The virtual reality simulator will increase training in vitreoretinal surgery

Reviewed by Fares Antaki, MD, CM

In an event followed by the TV show Tank Shark, 3 presenters of the annual meeting of the Canadian Ophthalmological Society participated in a retinal research contest, called The Lions’ Lair, where a maximum prize of $ 35,000 was awarded to the winning camp.

Fares Antaki, MD, CM, senior resident of the Department of Ophthalmology at the University of Montreal, Canada, presented a project for a virtual reality (VR) simulator designed to improve training in retinal surgery.

During his presentation, Antaki discussed the work of David Kasner, MD; and Robert Machemer, MD, who are considered the parents of pars plana vitrectomy.

He went on to discuss Halsted’s learning model that has been employed in vitreoretinal surgery where “see 1, do 1, teach 1” has been the guiding principle. The incorporation of technology into vitreoretinal teaching can complement this model through “seeing 1, simulating 1, doing 1 and teaching 1,” Antaki explained.

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Training in vitreoretinal surgery is not usually provided during residency in ophthalmology and requires several years of preparation to master the necessary skills, Antaki noted.

High-fidelity VR simulation provides a safe environment for risk-free learning and practice for patients.

With the imminent transition to new competency-based medical education models, the integration of virtual reality simulation can be useful for administering competency-based testing to ensure participants are prepared to perform procedures on patients, Antaki explained.

An example of VR in ophthalmic education is the Eyesi simulator. Antaki first encountered the Eyesi simulator in his native Syria, when Orbis Flying Eye Hospital visited Aleppo in 2007 and 2008.

The passengers of the plane had the mission to share knowledge and train local eye doctors through conferences, workshops and hands-on training.

“Looking back at this point, I realized that as soon as the plane left Syria, local doctors could no longer train through simulations,” Antaki said. “This is because simulators like the Eyesi have a very high purchase price, which limits their worldwide adoption. In addition, the size and weight of the Eyesi are limiting factors in terms of accessibility and mobility “.

The proposed VR simulator would be compatible with commercially available headphones like HTC Vive and Oculus Quest, as well as commercially available instruments such as tactile touch devices and touch controllers, Antaki said.

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Since the 1970s, VR headsets have steadily decreased in weight and improved computing capability.

Virtual reality headsets have surpassed academic labs and are commercially available, with prices ranging from $ 400 to $ 1200.

“Taking advantage of the powerful processors, cameras and sensors of these VR headsets, we believe we can build a fully immersive and low-cost portable vitreoretinal surgery VR simulator,” Antaki said.

Ophthalmologists will work with an engineering team to help develop the training modules, according to Antaki.

The principal investigator is Karim Hammamji, MD, FRCSC, head of the retinal division of the University of Montreal and vitreoretinal surgeon at the Center Hospitalier of the Université de Montréal.

The engineering team is made up of Benoît Ozell, PhD, professor and director of the Research Laboratory in Computer Graphics and Virtual / Augmented Reality at the University of Montreal, and Cédryk Doucet, a graduate in Computer Engineering, whose master’s thesis is will focus on the development of VR Simulator.

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Antaki will conduct a two-phase study in which the first 18-month phase will focus on simulator development.

The simulator will be developed in conjunction with the engineering team through iterative feedback with the ophthalmology team.

This process will ensure that the simulator tests 4 fundamental skills that are used during vitreoretinal surgery.

“We will provide feedback to improve the simulator during the early stages of its construction,” Antaki said.

The 4 training modules will simulate core vitrectomy and induction of posterior vitreous detachment, peripheral shaving, endolaser, and membrane desquamation, according to Antaki.

The second phase, scheduled to last 9 months, is a validation phase that will involve the validity of the construction and transfer of skills. Two prospective and controlled intervention trials will be conducted.

“The trials will first demonstrate the validity of the construction and skill transfer,” Antaki said. “We will also collect information about personal and environmental presence during the simulation to determine how realistic our simulator is.”

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Antaki also explained how the start-up funds would be allocated.

“Part of the money will be used to pay staff, but most of the money will go to pay for virtual reality headsets, haptic feedback devices and the virtual reality workstation,” he said. “With this funding, we will improve access to training in vitreoretinal surgery.”

When one of the competition judges asked him if this technology could be used for other training purposes, such as learning cataract surgery, Antaki said yes.

“Our focus right now is vitreoretinal surgery, but the opportunities are immense (using technology for other learning),” he said.

Rates Antaki, MD, CM
Antaki has no financial disclosures related to this content. The launch of Antaki turned out to be the winner of the competition, winning $ 35,000 (CAD $). The public also considered the winner to win an additional $ 5,000.

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