VR (virtual reality) to OR: Impact of residency training with the Eyesi simulator system on cataract surgery outcomes

Authors: Elizabeth Du; Ana G. Alzaga Fernandez; Sarah Khodadadeh; Daniel Steen; Russell Pokroy.

Publication: Poster presentation at ARVO2011.


Purpose: To objectively compare surgical outcomes and determine whether training on the EYESi surgical simulator (VRMagic) by residents decreased operating time and major surgical complications.

Methods: A retrospective review was performed of ophthalmic resident surgical outcomes data at a single residency-training site from 2006 to 2010. The primary outcome measures were defined as operating time and major surgical complications; including, a posterior capsule tear with or without vitreous loss occurring during a resident-performed case. The study population was divided into 2 groups. Group 1 (10 residents) comprised the first 50 surgical cases of residents trained before the EYESi surgical simulator was included in the surgical curriculum (academic years 2006 to 2008) and Group 2 (10 residents), the first 50 surgical cases of residents trained with the EYESi surgical simulator (academic years 2008 to 2010). All residents received traditional didactic and wet-lab training methods. Attending survey data was also compiled for subjective comparison between the two groups.

Results: There were 500 cases and 40 intraoperative complications in Group 1, and 500 cases and 35 complications in Group 2. Although the complication rate was lower in Group 2, the difference was not statistically significant. We excluded 10 cases from the entire group due to inaccuracy of operating times and the first 10 cases of every resident to allow for familiarity with instrumentation and attending variability. Group 1 had 399 cases with an average operating time of 40.9 min and Group 2 had 393 cases with an average time of 38.6 min. The reduction in operating time in the Group 2 was statistically significant (p<0.05). Five primary surgical instructors were surveyed. The compilation of their responses reflected the general opinion that the EYESi helps to improve the learning curve and lessen the amount of attending intervention in resident cataract surgery training.

Conclusions: Addition of the EYESi surgical simulator into the surgical curriculum resulted in a statistically significant reduction in the operating time, with a trend toward decreased number of major intraoperative complications in the initial acquisition of skills in the operating room.