due to the Covid pandemic, highlighted the requirement for a solution to provide effective remote digital training experiences to assist ophthalmology students in performing pupillary examinations. This training is to be delivered via 3D digital media and a Virtual Reality software application capable of delivering the required training experience on the Oculus Quest Virtual Reality headset.

The principal need is the provision of a mobile, digital training solution to enable ophthalmology students to be trained on a pupillary examination process. The steps of this process include preparing for eye examination, using a pen torch to examine patient’s right and left eyes, performing the 'swinging flashlight test,’ and checking accommodation. Throughout the eye examination, students are required to check for abnormal reactions, including if the pupil is fixed and does not react to the pen torch, or the pupil does not react or actually dilates when the light is shone into the eye.

It is required that the digital training solution covers 6 scenarios for each eye:

· afferent pupillary defect (APD)

· relative afferent pupillary defect (RAPD)

· fixed dilated pupil in a red sore eye

· fixed dilated pupil in an eye that also has a droopy eyelid and squint

· fixed dilated pupil in a normal-looking eye

· a completely normal eye

The digital training solution is required to present a typical clinical setting as background imagery within which the patient examination takes place. After the examination process, a simple multiple-choice question and answer session should be presented to capture the student’s diagnosis based on the responses observed during the pupillary examination. Alternatively, the student can specify the specific eye abnormality at the start of the training process and then practice examining a patient who exhibits responses associated with that particular scenario/diagnosis.


Our solution involved the development of a Virtual Reality (VR) software application for the Oculus Quest VR headset to create an immersive 3D digital training experience. VR provides a realistic and engaging means to delivering the requested form of training and the Oculus Quest headset was recommended on the combination of its price, performance and portability characteristics. The headset is competitively priced, has high-resolution displays and offers completely wireless operation. The Oculus Quest also supports so-called “6 degrees of freedom” experiences, meaning that the headset wearer can move around their physical space and that movement is translated into similar movement in the virtual 3D space. For this particular application, this capability means that the wearer can walk around the examination room, moving closer to and further from the virtual patient.

The key components of the project involved production of 3D media (models and 360-degree photographic images) for clinical environments and objects including typical furniture, a patient, pen torch, and a cylindrical 3D object to function as a target for the accommodation test, and development of a mobile software application for the Oculus Quest VR headset to provide the immersive training experiences.

These training experiences include the ability to preselect a specific eye abnormality for the virtual patient, to raise and lower the lighting levels in the 3D environment by interacting with a virtual light switch in the background, to pick up, switch on/off and direct the virtual 3D pen torch. The application includes the capability to move the virtual 3D object that functions as the target for the accommodation test, and to set the default position/colouring of the virtual patient’s eyelids in compliance with the assigned eye abnormality. In response to the pen torch being directed at the eyes or in response to the approach of the target object for the accommodation test, animations and movements are triggered in the virtual patient’s eyelids eyes and pupils.

A multiple-choice diagnostic question and answer exercise can be presented to students at the end of a pupillary examination via a 3D menu and console.


Virtual Clinical Classroom provides the opportunity to study pupillary reactions at any time, in any place, and as often as is necessary, to ensure that healthcare practitioners become confident in testing and observing pupillary reactions. The remote delivery is perfectly suited to a post Covid world, and the immersive environment provides memorable learning experiences, with enhanced retention rates for learners. The success of the project paves the way to extend the application to additional ophthalmologic conditions, and other clinical areas.

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