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Pankaj Singh, Svenja Deutchler, Stephanie Fassbender, Marcel Pfister, Michael Koss, Rami Al-Dwairi, Frank Koch; How efficient can we train indirect ophthalmoscopy in The Eye-simulator?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3802.
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To evaluate the potentials of the Eyesi® Binocular Indirect Ophthalmoscope (EBIO) for education purposes, which allows to train techniques of indirect ophthalmoscopy and identify clinical findings implemented in a database.
The EBIO is an augmented reality simulator for training of vitreoretinal fundus examinations and diagnosis. Our approach included the use of EBIO for education of medical students, residents and experts. Indirect ophthalmoscopy is a non-invasive method to view through a keyhole into the human brain and is essential for a variety of subspecialties in medicine. The database currently includes 40 clinically relevant pathologies with different variations presented as individual clinical cases. Both, procedural and diagnostic skills can be evaluated and scored. In our study 239 trainees worked on EBIO for 1 day (8 hrs.) and during this several criteria were evaluated namely: (1) localization of pathology, (2) size estimation of pathology, (3) time to reach a diagnosis, (4) accuracy of drawings and (5) efficiency of the examination procedure.
The trainees improved their skills gradually for abstract as well as clinical tasks. In the 1-day setup, 98% of all trainees learned how to localize pathology well (1); adequate size estimation of pathology (2) was managed by 75% at the end of the day. The time to finish the observations concluding with a diagnosis was cut in half (3), the accuracy of drawings (4) improved about 35 % and the efficiency of the examination (5) increased exponentially over the day, such as 30 % could detect the optic disc (mean time 65 sec.) after 10 min. of training, 60 % after 30 min. and 100 % at the end of the first hour of introduction. At the end of the 8 hr. course two thirds of them were able to recognize and adequately describe the morphology of different pathologies.
The EBIO is a novel tool that offers standardized and reproducible tasks to guarantee comparability. It allows objective differential diagnosis assessment and quality control as well as accurate documentation of performance. When training on the EBIO, the skills in indirect funduscopic examination procedures can be decisively increased and the time necessary to carry the procedures through can be reduced. We suggest that EBIO is accepted to be the gold standard for indirect ophthalmoscopy training, as it spares patients the inconvenience of multiple examinations, and allows for training on various pathologies with impressive efficiency.
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