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Claudio Spera, Andrew Somerville, Sebastian Caniff, Joe Keenan, M Dominik Fischer; Virtual reality haptic surgical simulation for sub-retinal administration of an ocular gene therapy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4503.
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© ARVO (1962-2015); The Authors (2016-present)
To design a novel educational modality as a practical alternative to surgical wet labs, using virtual reality (VR) with haptics integration to simulate the surgical delivery of ocular gene therapy voretigene neparvovec (VN) in the sub-retinal space of an anatomically accurate human eye.
A cognitive task analysis was conducted detailing the different steps of the surgical procedure tailored to the specific educational objectives of the lead and assistant surgeons. Each step of the procedure was developed and tested iteratively by technical teams at Fundamental VR. A series of quality assurance processes were followed until all features were deemed accurate by surgical experts and the final deliverable matched the intended functionality. A detailed haptic VR simulation user interface was designed to enable two surgeons to perform the surgery. The lead surgeon wears a VR headset and performs the surgery with both hands under a microscope on a fully mobile eye. The assistant observes on a monitor and, when instructed by the lead surgeon, uses a haptic syringe designed to deliver the dose of VN, with accurate feedback of volume delivered (Figure 1). To enhance the interactive experience, the simulation program can stage a surgical complication, e.g. blocked cannula, and present the users with options to rectify it. This design encourages verbal communication between surgeons during the critical stages of the subretinal administration.
The surgical simulation has achieved a number of key requirements:- Possibility to realistically simulate eye surgery using both hands;- Dual-user binocular microscopy at two zoom levels- Realistic haptic sensory feeling of cannula passing through ocular layers of human tissue with differing levels of resistance- Use of intraoperative optical coherence tomographyThe haptic VR simulation provides several benefits over traditional wet labs:- Accessible training that reflects the anatomical scale and pathology of real-world patient cases- Economical, portable, scalable and cost-effective
The VR surgical simulation for application to treatment with VN provides an accurate, easily accessible and cost-effective alternative to traditional wet labs. This modality can effectively improve the education of surgeons in the delivery of ocular gene therapies.
This is a 2020 ARVO Annual Meeting abstract.
Figure 1. Key components of the VR simulation user interface
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