A Not Too Geeky Look at VR Hardware with a Surgeon, Healthcare Futurist

Dr Rafael Grossmann with his SenseGlove. At the right, the Quest 2.

Conversation between Dr Rafael Grossmann and Denise Silber for VRforHealth

Rafael J. Grossmann Zamora, MD, FACS is an immigrant, surgeon, educator, speaker, patient advocate, and healthcare futurist, and immigrant. Originally from Caracas, Venezuela, Rafael did his surgery residency in Ann Arbor, MI, USA. After training as a general surgeon, he moved to Maine where he is a full-time practicing surgeon. Attracted by the paradoxical power of technology to facilitate more humane medical care, Dr Grossmann was the first to use Google Glass in the operating room. He keeps abreast not only of new applications, but of innovation in hardware.

DS As a surgeon and a healthcare futurist, you have been following the development of VR headsets as they come on the market.  Can you walk us through some of your early experiences?

RG If we start with the recent history of VR headsets, the first one to mention would be Google Cardboard, the fold-out cardboard viewer into which you could insert a smartphone. That was in 2014. There was some excitement around its launch, but Cardboard did not provide a fully immersive experience, and interest has waned as other products have come on the market.

Samsung Gear was launched in late 2015, through a collaboration with Oculus which I’ll mention next. The Samsung Gear was designed to work with the Samsung Galaxy smartphone. Samsung developed several models successively, but ended their investment in VR headsets in the fall of 2020, just a few weeks ago.

Oculus Rift launched in 2016. While the immersive experience was better, the headset still had important constraints. You had to be connected by a long cable, in order to have a mobile experience, and the sensors had to be in front of you, about a meter away.

The HTC Vive, the direct competitor to Oculus Rift, was also launched in 2016. Both the Oculus Rift and HTC Vive were immersive, but they were both tethered, heavy, and it was common to feel nausea and vertigo which limited the amount of time we would spend wearing these headsets.

DS And now we have the second generation of headsets…

RG Indeed with the launch of Oculus Go in mid 2018, the experience is quite different. The Go is completely untethered. The detail, the field of view or how much of your vision the headset covers, the refresh rate are significantly improved for a mobile device. We have a 360° view, and the audio quality is quite good. It’s pretty well adapted to relaxation and meditation and is democratizing access with an affordable entry-level price.

The Oculus Quest came out in May 2019. At first the Quest was not compatible with existing Oculus apps. Then the company developed a cable, the Oculus Link, to connect  the headset and the computer with those apps. The Oculus Quest 2, which launched mid-October is getting very good reviews. At 500 grams, it is lighter than the original Oculus, and the user can adjust the distance between his or her pupils. It also has better audio, better refresh rate, and a better battery life.

DS How do you feel about the requirement by Quest that the user have a Facebook account?

RG I loathe this requirement. I never had a Facebook account, and I created one just to  be able to use this model.

DS What about the Finnish VR headset, the Varjo? You have tried it.

RG I’ve tried the Varjo 1, 2 and the XR1 which I demoed during my keynote at the FDA this year.  The definition is unbelievable. If you see a blade of grass in the wind, you truly believe you are there. However, the headset is tethered, and the price precludes making it a consumer product for now. Still, there is no better VR headset. 

One of my best experiences in VR was when I was collaborating with Varjo on a demonstration of a surgical simulation in the OR. I was simultaneously wearing the iMotion sensors that were detecting my level of stress through the GSR (Galvanic Skin Resistance) and my heart rate. The aim was to compare the physiologic state of a more experienced surgeon to an inexperienced one while operating in VR.  It was kind of surreal.  I guess that’s what VIRTUAL really means.

DS What about haptics, such the VR gloves with sensors?

In addition to the Oculus Touch hand controllers with infrared tracking technology that are of course quite well known, there are several products to mention.

The SenseGlove from the Netherlands was developed to facilitate  rehabilitation after a stroke. The user interacts with a digital environment through  these gloves, “feeling” the digital representations as if they were real.

FundamentalVR has been developing surgery simulation scenarios which include haptic features that can change the simulation landscape.

The Tesla suit, a full body suit for physical VR experiences,  provides haptic feedback and captures both motion and biometrics. The technology is based on neuro-muscular stimulation.

OVR is a solution that adds olfactory stimulus to the VR experience. There will soon be a time when the VR experience will involve all senses, just like in science fiction.

DS Hygiene is of course critical for the hardware and not just during a pandemic.

RG Yes, indeed. I have a Cleanbox Tech unit in my office. Their technology seems to be a standard for the sanitization of head-mounted displays.

DS You are excited about the FDA’s openness to new technologies.

RG Yes, I am. As the pandemic pushes us to use new technologies, I see the FDA becoming more open to new technologies. I am optimistic that we will see an acceleration in the launch of digital health tools with real use cases and whose economic model makes sense.

DS And you are excited about VRforHealth.

RG Virtual Reality offers another exciting and efficient tool to the surgeon’s armamentarium, a proven solution based on the smart use of technology for the benefit of humanity. It’s digital health as it should be! So I am of course optimistic when I see initiatives like VRforHealth that facilitate and accelerate access by professionals and patients to quality information about immersive technologies.

Photo taken at the Cedars-Sinai Virtual Medicine conference, where both were speakers.