Low vision, cataract and macular degeneration: what changes in a session

A few weeks ago we wrote about what changes in a session when a person hears poorly, in hearing loss. This is its companion piece, and perhaps the more obvious one: virtual reality is, first of all, a visual experience. When sight fails, the question is not only “how do we adapt” but also “is it worth it?”.

The honest answer is: often it is, sometimes it is not. The World Health Organization, in its 2019 World report on vision, estimated that at least 2.2 billion people were living with some vision impairment — and cataract and age-related macular degeneration are among the most frequent causes in older people, exactly those we meet in care homes, day centres and inpatient services.

What each condition changes

It is not all the same thing, and the adaptation depends on what the person has lost.

• Cataract. The lens becomes cloudy. The image goes blurry, colours fade, bright light dazzles and low light is harder. The good news is that surgery is common; many residents have already had one eye done, or both.
• Age-related macular degeneration (AMD). It affects the macula, the part of the retina that gives central and detailed vision. Reading, recognising faces and seeing what is straight ahead become difficult, while peripheral vision usually remains. In the dry form the loss is slow; in the wet form it can be rapid. A sudden change — straight lines turning wavy, a new blob in the centre — is a reason to contact the eye specialist, not to wait.
• Low vision in general. Glaucoma, diabetic retinopathy, the after-effects of a stroke: each takes different things away. The person themselves knows best what they see, along with the team that is with them every day.

Before the first session, it is worth simply asking: which side do you see better on, and what is hardest to see?

Glasses inside the headset

It is the question we are asked most, and the answer is yes: the Meta Quest 3, which we use, can be worn with the person's own glasses. Meta's fit guide for the headset says lens depth can be adjusted to move the lenses away from the face or from eyeglasses. We do not use spacers; the adjustment is made on the headset itself. We explained the reasons for that choice in why we use the Meta Quest 3.

A few practical points:

• Put the headset on front to back, first over the glasses and only then the strap, so you do not push the arms or scratch the lenses.
• Move the headset lenses back far enough that they do not touch the glasses. Lenses that touch get scratched and stop focusing well.
• Adjust the distance between the lenses (the wheel under the headset) until the image is sharp for that person.
• If the person has different glasses for near and far, try both and note which worked. At the next session, no time is lost.
• Very wide frames may not fit. In that case, note it in the record rather than forcing it.

There are prescription lens inserts for the headset sold by third parties, but they are personal. On a device shared by several residents, the simplest approach is for each person to wear their own glasses.

Content with little fine detail and good contrast

A 360° video has the advantage of not needing fine detail to make sense. A beach, a garden, a village, the inside of a church are recognised by shape, light and sound, not by a sign in the background.

• Choose wide, calm scenes, with few elements and slow movement. See choosing a scene.
• Avoid relying on text or small details (“can you read the street name?” is a question that only frustrates).
• Watch out for glare. For someone with cataract, a scene with a lot of sun, snow or reflections on water can be uncomfortable. Start with moderate brightness and adjust the headset brightness with the person telling you.
• Very dark scenes are hard too: there is little information for someone who already sees with poor contrast.
• With AMD, let the person move their head. Someone who has lost the centre learns to look sideways. In a 360° video that is possible — do not insist on “look straight ahead”.

More sound, more words

When the picture gives less, the rest has to give more.

• Describe. Whoever runs the session can say what is in the scene: “you are on a beach, the sea is on your left, there are boats in the distance”. It is not being patronising; it is supplying what is missing.
• Use the ambient sound. Waves, bells, birds, distant voices: often it is the sound that brings back the memory.
• Talk about the place. A question about the place — “have you been to a beach like this?” — is worth more than a question about what can be seen.
• Check hearing too. Sight and hearing often fail together; if the person hears poorly, the hearing loss article has the adaptations.

When it is not worth it

There are situations where the session does not deliver what it promises, and it is better to say so.

• Severe loss in both eyes, where the person no longer makes out shapes or light. Then the headset covers the face and gives nothing in return.
• Straight after eye surgery or treatment. A headset rests against the face; wait for advice from whoever did the surgery or treatment, and follow the recovery instructions.
• When seeing poorly is frustrating. If the person becomes distressed at not being able to see, or keeps saying “I can't see anything”, stop. A conversation about the same place, without the headset, may work better.
• Discomfort, dizziness or nausea. Stop and note it; there is more on this in comfort and motion sickness. Meta itself recommends consulting a doctor before using the headset when there are pre-existing binocular vision abnormalities.

Where RVer fits, and where it does not

RVer can be a calm, accompanied activity for many people with cataract, AMD or low vision, as long as the session is chosen for that person: wide scenes, moderate light, glasses properly in place, and someone alongside describing and listening. All the content is on the device and works without internet, so the session can happen wherever the person is, including lying down.

What it does not do: it does not assess vision, does not correct it, and is not for training or restoring sight. Nor does it make up for total loss. For the general limits of who can and cannot use it, see accessibility.

In summary

• Cataract, AMD and other forms of low vision change different things; ask what is hardest to see.
• The Meta Quest 3 can be worn with glasses: move the lenses back, put it on front to back, note which glasses worked.
• Wide, calm scenes without text; moderate light, no glare; with AMD, let the person look sideways.
• When the picture gives less, describe more and use the sound.
• Severe loss in both eyes, recent surgery or obvious frustration: the session is not worth it.

This article is for information only and does not replace an eye examination. If vision changes suddenly, contact the doctor or eye specialist; after eye surgery or treatment, follow the advice of whoever carried it out.

RVer is a virtual reality system for clinical use designed for healthcare settings, whose base product is registered as a Class I Medical Device in EUDAMED (Basic UDI-DI 56006195127RVERTZ) and with INFARMED (Portugal, CDM 94571546) and bears the CE mark under MDR 2017/745. The RVer Motion, RVer Neuro and RVer Exposure modules are in development and are not covered by that registration.