Impact of Microscope Integrated OCT on ophthalmology resident performance of anterior segment maneuvers in model eyes.

Abstract

 

Purpose

 

The integration of swept-source optical coherence tomography (SS OCT) in the operating microscope enables real-time, tissue-level imaging to aid in ophthalmic microsurgery. In this prospective randomized controlled study, we evaluated the impact of SS microscope-integrated OCT technology (MI OCT) on ophthalmology residents’ performance in anterior segment surgery.

 

Methods

 

Ophthalmology residents (N=14) were recruited, stratified by year of training, and randomized to perform the following four anterior segment maneuvers on porcine eyes without (Group A) or with (Group B) direct MI OCT guidance: 50% and 90% depth corneal suture passes, repair of vertical linear corneal laceration via suturing at 90% thickness, and creation of a tri-planar clear corneal incision. Both groups of residents then repeated the maneuvers without MI OCT guidance. Lastly, the non MI-OCT controls (Group A) repeated all maneuvers under direct MI OCT guidance.<br /> <br /> Volumetric OCT scans acquired at the end of each maneuver were manually segmented to compute point of maximal depth of each corneal pass and tri-planar corneal incision profile. Differences between Group A and B were compared using one-way ANOVA (Figure 1A). Subjective feedback through a survey was also obtained from each resident after they had completed all maneuvers (Figure 1B).

 

Results

 

Figure 1 shows the results from Group A (no MIOCT guidance) and Group B (MIOCT guidance). Residents operating with direct MI OCT feedback demonstrated enhanced performance in depth-based anterior segment maneuvers compared to the control group (p<0.0001). Residents trained with MI OCT continued to outperform the controls when operating without direct MI OCT feedback (p<0.0001) (Fig 1A). Surgical performance of residents who were trained and tested without MI OCT improved to equivalent performance when given MI OCT feedback. Resident surgeons rated subjective experience of using MI OCT very favorably and on average are “more likely” to use it in their future practice (Fig 1B).

 

Conclusions

 

Real-time MI OCT guidance improved depth based surgical maneuvers. MI OCT may be a useful adjunct in surgical education of ophthalmology residents.  

 

Figure 1. Surgical performance (A) and subjective feedback (B) of ophthalmology residents with and without MI OCT feedback.