The Effects of Virtual Reality Training on the Performance of Corneal Laceration Repair

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The Effects of Virtual Reality Training on the
Performance of Corneal Laceration Repair

• Brad Feldman, MD, Reecha Sachdeva, BS,
  Jennifer Ake, MD, Sarah Brown, Yasmeen Mahmood,
  BS, Amir Faghfoory, BS, Adam Braganza, MD,
  Melissa Moncavage, MD, Dhanu Meleth, MD, Craig
  Geist, MD
• Department of Ophthalmology
• George Washington University
• George Washington School of Medicine
• George Washington University, Washington, DC
• INOVA Fairfax Hospital, Fairfax, Virginia
• Statistical analysis provided by Stacie
  Trollinger, Department of Biostatistics, George
  Washington University

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BACKGROUND

• Surgical virtual reality simulation offers the
  exciting prospect of transferring the burden of
  psychomotor skill acquisition from high stakes
  environment of the OR to the safe environment of
  the simulator.
• VRMAGICs EYESI ophthalmosurgical simulator
  simulates both vitreoretinal and anterior segment
  surgical techniques, including membrane peels,
  capsulorrhexis, and phacoemulsification.
• No randomized studies have determined if training
  on the EYESI can improve the surgical skills of
  trainees.
• .

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PURPOSE

• To evaluate the effects of training with an
  ophthalmic surgical simulator (EYESI) on the
  acquisition of the microsurgical skills necessary
  to repair a corneal laceration.

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METHODS

• Pre-medical undergraduate and 1st or 2nd medical
  students without prior surgical experience were
  recruited from George Washington University.
• Participants were assessed performing a
  standardized ovine corneal laceration repair.
• The participants were randomized to either 3
  hours of training on the EYESI ophthalmosurgical
  simulator or to a control group assigned 1 hour
  of reading on corneal laceration repair. The
  EYESI training modules used in this study
  simulated intraocular surgery but did not
  directly simulate corneal laceration repair.

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METHODS

• Following training, both groups were re-assessed
  performing ovine corneal laceration repair in
  order to evaluate interval improvement.
• Performance was evaluated using an objective
  grading scale, the Corneal Laceration Repair
  Assessment (CLARA)
• Improvement on the Corneal Laceration Repair
  Assessment (CLARA) was assessed by subtracting
  each of the seven baseline results from the
  corresponding second round result. These
  categories were
• time in seconds, number of sutures, suture
  re-throws, distance between suture score, bite
  size score, depth score, and overall score

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Ovine Corneal Laceration Repair

• Participants were instructed to suture a
  full-thickness corneal wound with 4 throws of
  interrupted 6-0 Vicryl suture using a CastroViejo
  0.12mm forceps, a needle-holder and Westcott
  scissors under a surgical microscope
• The goals of the exercise were to insert and exit
  with precision at 1 mm from the laceration edge
  with
• 1 mm between sutures
• The sutures were to be placed at 90 of corneal
  thickness in the deep stroma. No knots were to be
  tied.
• The time limit was 15 minutes.
• The pictures above demonstrate a study
  participant placing sutures through a corneal
  laceration on a sheeps eye.

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Corneal Laceration Repair Assessment
These were the objective criteria used to score
participant performance. Criteria for sutures
3-4 were identical to those shown for 1-2. Each
column corrresponds to a score of 0-4, from left
to right.
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RESULTS

• Forty-three students were randomized to the
  simulator group (n22) and the control group
  (n-21).
• Table 1 shows the baseline CLARA results by group
  and reveals that the initial performances of the
  simulator and control groups were similar. There
  were no significant differences in any of the
  CLARA criteria between the simulator and control
  groups.

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RESULTS

• Table 2 shows the improvement in CLARA scores
  (Session 2- Session 1) for the simulator and
  control groups.
• Mean improvement of the simulator and control
  groups was not significantly different for any of
  the CLARA criteria.

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DISCUSSION

• This study, the only randomized controlled trial
  to evaluate the effect of virtual reality
  training with the EYESI, found no difference in
  improvement in corneal laceration repair between
  EYESI-trained participants versus controls
• These results suggest that 3 hours of EYESI
  training is not effective in teaching the
  fundamental microsurgical skills necessary to a
  perform corneal laceration repair
• We believe the EYESI will be proven a useful
  tool. Limitations of this study are as follows
• A single 3 hour session may be an inadequate
  amount of time to teach fundamental microsurgical
  skills
• The EYESI may be more effective in improving
  skills on one of the tasks that it attempts to
  simulate, such as capsulorrhexis creation.
  Unfortunately, the limitation in studying such
  tasks is the very reason why the EYESI was
  created--they are difficult to simulate outside
  the living human eye.