Abstract
Purpose :
To develop and validate RetinaVR, an affordable, portable, and fully-immersive virtual reality (VR) simulator for vitreoretinal surgery training.
Methods :
RetinaVR was built, then deployed as a standalone app on the Meta Quest 2 VR headset. It simulates core vitrectomy, peripheral shaving, membrane peeling, and endolaser application. In the validation study, we recruited 10 novice ophthalmology residents and 10 expert vitreoretinal surgeons from the University of Montreal in Canada. We collected the following performance metrics: efficiency (completion time), safety (number of iatrogenic retinal touches), and module-specific performance metrics (target sphere exits, deviations from the shaving path, membrane grasps and laser spot applications). We first explored unadjusted performance differences through an effect size analysis. Then, a linear mixed-effects model was used to isolate the impact of age, sex, expertise and experimental run on performance.
Results :
Novices were significantly younger (p=0.001) and predominantly female (70%). Experts were significantly safer in membrane peeling (unadjusted model) but not when controlling for other factors. Experts were significantly better in core vitrectomy, even when controlling for other factors (p=0.014). Heatmap analysis of endolaser applications showed more uniform and consistent retinopexy among experts. Age had no impact on performance, but males were faster than females in peripheral shaving (p=0.036) and membrane peeling (p=0.004). A learning curve was demonstrated with improving efficiency at each experimental run for all modules. Repetition also led to improved safety during membrane peeling (p=0.003), and better task-specific performance during core vitrectomy (p=0.038), peripheral shaving (p=0.011) and endolaser application (p=0.043). Users rated the simulator as favorable-to-excellent in all user experience spheres.
Conclusions :
RetinaVR demonstrates potential as an affordable, portable training tool for vitreoretinal surgery. Its construct validity is established, showing varying performance in a way that correlates with experimental runs, age, sex, and level of expertise. The study highlights the potential for wider adoption of fully-immersive VR technology in surgical training, with implications for democratizing access to developing nations in the metaverse.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.