The Effect of Virtual Reality Technology on Anxiety in Children Undergoing Ophthalmic Surgery: A Randomized Clinical Trial

BACKGROUND: Eye surgery, along with the short-term visual difficulties, often translates to anxiety in both children and their families. The emotional well-being of child's guardian can influence the child's anxiety. Virtual reality (VR) technology, which offers a 360° immersive experience, has emerged as an effective nonpharmacological method for reducing anxiety among children through virtual exposure and distraction. OBJECTIVE: To assess the effectiveness of VR in alleviating anxiety in children and their guardians during eye surgery under general anesthesia. METHODS: In total, 31 children aged 3-10 years, who were scheduled for elective eye surgery, were randomly assigned to either the VR or the control group. In the VR group, both the children and their guardians were introduced to the surgical process and the operating room environment by using a helmet-mounted VR a day before the surgery. On the day of surgery, the children in the VR group watched an animation video through VR while receiving the intravenous injection. In contrast, children in the control group were verbally informed about the surgery a day before and accepted the intravenous injection as usual on the day of surgery. The guardians' anxiety were assessed on day 1 preoperatively by using the Preoperative Anxiety Scale-7 and the Amsterdam Preoperative Anxiety and Information Needs Scale. Children's anxiety on the day of surgery was measured by using the modified Yale Preoperative Anxiety Scale (m-YPAS). Guardian satisfaction was evaluated on day 1 postoperatively. RESULTS: Children in the VR group showed significantly lower m-YPAS anxiety scores than those in the control group [23.4 (23.4-28.4) vs. 38.4 (31.6-46.6), rank-biserial correlation = 0.91, p < 0.001]. Similarly, the Preoperative Anxiety Scale-7 scores of guardians in the VR group were notably lower than those in the control group [2 (0-5) vs. 11 (4-12), rank-biserial correlation = - , p < 0.001]. The Amsterdam Preoperative Anxiety and Information Needs Scale results also indicated lower anxiety scores in the VR group [4 (4-6)] than in the control group [8 (7-11), rank-biserial correlation = -0.64, p < 0.001]. Furthermore, the VR group demonstrated a reduced need for additional information [2 (2-3)] when compared with the control group [4 (2-5), rank-biserial correlation = 0.17, p = 0.008]. Guardian satisfaction scores were higher in the VR group [90 (87-100)] than in the control group [85 (80-87), rank-biserial correlation = 0.44, p < 0.001]. CONCLUSIONS: The use of VR technology could be a promising nonpharmacological intervention for alleviating preoperative anxiety in pediatric patients undergoing ophthalmic procedures.