Evaluation of eye-tracking capabilities in Apple Vision Pro for training in hybrid ventricular septal defect procedures

Three-dimensional visualization of anatomical structures is a crucial skill for ventricular septal defect closure hybrid procedures, a task that takes years of training to master. The use of virtual and augmented reality has recently increased in the medical field to assist with these visualization challenges during surgery. Apple's Vision Pro is one of the most recent virtual/augmented reality headsets to show promise in this area because it relies on eye-tracking to navigate its interface. This research aims to provide a quantitative assessment of the Vision Pro's eye-tracking capabilities to determine whether it is an appropriate tool to use for training cardiac surgeons, whose precision skills are of utmost importance. To do so, we recruited a cohort of 44 participants and developed a user study in two parts. The first was a 2D random saccades task which gave a baseline evaluation of the Vision Pro and the second was an evaluation in a more clinical setting involving the selection of anatomical landmarks on a 3D pediatric heart model molded in polyvinyl alcohol cryogel. We obtained an accuracy of 0.59 degrees, an RMS precision of 0.41 degrees, and a standard deviation precision of 0.21 for the first part, and an accuracy of 3.70 degrees, RMS precision of 0.96 degrees, and standard deviation of 0.23 degrees for the second part. The eye tracking capabilities of the Vision Pro are promising for navigation guidance during cardiac surgery, and might provide additional visualization cues such as an overlay of a 3D preoperative model.