The first thing to do is to go to the Settings Menu, followed by the Graphics Settings, and adjust the resolution, anti-aliasing, and scaling settings. When you first load Euro Truck Simulator 2 VR, the graphics may not look great, or you may find performance to be suboptimal, but there are a number of adjustments you can make to optimize your experience. I have played ETS2 on a number of VR headsets, including the HP Reverb G2, Meta Quest 2, Pico 4, and Valve Index, and I can confirm that each headset worked great using this method.
Add -openvr or -oculus to the Launch Options to play ETS2 in VR
