A virtual training simulator for learning cataract surgery with phacoemulsification

Author name used in this publication: Fu-Lai Chung2009-2010 > Academic research: refereed > Publication in refereed journalAccepted ManuscriptPublishe

Ethical Dilemmas in Contemporary Ophthalmic Practice in Nigeria

Background: Ethics, as a branch of both philosophy and theology, is a systematic study of what is right and wrong withrespect to conduct and character. As an intellectual discipline, ethics seeks to provide good reasons for our moral choices.Aim: The aim was to discuss common plausible clinical scenarios that pose ethical questions in typical ophthalmic set‑ups in Nigeria and suggest modalities of resolving them. Methods: Involved extensive literature search on ethics and medical jurisprudence. Result: There is hardly an area in medicine that does not have an ethical aspect. For example, there are ethical issues relating to abortion, organ donations, birth control, euthanasia, etc., Ethics in Ophthalmology have not been the focus of scholarly articles particularly in our African environment. Yet there is increasing consciousness of patients’ right to self‑determination that cuts across all areas of human endeavors.Conclusion: Ethics, and not the law, establishes the ultimate standard for evaluating conduct. Still, there is a moral obligation to obey the law, and thus ethical analyses need to take into account the relevant statutes and court decisions.Keywords: Ethics, Nigeria, ophthalmolog

I++ simulator used to support working with coordinate measuring machine

This paper presents examples of usage of Coordinate Measuring Machine simulator, which facilitate metrological tasks in laboratory and industrial conditions, and constitute a great convenience in Coordinate Measuring Technique learning process

Biomechanics of Eye Globe and Methods of Its Study

Knowledge of biomechanical properties of eye globe is necessary both for correct selection of candidates for refractive surgery and right choice of operative intervention parameters. No less important, it is for corneal ectatic disease diagnostics and monitoring. Also it gives inestimable contribution for interpretation of intraocular pressure (IOP) indices especially in cases with irregular eye shape or after past corneal surgical procedures. Moreover, it allows studying injury mechanism by glaucoma process on optic nerve head fibers. Above it, scleral biomechanical properties research is necessary for the investigation of pathophysiologic factors of myopia manifestation and progression. This chapter is devoted to review of existed to date methods of study of eye fibrous tunic biomechanical properties. It describes mathematical, experimental, and clinical models provided evaluation of unsearchable by direct measurement parameters. It also observes effective technics of impact on both sclera and cornea with the aim of correction of its biomechanical condition

Virtual Phacoemulsification Surgical Simulation Using Visual Guidance And Performance Parameters As A Feasible Proficiency Assessment Tool

Background: Computer based surgical training is believed to be capable of providing a controlled virtual environment for medical professionals to conduct standardized training or new experimental procedures on virtual human body parts, which are generated and visualised three-dimensionally on a digital display unit. The main objective of this study was to conduct virtual phacoemulsification cataract surgery to compare performance by users with different proficiency on a virtual reality platform equipped with a visual guidance system and a set of performance parameters. Methods: Ten experienced ophthalmologists and six medical residents were invited to perform the virtual surgery of the four main phacoemulsification cataract surgery procedures – 1) corneal incision (CI), 2) capsulorhexis (C), 3) phacoemulsification (P), and 4) intraocular lens implantation (IOL). Each participant was required to perform the complete phacoemulsification cataract surgery using the simulator for three consecutive trials (a standardized 30-min session). The performance of the participants during the three trials was supported using a visual guidance system and evaluated by referring to a set of parameters that was implemented in the performance evaluation system of the simulator. Results: Subjects with greater experience obtained significantly higher scores in all four main procedures – CI1 (ρ = 0.038), CI2 (ρ = 0.041), C1 (ρ = 0.032), P2 (ρ = 0.035) and IOL1 (ρ = 0.011). It was also found that experience improved the completion times in all modules – CI4 (ρ = 0.026), C4 (ρ = 0.018), P6 (ρ = 0.028) and IOL4 (ρ = 0.029). Positive correlation was observed between experience and anti-tremor – C2 (ρ = 0.026), P3 (ρ = 0.015), P4 (ρ = 0.042) and IOL2 (ρ = 0.048) and similarly with anti-rupture – CI3 (ρ = 0.013), C3 (ρ = 0.027), P5 (ρ = 0.021) and IOL3 (ρ = 0.041). No significant difference was observed between the groups with regards to P1 (ρ = 0.077). Conclusions: Statistical analysis of the results obtained from repetitive trials between two groups of users reveal that augmented virtual reality (VR) simulators have the potential and capability to be used as a feasible proficiency assessment tool for the complete four main procedures of phacoemulsification cataract surgery (ρ < 0.05), indicating the construct validity of the modules simulated with augmented visual guidance and assessed through performance parameters

Rapid learning curve assessment in an ex vivo training system for microincisional glaucoma surgery

Increasing prevalence and cost of glaucoma have increased the demand for surgeons well trained in newer, microincisional surgery. These procedures occur in a highly confined space, making them difficult to learn by observation or assistance alone as is currently done. We hypothesized that our ex vivo outflow model is sensitive enough to allow computing individual learning curves to quantify progress and refine techniques. Seven trainees performed nine trabectome-mediated ab interno trabeculectomies in pig eyes (n = 63). An expert surgeon rated the procedure using an Operating Room Score (ORS). The extent of outflow beds accessed was measured with canalograms. Data was fitted using mixed effect models. ORS reached a half-maximum on an asymptote after only 2.5 eyes. Surgical time decreased by 1.4 minutes per eye in a linear fashion. The ablation arc followed an asymptotic function with a half-maximum inflection point after 5.3 eyes. Canalograms revealed that this progress did not correlate well with improvement in outflow, suggesting instead that about 30 eyes are needed for true mastery. This inexpensive pig eye model provides a safe and effective microsurgical training model and allows objective quantification of outcomes for the first time