Cataract surgeons outperform medical students in Eyesi virtual reality cataract surgery: evidence for construct validity

Abstract

. Purpose: To investigate construct validity for modules hydromaneuvers and phaco on the Eyesi surgical simulator. Methods: Seven cataract surgeons and 17 medical students performed capsulorhexis, hydromaneuvers, phaco, navigation, forceps, cracking and chopping modules in a standardized manner. Three trials were performed on each module (two on phaco) in the above order. Performance parameters as calculated by the simulator for each trial were saved. Video recordings of the second trial of the modules capsulorhexis, hydromaneuvers and phaco were evaluated with the modified Objective Structured Assessment of Surgical Skill (OSATS) and Objective Structured Assessment of Cataract Surgical Skill (OSACSS) tools. Results: Cataract surgeons outperformed medical students with regard to overall score on capsulorhexis (p < 0.001, p = 0.035, p = 0.010 for the tree iterations, respectively), navigation (p = 0.024, p = 0.307, p = 0.007), forceps (p = 0.017, p = 0.03, p = 0.028). Less obvious differences in overall score were found for modules cracking and chopping (p = 0.266, p = 0.022, p = 0.324) and phaco (p = 0.011, p = 0.081 for the two iterations, respectively). No differences in overall score were found on hydromaneuvers (p = 0.588, p = 0.503, p = 0.773), but surgeons received better scores from the evaluations of the modified OSATS (p = 0.001) and OSACSS (capsulorhexis, p = 0.003; hydromaneuvers, p = 0.017; phaco, p = 0.001). Conclusions: Construct validity was found on several modules previously not investigated (phaco, hydromaneuvers, cracking and chopping, navigation), and our results confirm previously demonstrated construct validity for capsulorhexis and forceps modules. Interestingly, validation of the hydromaneuvers module required OSACSS video evaluation tool. A further development of the scoring system in the simulator for the hydromaneuvers module would be advantageous and make training and evaluation of progress more accessible and immediate.

The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies)

“…However, the internal numerical variance and its statistical significance have not been analysed in detail before and this is relevant for the trainers, the individual trainees but also for the design of a training syllabus. Construct validation on the simulator has been established comparing novice groups with a more senior surgical cohort [12][13][14] and on average the more experienced performed better. All trainees enroled in this study had previously passed through a competitive selection process and were now in their first year of the London Deanery School of Ophthalmology Programme.…”

“…The ability to differentiate between different levels of expertise (construct validity) has been demonstrated for the capsulorhexis, cracking and chopping, navigation, and anti-tremor modules. [12][13][14] The capsulorhexis involves the following steps: injection of viscoelastic into the anterior chamber, flap creation, and capsulorhexis formation. For the cracking and chopping, the trainee is required to pull two spheres simultaneously until they reach a given length illustrated by a change in colour.…”

“…6,9 However, no specific analysis was ever undertaken with regard to the repeatability, reproducibility, or variability among novice trainees but rather these subjects were compared with more senior colleagues. 5,6,[8][9][10][11][12][13][14][15] What we therefore do not know is how an individual with minimal experience scores when undertaking the same task on several occasions (variability and reproducibility).…”

Efficacy of Eyesi® surgical simulator training in improving high-tension capsules capsulorhexis performance

“…The construction validity of the Eyesi® cataract surgical simulator capsulorhexis exercise has already been demonstrated, representing that its scoring system can effectively discriminate between a high skilled surgeon and a low skilled one (11,12) , as well as the positive repercussion of simulator training on cataract surgery learning curve of ophthalmology residents (1,14) and on wet lab performance (2) . On the present paper, we evaluated if the standard training course curriculum of exercises offered by Eyesi cataract simulator, on version 2.1, was effective in improving the surgical abilities of novice surgeons on a specific high difficult task such as performing a capsulorhexis on a high-tension capsule.…”

“…Simulators have also been useful on developing new surgical techniques (4)(5) , evaluation of the impact of stereo acuity, distraction and sleep deprivation on cataract surgeons performance (6)(7)(8)(9) and even in certification of surgeon abilities, without exposing patients to risk (10,11) . Eyesi® surgical simulator (VRMagic, Germany) is a high-fidelity virtual reality device developed for intraocular surgery training, including cataract and vitreoretinal procedures ( Figure 1).…”