Teaching binocular indirect ophthalmoscopy to novice residents using an augmented reality simulator

Authors: Amandeep S. Rai, Amrit S. Rai, Emmanouil Mavrikakis, Wai Ching Lam.

Publication: Canadian Journal of Ophthalmology, published online: April 21, 2017.



To compare the traditional teaching approach of binocular indirect ophthalmoscopy (BIO) to the EyeSI augmented reality (AR) BIO simulator.


Prospective randomized control trial.


28 post-graduate year one (PGY1) ophthalmology residents.


Residents were recruited at the 2012 Toronto Ophthalmology Residents Introductory Course (TORIC). 15 were randomized to conventional teaching (Group 1), and 13 to augmented reality simulator training (Group 2). 3 vitreoretinal fellows were enrolled to serve as experts. Evaluations were completed on the simulator, with 3 tasks, and outcome measures were total raw score, total time elapsed, and performance.


Following conventional training, Group 1 residents were outperformed by vitreoretinal fellows with respect to all 3 outcome measures. Following AR training, Group 2 residents demonstrated superior total scores and performance compared to Group 1 residents. Once the Group 1 residents also completed the AR BIO training, there was a significant improvement compared to their baseline scores, and were now on par with Group 2 residents.


This study provides construct validity for the EyeSI AR BIO simulator and demonstrates that it may be superior to conventional BIO teaching for novice ophthalmology residents.