Development of a virtual reality training curriculum for phacoemulsification surgery

Abstract

Purpose Training within a proficiency-based virtual reality (VR) curriculum may reduce errors during real surgical procedures. This study used a scientific methodology to develop a VR training curriculum for phacoemulsification surgery (PS). Patients and methods Ten novice-(n) (performed o10 cataract operations), 10 intermediate-(i) (50-200), and 10 experienced-(e) (4500) surgeons were recruited. Construct validity was defined as the ability to differentiate between the three levels of experience, based on the simulator-derived metrics for two abstract modules (four tasks) and three procedural modules (five tasks) on a high-fidelity VR simulator. Proficiency measures were based on the performance of experienced surgeons. Results Abstract modules demonstrated a 'ceiling effect' with construct validity established between groups (n) and (i) but not between groups (i) and (e)-Forceps 1 (46, 87, and 95; Po0.001). Increasing difficulty of task showed significantly reduced performance in (n) but minimal difference for (i) and (e)-Anti-tremor 4 (0, 51, and 59; Po0.001), Forceps 4 (11, 73, and 94; Po0.001). Procedural modules were found to be construct valid between groups (n) and (i) and between groups (i) and (e)-Lenscracking (0, 22, and 51; Po0.05) and Phacoquadrants (16, 53, and 87; Po0.05). This was also the case with Capsulorhexis (0, 19, and 63; Po0.05) with the performance decreasing in the (n) and (i) group but improving in the (e) group (0, 55, and 73; Po0.05) and (0, 48, and 76; Po0.05) as task difficulty increased. Conclusion Experienced/intermediate benchmark skill levels are defined allowing the development of a proficiency-based VR training curriculum for PS for novices using a structured scientific methodology.

Intraocular surgery – assessment and transfer of skills using a virtual‐reality simulator

“…Relevant benchmark levels have been developed for cataract surgical training on the EyeSi simulator (Spiteri et al. ; Thomsen et al. 2015).…”

Consensus on procedures to include in a simulation‐based curriculum in ophthalmology: a national Delphi study

“…• Wet laboratory using a porcine model (Kersey 2009(Kersey ) et al 2014. In this study, only four procedures were excluded during the last Delphi round, reflecting a high level of consensus among survey participants.…”

“…It is widely recognized that training based solely on the apprenticeship model is not an ideal approach for technical skills training (Oetting 2009;Lorch & Kloek 2017). As a consequence, there has been a significant increase in the utilization of simulation-based models in resident education, extending from wet laboratory to virtual reality training (Henderson et al 2009;Spiteri et al 2014;Thomsen et al 2015b;Vergmann et al 2017).…”

Quantifying the real-world cost saving from using surgical adjuncts to prevent complications during cataract surgery

“…In light of this, many authors have recommended the use of prior simulation to guide the surgeon in these rare but predictable surgical scenarios, through low-cost surveys of trainee experience, wet and dry laboratory facilities and computer simulation [9][10][11][12][13][14][15][16][17]. Ease of access to a pre-prepared Anterior Vitrectomy Kit with associated adjuncts (AntVitKit) to help with the prompt and appropriate management of VL has been previously described [18].…”