Use of Apple Vision Pro as Virtual Monitor for Diagnostic and Therapeutic Procedures

Study Procedures

Enrolled physicians use the Apple Vision Pro (AVP) in place of a traditional monitor for the duration of each participating case. The AVP is worn from intra-operative visualization setup (typically at incision or first use of the imaging system) until the conclusion of the primary intra-operative visualization phase.

No modifications are made to the physician's standard operative technique, instrumentation, or intra-operative workflow apart from substitution of the display device. If the physician determines at any point during a case that the AVP cannot support safe completion of the procedure, they may revert to the traditional monitor without penalty; such cases are documented with a structured reason for conversion.

Data Collection Instruments

Data are collected via a structured post-case survey administered in REDCap immediately following case completion. The survey captures:

Case characteristics: date, operating physician, specialty, procedure name, operative time, and patient information (height, weight, body mass index).

Overall visualization rating: a single-item 5-point Likert-type comparative scale (1 = much worse than a traditional monitor; 5 = much better).

NASA Task Load Index (NASA-TLX): the raw unweighted version, comprising six subscales (mental demand, physical demand, temporal demand, performance, effort, frustration). The overall NASA-TLX score is computed as the mean of the six subscale ratings.

Per-case ergonomic symptom checklist: twelve pre-specified symptom dimensions (eye strain, headache, dizziness, nausea, blurred or double vision, light sensitivity, puffiness of the eyelids, face discomfort, neck discomfort, shoulder discomfort, back discomfort, and other AVP-related discomfort). Each symptom is captured using a two-step response format: first, a yes/no screen for whether the symptom was experienced; then, if experienced, a comparative severity rating (1 = much worse than a traditional monitor to 5 = much better). Cases in which a symptom is not experienced are coded as 0.

Feasibility of using AVP: binary yes/no field with a structured failure reason if the case could not be completed on the AVP (device failure, inadequate visual quality, negative ergonomic factors, or other).

Data Management

All study data are stored in REDCap hosted on Houston Methodist's institutional server infrastructure, which is HIPAA-compliant and access-controlled. Patient identifiers (medical record numbers) are used at the point of data entry to link procedure-specific metadata (e.g., patient BMI, operative timing from the electronic health record). Prior to analysis, all patient identifiers are removed and cases are analyzed using de-identified case-level records only.

Access to the REDCap project is restricted to study personnel with active IRB approval and REDCap credentials, managed through the Houston Methodist REDCap administrative team. Role-based user rights limit editing and export privileges according to each user's study responsibilities.

Quality Assurance

Structured, coded response fields (radio buttons, validated numeric inputs, checkbox groupings) are used throughout the data collection instrument to minimize free-text entry and reduce data entry error. Branching logic is used to ensure that follow-up items are displayed only when relevant, reducing survey burden and preventing invalid response combinations.

Range and consistency checks are built into the REDCap instrument, including validated time and integer entry, and permitted value ranges for continuous variables. Periodic data quality review is conducted by the study coordinator, including checks for completeness, out-of-range values, internal consistency between related fields, and follow-up on missing or incomplete records. Data queries are resolved with the responsible surgeon or clinical staff.