Validity and usability of a virtual reality intraocular surgical simulator

Cataract surgery is one of the most common surgical procedures in Sweden and around 90 000 operations are made each year. An aging population with increased demands on quality of life and good visual acuity, has led to an increased rate of surgery and more surgeons needs to be trained. Training of new cataract surgeons is done on scarce wet-lab training but mainly on patients. Training is costly and complications are higher for new surgeons compared to experienced ones. In the airline industry simulators are used for training. Pilots have to prove competent before flying a new airplane. No such standards exist for new cataract surgeons. Surgical simulators have been used in other surgical fields for training and reports have shown that training has improved performance on real operations. The purpose of this work was to validate Eyesi, a surgical simulator for cataract surgery training, and analyze learning curves. Furthermore we set out to investigate whether factors like stereoacuity and sex would be important for performance in the simulator. Evidence for construct validity was found for cataract specific modules capsulorhexis, hydromaneuvers and phaco divide and conquer and for manipulating modules cataract navigation training, cataract forceps training and cataract cracking and chopping training. Analysis of learning curves showed significant improvement throughout training. Evidence for concurrent validity was established for the capsulorhexis module. For the hydromaneuvers and phaco modules, the innate simulator scoring could not distinguish surgical skill but discrimination was dependent on video based human scoring. Stereoacuity was found to correlate with performance on the simulator but there were large individual variations. An individual’s sex had no influence on performance. We have shown that Eyesi can differentiate cataract surgical skill and that naïve can train in the simulator and improve. Stereoacuity has an effect on performance but there were large individual variations. Simulation-based training has the potential to move the early learning curve out of the operating room

Can simulators be applied to improve cataract surgery training: A systematic review

Objective: The purpose of this paper was to conduct a systematic review of existing literature on simulation-based training of cataract surgery. Available literature was evaluated and projections on how current findings could be applied to cataract surgery training were summarised. The quality of included literature was also assessed.Methods and analysis: The PubMed, Embase and Cochrane Library databases were searched for articles pertaining to simulation training in cataract surgery on 18 November 2019. Selected articles were qualitatively analysed.Results: A total of 165 articles were identified out of which 10 met inclusion criteria. Four studies reported construct validity of the EyeSi simulator. Six studies demonstrated improved surgical outcomes corresponding to training on the simulator. Quality assessment of included studies was satisfactory.Conclusion: Current studies on simulation training in cataract surgery all point towards it being an effective training tool with low risk of study biases confounding this conclusion. As technology improves, surgical training must embrace and incorporate simulation technology in training

Cataract complications study : an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Background: To evaluate the learning-curve in performing cataract surgery with respect to developments in technology and different teaching strategies by comparing the incidence of capsular bag-related complications to operator experience. Methods: A review of the registry of 14,520 cataract surgeries carried out at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland, from August 8, 2009 to July 31, 2017. Results: We identified 144 cases with posterior capsule rupture and/or loss of capsular bag support (incidence 0.99% of all surgeries). The mean age of patients was 76.99.1 years and gender distribution ratio 29:71 male:female. Pseudoexfoliation syndrome (PXF; incidence 21%) and small pupil (incidence 14%) were over-represented in complication eyes, especially at the beginning of the study. Capsular bag-related complication rates were reported in 0.36% of surgeries for senior and 7.03% for resident surgeons at the beginning of the study, compared to 0.32% and 1.32%, respectively, at the end of the study. Best-corrected visual acuity at the final post-operative visit was 0.61 +/- 0.16 decimals at the beginning of the study, and 0.81 +/- 0.19 decimals at the end of the study. The mean number of post-operative visits was 4.3 +/- 2.7 and did not show trend over the study period. Conclusions: Real-world evidence suggests PXF and small pupil as significant risk factors in cataract surgery. A gradual decline in the rate complications was noted with increasing surgical experience, also among residents over the follow-up period.Peer reviewe

Surgical training in ophthalmology: Role of EyeSi in the era of simulation-based learning

Recent advancements in surgical training methods have escalated the need for simulators. The EyeSi simulation has played a major role in Ophthalmology training by providing opportunity to the novice residents to grasp the surgical steps of the procedure and master the skill by repeated attempts. Participants were assessed on single level of cataract module and their consecutive scores were assessed with each attempt. It was found that repetitive practice on simulator can help develop proficiency in the desired steps that can ultimately prepare the surgical trainees for real life surgery

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

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

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