Assessment of fatigue in intraocular surgery: analysis using a virtual reality simulator

Authors: Waqar S, Park J, Kersey TL, Modi N, Ong C, Sleep TJ.

Publication: Graefes Arch Clin Exp Ophthalmol. 2011 Jan;249(1):77-81. Epub 2010 Oct 2.



To determine the effect of fatigue on intraocular surgical performance using a virtual reality simulator.


Seven experienced ophthalmic surgeons were recruited. The first set of data collection was immediately before a live theatre session. Each surgeon received a standardized orientation to a virtual reality cataract surgery simulator (Eyesi©, VRmagic, Mannheim, Germany). All surgeons then completed ten attempts on level-four forceps module. The parameters recorded were total score, total time, total time score, corneal injury score, lens injury score, odometer score, and operating without red reflex score. To reduce the effect of the learning curve, each surgeon had a “plateau” score calculated for every parameter, which was the average of their final four attempts. The surgeons then returned immediately after their scheduled theatre lists to complete a further ten attempts on the same module and similar parameters were recorded.


Following routine theatre lists, simulator parameters slightly improved, with only the total score (97.28 to 98.57, p = 0.028) and total time (44 s to 35 s, p = 0.033) being statistically significant. The mean theatre list operating time was 197 min (SD ± 23.60).


No detrimental effect of fatigue was demonstrated following a routine operating list. The study provides a template for further assessments of fatigue in high-volume cataract surgery lists.