Surgical Outcomes in Cataract Surgeries Performed by Residents Training With the EYESI Simulator System

Abstract

Purpose:: This study seeks to compare objective surgical outcomes in cataract surgeries performed by residents who have trained with the EYESI ophthalmosurgical simulator system (VRmagic GmbH, Germany) versus those who have trained utilizing traditional didactic and wet-lab methods.

Methods:: Seven PGY-4 ophthalmology residents from one institution received traditional didactic and wet-lab training in preparation for intraocular surgery. Four residents were randomized to have access to the EYESI surgical simulator system and three residents were randomized to the control group. Residents in the EYESI group self-selected into a frequent-users group and an infrequent-users group. Data were obtained for all resident surgical cases over a 6-month period by using Objective Assessment of Skills in Intraocular Surgery (OASIS) evaluation forms (Cremers, et al. Ophthalmology 112(7):1236-41, July 2005). Results including total surgery time, total ultrasound time, cumulative dissipated energy, pre- and post-operative visual acuity were compared between the two groups using unpaired two-sample student t-test and Wilcoxon rank sum test. Analysis was also performed on categorical data including intra-operative complications and attending interventions.

Results:: Preliminary data from the first quarter (July - October 2006) have been collected and analyzed. Data were analyzed from 26 cases performed by residents who trained on EYESI and 33 cases performed by residents in the control group. EYESI training was correlated with a 10-minute decrease in mean surgery time, 22-second decrease in mean ultrasound time, and 3.3-unit decrease in cumulative dissipated energy during phacoemulsification; however, these did not reach statistical significance (p = 0.14, p = 0.15, and p = 0.29 respectively). Frequent EYESI users demonstrated a 20% decrease in incidence of cases requiring attending help with continuous capsulorrhexis and 14% decrease in incidence of cases requiring any attending intervention.

Conclusions:: Preliminary results suggest that ophthalmology residents who train with the EYESI simulator system may decrease surgical time, ultrasound time and energy dissipation, and rely less on attending interventions compared to residents who begin training directly with patients. However, further studies with larger sample sizes should be conducted to verify whether virtual surgery training translates to operating room performance.

Keywords: training/teaching cataract surgery • treatment outcomes of cataract surgery