International Journal of Healthcare Simulation

Background:

Cataract surgery is one of the most performed procedure worldwide with a fascinating evolution in the use of technology [1]. EyeSi is a high-fidelity, task-oriented, virtual reality, intraocular surgery simulator widely adopted by residency programs across the developed world for skill development in cataract surgery, with proven effectiveness and decrease in complication rates [2]. We aim to provide a trainee’s reflective perspective on learning cataract surgery via virtual reality simulation and performing first real surgery from a low middle-income, developing country [3].

Methods:

Simulation training as part of formal residency curriculum was documented, hence ethical approval was exempted. EyeSi course software (V3.0.6) was used for skill development as a self-learning tool, reinforced with real cataract surgery training, documented over a period of 8 months for a single participant. EyeSi provides a binocular microscopic viewing system, with hand-piece instruments and foot pedals of the same configuration as used in operating theatres. The software generates feedback reports for each task using microscopic calibrations inside the model eye.

Results:

By the end of the 8-month period, simulation data showed a logged time of 45.7 hours, 74 intraocular lenses injected, 1,581 intraocular tasks completed and 772 capsulorhexis done with complications including 679mm2 of injured corneal area, 113 mm2 of injured lens area and 862 posterior capsule ruptures. In comparison, the real surgery logbook noted 30 intraocular lenses injected, 86 intraocular tasks and 31 capsulorhexis complete with a total of 1 complication and 1 complete cataract case performed. Subjective comparison reported increased confidence, lower stress levels, good preparation of left-hand skills, and passive learning of surgical theory and technicalities (Table 1).

Table 1:

Comparison of virtual reality and real surgery experience

Conclusion:

Despite challenges of affordability and traditional surgical culture in a low middle-income country, simulation training provides safe learning alternatives to trainees which are effective and should be widely adopted. Although the learning curve is slightly longer, but skills acquired are replicable in operation theatre and significantly reduce the complication rate in the interest of patient safety.

References

1. Davis G. The Evolution of Cataract Surgery. Missouri Medicine. 2016;113(1):58. https://pmc/articles/PMC6139750/

2. Ahmed TM, Hussain B, Siddiqui MR. Can simulators be applied to improve cataract surgery training: a systematic review. BMJ Open Ophthalmology. 2020;5(1):e000488.

3. Aga Khan University. Simulation success story: Eye surgery. https://www.aku.edu/news/Pages/News_Details.aspx?nid=NEWS-002669 [Accessed on 26/08/2022]