Wearable Wonder

Experts predict that as early as 2016, wearable technology could fuel a multibillion-dollar market. This market has the potential to transform health care. But how soon the optometric office of the future will become a reality depends on companies resolving long-standing technical issues and on costs that currently limit wearable technology to early adopters and gadget-heads.

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By Heather Boerner, AOA Focus, October, 2014, pages 22-29

Imagine a patient walking into your office. Now imagine that very act triggers the GPS systems in the patient's health monitoring contact lenses, sensor-equipped t-shirt, exercise- monitoring system, and insulin pump to download the patient's blood pressure, blood glucose, heart rate and other vital signs directly to his or her electronic health record.

Meanwhile, you're in an exam room with a patient whose cell phone—linked to high-tech contact lenses—alerted that patient that his or her intraocular pressure changed dramatically. Later, you'll have an appointment with a patient to use a virtual reality head-mounted display to help him or her improve visual acuity after surgery.

All the while, you're directing your staff from your command center, the smart glasses that sit unobtrusively on the bridge of your nose: Put drops in room 3; conduct pretesting in room 1.

Welcome to the optometric office of the future—at least as envisioned by Andrew Morgenstern, O.D., a consultant with Booz Allen Hamilton whose current assignment is with the Vision Center of Excellence at Walter Reed National Military Medical Center in Bethesda, Maryland. Dr. Morgenstern has thought a lot about technology, and he sees wearables—the augmented and virtual reality headgear, the vital signs monitoring clothing and the medical contact lenses—as the future of optometry.

It's not so far-fetched. Already, wearable gadgets such as exercise monitoring wristband systems have begun regularly appearing on Americans. Elite athletes are trying out augmented-reality headsets that monitor their heart rate and track their distance and speed wirelessly. By 2018, market intelligence company IHS Inc. predicts wearable technology could fuel a $60 billion market.

This market has the potential to transform not only health care but also entertainment, industry, athletics and the military, according to IHS. But how soon the optometric office of the future will become a reality depends on companies resolving long-standing technical issues and on costs that currently limit wearables to early adopters and gadget-heads. And while most of this technology isn't expected to hurt the eye, some of it has a way to go before it can come to market.

Trends in wearable tech
If you want to know where wearables are going, start by scrolling through the 70 or so campaigns on crowdfunding site Kickstarter for the technology. Artificial intelligence eye masks that regulate, monitor and optimize your sleep. Augmented reality headgear that translates the eye movements of people with Lou Gehrig's disease, spinal cord injuries and muscular dystrophy into speech. Eyeglasses that provide captions of what people are saying for people with hearing loss. If you judge by the hundreds of thousands of dollars people have given for these devices, you might conclude that the future of high-tech is all about the eye.

And you'd be right, says Tim Moore, director of digital vision for Rochester Optical. Right now, you're seeing a lot of fitness wristbands, such as the FitBit or Jawbone Up, or smart watches such as Samsung's Gear. But the end game, Moore says, has always been the head—and the eye, specifically.

"Those wristbands and smart watches are really an effort to get you off your phone and putting [technology] on your wrist," he says. "The goal is to work your way up the arm to the head. The head is where all the senses converge—you've got smell, hearing, speech, vision. Whether you wear glasses or not, having all this data up close to your head is the ultimate money spot."

Sports and fitness are a natural fit for this kind of technology, because avid exercisers already track their progress. But it's important in the entertainment world, too, as companies race to release virtual reality headgear that makes games seem more real. And in the health world, doctors, entrepreneurs and patients are all imagining that future office, where wearable technology helps identify signs of cancer resurgence, or out-of-control blood sugar in a diabetic, with contact lenses.

But there's another group likely to use wearable technology, says Morgenstern.

"First, it will be people with low vision and other disabilities," he says. "Then you'll have people with normal vision, and then the category of doctors using it to increase their effectiveness."

Dominick Maino, O.D., professor of pediatrics and binocular vision at the Illinois College of Optometry and private practitioner at Lyons Family Eye Care in Chicago, imagines a world in which people with dementia wear unobtrusive GPS devices that allow family members to easily track them if they leave the safety of their homes. Or, he imagines Google Contacts, which are being designed to monitor blood glucose levels, working seamlessly with insulin pumps, so one's blood sugar never veers out of healthy range. The possibilities are endless. Already, engineers are developing bracelets for the hearing impaired that can translate hand movements into words. For optometrists such as Dr. Maino, who see a great number of patients with disabilities, such technology could be quite useful.

"In the not-too-distant future—probably in my lifetime—both in terms of prevention and monitoring of health, we will probably all be wearing one or more devices that talk to each other," Dr. Maino says. "But right now, much of this is in the development stage or just vaporware."

Clearing the Vapor
Vaporware. It's a term for a technology that's talked about and lauded, but not available now and that may never become available. Right now, according to Dr. Maino and Dr. Morgenstern, that's where most wearable tech lives .

What wearables need, says Moore, is a purpose. Think about the cell phone, he says. Back when we had our Blackberries, the functionality was limited. It wasn't until the iPhone, with its functionality paired with "there's an app for that" software, that Americans converted to higher-tech phones.

"We're already seeing a plateau in interest for smart glasses," he says. "The reason is the software. It's the actual solutions: What do these things perform? What can they do?"

In the short term, the answer is that wearables will continue to tether to smartphones, until a small enough battery or the equivalent of a SIM card (which gives you a phone number and access to the Internet) is created to allow smart glasses and other eye-related wearables to cross over from mobile accessory to freestanding smart device. According to IHS's Shane Walker, associate director of IHS's Healthcare and Medical Devices division, in the company's September 2013 market assessment, cell phones will continue to be the hub for wearables. This "stresses the need for apps." (Find out what apps mean for your practice in the April 2014 edition of AOA Focus.)

And there's another challenGoogle Glassge for wearable tech of the virtual reality sort: motion sickness. Although Dr. Morgenstern says he wants to be "the first virtual reality optometrist," virtual reality technology still poses some problems.

"The technology has improved dramatically over the past 20 years," says Thomas Stoffregen, director of the Affordance Perception-Action Lab at the University of Minnesota School of Kinesiology. "But virtual reality head-mounted displays are still dogged by a very serious problem, which is that they tend to make people very sick."

Stoffregen has been studying motion sickness for decades. By most accounts, he says, virtual reality head-mounted displays cause motion sickness in about 40 percent of users. That motion sickness is more likely in women, for reasons Stoffregen says no one has been able to yet discern.

The problem is that the eye is constantly reworking accommodation and convergence to see things clearly and with the correct depth perception. But the technology hasn't been able to mimic the eye's complexity, he says.

"All the head-mounted displays I've studied are still a part of reality; that is, the screen is still six inches in front of your face," he says. "Your eyes accommodate to that. Even if the computer could convincingly simulate your fingers at arm's length, your eyes will naturally wish to accommodate at arm's length, but to do that, the vision up close [where the display is] gets fuzzy and goes out of focus."

Some people can adapt to this easily; others can't, and they get sick. This is one reason why, he says, the Oculus Rift Virtual Reality player, bought by Facebook for $2 billion in March, hasn't been released to consumers.

"Head-mounted displays and virtual reality devices will not enter the mainstream until and unless they can solve the motion sickness problem," he says.

Other than that, the optometrists who spoke to AOA Focus say they don't expect wearable devices to trouble the eyes.

A bigger problem with adoption, Dr. Maino says, will be price. Digital cameras offered great technology but didn't become popular until the price dropped below $1,000. With Google Glass still costing about $1,500 and devices like OrCam, which use a camera software-headphone combination to read written words to the visually impaired, still hovering around $3,500, wearable technology still has a way to go before it will usurp the role the cell phone and its apps play in our lives.

Still, wearables are coming, says Moore: First to business and warehouse settings where people need to be connected throughout the day, and then to the millennials and beyond for whom wearables "are like breathing." He estimates it will be 2016 before wearables come to business in a big way. But then, all bets will be off.

"The year 2016 is plenty of time to make one, maybe two revisions to the hardware and for software to be developed," says Moore. "It's not if, it's when."

Wearable Tech Vocabulary:

What's a heads-up display vs. a head-mounted display? Augmented reality vs. virtual reality? When it comes to wearable tech that affects the eyes, there are lots of terms to learn. Consider these.

Heads-Up Display
A heads-up display is the idea behind Google Glass and all other smart glasses. The idea is to keep the wearer from rooting around in a bag or pocket for a cell phone, thus losing track of what's in front of them. Long used for GPS in the traditional sense, they are now being employed by a variety of smart-glasses makers.

Garmin HUD
Projects your navigation information onto your windshield so you don't have to keep looking down at a phone or other GPS device to find your way.

Recon Jet
Specifically designed for cyclists, the Recon Jet places a small screen on the lower right-hand corner of a pair of wrap-around sunglasses. The small screen can measure speed, distance, elevation gain and more, while connecting to other sensor devices, such as the Fitbit or Jawbone Up exercise-monitoring wristband systems, and receiving texts from your cell phone.

Head-Mounted Display

his is the virtual-reality world and the auspices of video gamers and flight simulators. The idea is to isolate view.

Oculus Rift Development Kit
This virtual-reality kit is under development. None of the devices have been released for consumers yet (the development kit is meant for app developers).

Wearable HDTV 2D/3D Virtual 7.1 Surround Sound Display
$ $999.99
Watch movies and TV and connect to your computer and cell phone via this display.

Augmented Reality vs. Virtual Reality

Think of it this way, says Thomas A. Stoffregen, director of the Affordance Perception-Action Lab at the University of Minnesota School of Kinesiology: Google Glass is augmented reality, with clear lenses and the ability and desire to see the world around you. Oculus Rift is virtual reality, designed to shield you from the world and direct your mind into a world created on a screen located inches from your eyes.