The Virtual World: Evaluating VR in Medicine

I have always been skeptical about the applications of VR (Virtual Reality) in general, and more specifically in the medical field. The reason is that I humbly believe that one can never compete with nature. Our natural senses are so powerful and multilayered that it is inconceivable to recreate them entirely in a virtual environment. While the visual recreation of reality might be very impressive at first glance, without the integration of other senses and the sense of spatial freedom, it can never truly compete.

Understanding Visual Experience

To grasp the complexity of visual experience alone, one should read An Anthropologist on Mars by the late, brilliant neurologist Oliver Sacks. In the first chapter, Sacks describes a patient who was an accomplished painter and suddenly became colorblind. His colorblindness was unique—cerebral achromatopsia, caused by a problem in the brain rather than the eyes. This condition, once controversial, challenged long-standing perceptions.

?We see color because retinal cells in our eyes translate light wavelengths into colors. However, if this were all there was to it, we would perceive the same object in different colors under varying lighting conditions, which would be maddening. It appears there is a center in the brain that maintains color constancy for objects. In Sacks' patient, this center was disabled, causing him to see the world in constantly changing shades of grey.

?Considering the visual cortex's prominence and the fact that what we see is a brain creation rather than a pure window into reality reconfirms that reality is a product of the interaction between our being (not just our brain) and the world.

?Subjectivity of Perception

?In Cosmic Trigger, the late Robert Anton Wilson describes an experiment where students were asked to describe items they saw in a corridor they passed daily. No two students described the same items, and few noticed changes made to the corridor. This suggests that everyone experiences their own "virtual hall." In everyday life, this subjectivity is multiplied by our characters, cultures, religions, and the information we consume, all of which shape how we perceive the world.

?Nietzsche's quote, "We are more like the artists than we realize," reflects this idea. A virtual world would never feel complete without these nuances. This is evident as VR has existed for decades without a massive societal shift toward it.

?Applicability in Healthcare

?Over a decade ago, I explored 3D-image reconstruction of medical images for planning minimally invasive heart operations. I discovered a small company in Amsterdam that created software and hardware to convert 2D medical images into interactive 3D holograms. Impressed, I adopted this technology, initially in a study setting, and later for all my operations. Many similar platforms have since been developed.

?However, there are issues to consider. Converting 2D images to 3D does not provide more data or details but offers a better appreciation of spatial relationships between structures, crucial for surgeons. How one experiences these 3D images—through VR sets, 3D glasses, mixed reality, holograms, or simulated reality—doesn't change the essential benefit of understanding spatial relationships. Though holograms were impressive, I found viewing 3D images on a 2D laptop screen more practical.

A technology is truly disruptive when users can't get enough of it. In healthcare, technology must solve a clinical problem, demonstrate safety and efficacy, and show superiority with a clinical impact on patient care and cost-benefit analysis.

Experimenting with VR

During a recent visit to the US, after discussing VR critically with colleagues, I decided to try the Apple Vision Pro to overcome any biases. The experience was mind-boggling, and I immediately acquired one to experiment with simulation devices for heart operations, aiming to solve surgical problems. Quality of care in surgery is highly operator-dependent, with outcomes strongly associated with individual surgeon volume.

?Combining high-fidelity simulations with VR technology, mixed reality, and AI-assisted virtual surgical tutors could transform medical education. I recently posted my first experiments on this vision, and only time will tell if VR can make a significant impact in this area.