The role of simulators in improving vitreoretinal surgery training - A systematic review

Objective: To conduct an appraisal of current evidence regarding the effectiveness of EyeSi®-based training of vitreoretinal surgery.Methods: The systematic review was conducted in July 2020, and comprised literature search on Cochrane Library, PubMed and Embase for articles regarding simulation training in vitreoretinal surgery. The shortlisted articles were subjected to qualitative analysis. Existing evidence was assessed, and predictions on how outcomes may be applied to improve vitreoretinal surgery training were made. The risk of bias of each study was calculated in line with the guidelines of the Cochrane Handbook.Results: Of the 124 articles identified, 7(5.6%) were shortlisted; 5(71.4%) established construct validity; 1(14.3%) discriminate validity and 1(14.3%) concurrent validity. Analysis disclosed minimal bias in the selected studies.Conclusions: Current evidence on simulation training in vitreoretinal surgery suggests it is a thoroughly validated training tool with minimal risk of bias. Vitreoretinal surgery training programmes should adopt and gauge the impact simulation training has on patient-related outcomes

Sensorimotor integration processing in Diabetic Retinopathy and Diabetic Peripheral Neuropathy

This study evaluated the direct link between visual perception and related motor output responses during an optic flow stimulation which induced a perception of forward movement, and during a driving task using a simulator. The experiments focussed on the evaluation of two different complications of diabetes, diabetic retinopathy and diabetic peripheral neuropathy (DPN), in order to evaluate the different contributions of both central and peripheral nervous factors in affecting the sensorimotor integration process in diabetes. Study I. The aim was to assess how optic flow processing contributes to the control of posture and whether it requires the predominant activation of cortical networks involved in motion perception or the intervention of subcortical loops. People with retinopathy and people who had undergone laser treatment showed a higher postural instability compared to control subjects. Differing retinal functionality produced different postural strategies. Based on these findings, postural control seems to be a process dependent on perceptual analysis via feed-forward cortical circuits. Study II. The aim was to assess whether diabetes was associated with alterations of visual gaze behaviour and/or neuromuscular impairment that might adversely affect driving performance. The potential for impaired driving performance with diabetes seems to be represented by diminished eye-steering coordination. While proprioception function seems to indicate the potential for improvement, a slower production of strength in the plantar flexor muscles seems not to influence accelerator pedal control during a driving simulation task in people with diabetes (with and without diabetic peripheral neuropathy). These results confirm the role of visual perception and eye movements in guiding human movements during dailylife activities. In particular, we demonstrated the detrimental effects of diabetes and the different contribution of diabetic retinopathy and diabetic peripheral neuropathy in affecting both central and peripheral components of the sensorimotor integration process

Virtual interactive practice™: Utilising healthcare information systems to contexturalise the skills associated with clinical decision making within nurse education

This paper reports on a Virtual Interactive Practice (VIP) project that has the potential to revolutionise the educational delivery and learning of clinical skills complementing "real" practice. The focus is currently on nurse learning but the principles could equally be applied to multi and inter-professional learning and clinical decision-making. This project represents a new model to enhance clinical skill acquisition and clinical reasoning using a structured competency base. Integral to this is a strong partnership between education and practice utilising "real" live and recorded anonymised patient data from a critical care clinical information system (CIS) within a large district general hospital to structure scenarios fostering problem-based learning. This educational practice interface enables the synthesis of clinical data using virtual technology and sophisticated scenario-based simulation within a skills laboratory. The aim is to enhance the more ad hoc system of learning within conventional practice placements. Early findings suggest that VIP enhances practice providing a safe but challenging learning experience with the benefit of instant performance feedback to students

Enhancing Fundamental Robot-Assisted Surgical Proficiency by Using a Portable Virtual Simulator

Background. The development of a virtual reality (VR) training platform provides an affordable interface. The learning effect of VR and the capability of skill transfer from the VR environment to clinical tasks require more investigation. Methods. Here, 14 medical students performed 2 fundamental surgical tasks—bimanual carrying (BC) and peg transfer (PT)—in actual and virtual environments. Participants in the VR group received VR training, whereas participants in the control group played a 3D game. The learning effect was examined by comparing kinematics between pretraining and posttraining in the da Vinci Surgical System. Differences between VR and playing the 3D game were also examined. Results. Those who were trained with the VR simulator had significantly better performance in both actual PT (P = .002) and BC (P \u3c .001) tasks. The time to task completion and the total distance traveled were significantly decreased in both surgical tasks in the VR group compared with the 3D game group. However, playing the 3D game showed no significant enhancement of fundamental surgical skills in the actual PT task. The difference between pretraining and posttraining was significantly larger in the VR group than in the 3D game group in both the time to task completion (P = .002) and the total distance traveled (P = .027) for the actual PT task. Participants who played the 3D game seemed to perform even worse in posttraining. Conclusions. Training with the portable VR simulator improved robot-assisted surgical skill proficiency in comparison to playing a 3D game

Development of a virtual reality ophthalmoscope prototype

El examen visual es un procedimiento importante que proporciona información acerca de la condición del fondo de ojo, permitiendo la observación e identificación de anomalías, como ceguera, diabetes, hipertensión, sangrados resultado de traumas, entre otros. Un apropiado examen permite identificar condiciones que pueden comprometer la visión, sin embargo, éste es desafiante porque requiere de una práctica extensiva para desarrollar las habilidades para una adecuada interpretación que permiten la identificación exitosa de anomalías en el fondo de ojo con un oftalmoscopio. Para ayudar a los practicantes a desarrollar sus habilidades para la examinación ocular, los dispositivos de simulación médica están ofreciendo oportunidades de entrenamiento para explorar numerosos casos del ojo en escenarios simulados, controlados y monitoreados. Sin embargo, los avances en la simulación del ojo han llevado a costosos simuladores con acceso limitado ya que la práctica se mantiene con interacciones para un aprendiz y en algunos casos, ofreciendo al entrenador la visión para la interacción del practicante. Gracias a los costos asociados a la simulación médica, hay varias alternativas reportadas en la revisión de la literatura, presentando aproximaciones efectividad-costo y nivel de consumo para maximizar la efectividad del entrenamiento para el examen de ojo. En este trabajo se presenta el desarrollo de una aplicación con realidad aumentada inmersiva y no-inmersiva, para dispositivos móviles Android con interacciones a través de un controlador impreso en 3D con componentes electrónicos embebidos que imitan a un oftalmoscopio real. La aplicación presenta a los usuarios un paciente virtual visitando al doctor para un examen ocular, y requiere que el aprendiz ejecute el examen de fondo de ojo haciendo diagnosticando sus hallazgos. La versión inmersiva de la aplicación requiere del uso de un casco de realidad virtual, además del prototipo 3D de oftalmoscopio, mientras que la no inmersiva, requiere únicamente del marcador dentro del campo de visión del dispositivo móvil.The eye examination is an important procedure that provides information about the condition of the eye by observing its fundus, thus allowing the observation and identification of abnormalities, such as blindness, diabetes, hypertension, and bleeding resulting from traumas among others. A proper eye fundus examination allows identifying conditions that may compromise the sight; however, the eye examination is challenging because it requires extensive practice to develop adequate interpretation skills that allows successfully identifying abnormalities at the back of the eye seen through an ophthalmoscope. To assist trainees in developing the eye examination skills, medical simulation devices are providing training opportunities to explore numerous eye cases in simulated, controlled, and monitored scenarios. However, advances in eye simulation have led to expensive simulators with limited access as practice remain conducted on a one trainee basis in some cases offering the instructor a view of the trainee interactions. Because of the costs associated with medical simulation, there various alternatives reported in the literature review presenting cost-effective and consumerlevel approaches to maximize the effectiveness of the eye examination training. In this work, we present the development an immersive and non-immersive augmented reality application for Android mobile devices with interactions through a 3D printed controller with embedded electronic components that mimics a real ophthalmoscope. The application presents users with a virtual patient visiting the doctor for an eye examination, and requires the trainees to perform the eye fundus examination and diagnose their findings. The immersive version of the application requires the trainees to wear a mobile VR headset and hold the 3D printed ophthalmoscope, while the non-immersive version requires them to hold the marker within the field of view of the mobile device.Pregrad

An update on retinal prostheses

Retinal prostheses are designed to restore a basic sense of sight to people with profound vision loss. They require a relatively intact posterior visual pathway (optic nerve, lateral geniculate nucleus and visual cortex). Retinal implants are options for people with severe stages of retinal degenerative disease such as retinitis pigmentosa and age-related macular degeneration. There have now been three regulatory-approved retinal prostheses. Over five hundred patients have been implanted globally over the past 15 years. Devices generally provide an improved ability to localize high-contrast objects, navigate, and perform basic orientation tasks. Adverse events have included conjunctival erosion, retinal detachment, loss of light perception, and the need for revision surgery, but are rare. There are also specific device risks, including overstimulation (which could cause damage to the retina) or delamination of implanted components, but these are very unlikely. Current challenges include how to improve visual acuity, enlarge the field-of-view, and reduce a complex visual scene to its most salient components through image processing. This review encompasses the work of over 40 individual research groups who have built devices, developed stimulation strategies, or investigated the basic physiology underpinning retinal prostheses. Current technologies are summarized, along with future challenges that face the field

Visual Impairment and Blindness

Blindness and vision impairment affect at least 2.2 billion people worldwide with most individuals having a preventable vision impairment. The majority of people with vision impairment are older than 50 years, however, vision loss can affect people of all ages. Reduced eyesight can have major and long-lasting effects on all aspects of life, including daily personal activities, interacting with the community, school and work opportunities, and the ability to access public services. This book provides an overview of the effects of blindness and visual impairment in the context of the most common causes of blindness in older adults as well as children, including retinal disorders, cataracts, glaucoma, and macular or corneal degeneration

Cable-driven parallel robot for transoral laser phonosurgery

Transoral laser phonosurgery (TLP) is a common surgical procedure in otolaryngology. Currently, two techniques are commonly used: free beam and fibre delivery. For free beam delivery, in combination with laser scanning techniques, accurate laser pattern scanning can be achieved. However, a line-of-sight to the target is required. A suspension laryngoscope is adopted to create a straight working channel for the scanning laser beam, which could introduce lesions to the patient, and the manipulability and ergonomics are poor. For the fibre delivery approach, a flexible fibre is used to transmit the laser beam, and the distal tip of the laser fibre can be manipulated by a flexible robotic tool. The issues related to the limitation of the line-of-sight can be avoided. However, the laser scanning function is currently lost in this approach, and the performance is inferior to that of the laser scanning technique in the free beam approach. A novel cable-driven parallel robot (CDPR), LaryngoTORS, has been developed for TLP. By using a curved laryngeal blade, a straight suspension laryngoscope will not be necessary to use, which is expected to be less traumatic to the patient. Semi-autonomous free path scanning can be executed, and high precision and high repeatability of the free path can be achieved. The performance has been verified in various bench and ex vivo tests. The technical feasibility of the LaryngoTORS robot for TLP was considered and evaluated in this thesis. The LaryngoTORS robot has demonstrated the potential to offer an acceptable and feasible solution to be used in real-world clinical applications of TLP. Furthermore, the LaryngoTORS robot can combine with fibre-based optical biopsy techniques. Experiments of probe-based confocal laser endomicroscopy (pCLE) and hyperspectral fibre-optic sensing were performed. The LaryngoTORS robot demonstrates the potential to be utilised to apply the fibre-based optical biopsy of the larynx.Open Acces

Advancing treatment of retinal disease through in silico trials

Abstract Treating retinal diseases to prevent sight loss is an increasingly important challenge. Thanks to the configuration of the eye, the retina can be examined relatively easily in situ. Owing to recent technological development in scanning devices, much progress has been made in understanding the structure of the retina and characterising retinal biomarkers. However, treatment options remain limited and are often of low efficiency and efficacy.&amp;#xD;&amp;#xD;In recent years, the concept of in silico clinical trials has been adopted by many pharmaceutical companies to optimise and accelerate the development of therapeutics. In silico clinical trials rely on the use of mathematical models based on the physical and biochemical mechanisms underpinning a biological system. With appropriate simplifications and assumptions, one can generate computer simulations of various treatment regimens, new therapeutic molecules, delivery strategies and so forth, rapidly and at a fraction of the cost required for the equivalent experiments. Such simulations have the potential not only to hasten the development of therapies and strategies but also to&amp;#xD;optimise the use of existing therapeutics.&amp;#xD;&amp;#xD;In this paper, we review the state-of-the-art in in silico models of the retina for mathematicians, biomedical scientists and clinicians, highlighting the challenges to developing in silico clinical trials. Throughout this paper, we highlight key findings from in silico models about the physiology of the retina in health and disease. We describe the main building blocks of in silico clinical trials and identify challenges to developing in silico clinical trials of retinal diseases.</jats:p