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Emily Li, Peter Fay, Paul Greenberg; A Virtual Cataract Surgery Course for Ophthalmologists-in-Training. Invest. Ophthalmol. Vis. Sci. 2013;54(15):803.
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Virtual reality (VR) surgery simulators have potential to be an important teaching modality for ophthalmology training programs. A key factor limiting the widespread adoption of virtual surgery in ophthalmic graduate medical education (GME), however, is the lack of evidence that virtual surgery training improves trainee cataract surgery outcomes. This problem is compounded by the lack of published validated VR cataract surgery curricula. As a first step to addressing these challenges, we present herein a VR cataract surgery course for ophthalmologists-in-training.
The VR course is designed to be used alongside of the EyeSi® ophthalmosurgical simulator (VRMagic, Mannheim, Germany). The course is divided into two main parts: (1) a didactic section based on the America Academy of Ophthalmology (AAO) Basic and Clinical Science Course® (BCSC), “Lens and Cataract” and (2) a VR section organized into subsections based on training targets for each post-graduate year (PGY) level (2-4) in US ophthalmology residency programs. Within each PGY level are select VR surgery simulator modules, each of which includes multiple training tasks aimed at a specific basic skill or a more advanced cataract surgery step. Early levels focus on more basic modules that then progress to more advanced modules in later PGY levels to transition residents into the operating room (OR).
The didactic section of the course explores the pathophysiology of the human lens. It introduces trainees to ocular anatomy, physiology and pathology and serves as a reference to be used alongside the surgery modules. Its subsections include Lens Anatomy, Lens Pathophysiology, Preoperative Care, Procedure, Postoperative Care and Complications of Cataract Surgery. The VR section focuses on cataract surgery training in the simulator. The basic skills practiced include intraocular navigation, anti-tremor handling of targeted instrument motions, bimanual coordination, forceps maneuvering and phacoemulsification machine calibration. The more advanced skills include capsulorhexis, hydrodissection, nuclear rotation, irrigation, aspiration, emulsification and nuclear disassembly.
We describe a virtual cataract surgery curriculum that can facilitate the incorporation of simulation technology into ophthalmic GME programs and encourage the critical evaluation of VR-to-OR outcomes for ophthalmologists-in-training.
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