High correlation between performance on a virtual-reality simulator and real-life cataract surgery.
OBJECTIVE
To investigate the correlation in performance of cataract surgery between a virtual-reality simulator and real-life surgery using two objective assessment tools with evidence of validity.


METHODS
Cataract surgeons with varying levels of experience were included in the study. All participants performed and videorecorded three standard cataract surgeries before completing a proficiency-based test on the EyeSi virtual-reality simulator. Standard cataract surgeries were defined as: (1) surgery performed under local anaesthesia, (2) patient age >60 years, and (3) visual acuity >1/60 preoperatively. A motion-tracking score was calculated by multiplying average path length and average number of movements from the three real-life surgical videos of full procedures. The EyeSi test consisted of five abstract and two procedural modules: intracapsular navigation, antitremor training, intracapsular antitremor training, forceps training, bimanual training, capsulorhexis and phaco divide and conquer.


RESULTS
Eleven surgeons were enrolled. After a designated warm-up period, the proficiency-based test on the EyeSi simulator was strongly correlated to real-life performance measured by motion-tracking software of cataract surgical videos with a Pearson correlation coefficient of -0.70 (p = 0.017).


CONCLUSIONS
Performance on the EyeSi simulator is significantly and highly correlated to real-life surgical performance. However, it is recommended that performance assessments are made using multiple data sources.
Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark.|Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.
Ann Sofia Skou
http://orcid.org/0000-0002-4249-581X
AS
Thomsen
Department of Computer Science, University of Surrey, Guildford, England.
Phillip
P
Smith
Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.
Yousif
http://orcid.org/0000-0001-6620-5365
Y
Subhi
Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark.
Morten la
M
Cour
Department of Computer Science, University of Surrey, Guildford, England.
Lilian
L
Tang
Department of Computer Science, University of Surrey, Guildford, England.|Department of Education, Moorfields Eye Hospital NHS Foundation Trust, London, England.|The National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, Moorfields Eye Hospital, London, England.
George M
GM
Saleh
Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.
Lars
L
Konge
D000328:Adult; D002387:Cataract Extraction / Q000193:education* / Q000379:methods; D002983:Clinical Competence; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D003718:Denmark; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education*; D025321:Surgery, Computer-Assisted / Q000193:education*; D014584:User-Computer Interface
assessment; cataract surgery; motion-tracking; validity; virtual-reality simulation