Table 1
Surgical Training/Assessment
Reference Study design Technology used Topic studied Summary of purpose Summary of findings
AR Menozzi 20209
No study design
specified Microsoft HoloLens
Vitreoretinal surgery
Investigated the effect of an AR training simulator on motor skills.
Study found it’s possible to improve microsurgical motor skills using the developed AR simulator
Ropelato 20208
No study design specified
Surgical simulator prototype developed using Microsoft HoloLens
Vitreoretinal surgery
Used AR to develop a simulator for training microsurgical skills.
AR surgical simulator can be used to train micromanipulation skills
VR
Spiteri 201413 No study design
specified EyeSi Simulator Cataract
surgery
Developed an evidence based and proficiency-based training curriculum for phacoemulsification surgery for novices.
Evidence based and proficiency-based training curriculum was developed for phacoemulsification surgery for novices which demonstrated construct validity.
Sikder 201523 Prospective, unmasked,
Non-randomized study MicroVisTouch Cataract
surgery Assessed whether OR experience impacted capsulorhexis
performance using the MicroVisTouch simulator. Improved simulator performance correlated with cataract surgery experience in the OR.
Thomsen 201519
Prospective controlled
interventional study EyeSi Simulator
Cataract surgery
Designed an evidence-based pass/fail assessment tool for cataract surgery and investigated whether the simulator content is specific for cataract surgery
Successfully designed an evidence-based pass/fail assessment tool for cataract surgery and found EyeSi assessed general microsurgical skills.
Gonzalez- Gonzalez 201630
Nonrandomized,
prospective study EyeSi Simulator
Cataract surgery
Determined whether a structured training program using the simulator improved dexterity in non-dominant (ND) hands.
There was improvement in the overall average scores comparing baseline vs. final performances in both the dominant hand and the non-dominant hand.
McCannel 201726
Retrospective educational interventional
case series EyeSi Simulator Cataract
surgery
Assessed vitreous loss rates during cataract surgery in order to demonstrate the specificity of simulation-based VR cataract surgery using the EyeSi simulator.
Overall vitreous loss rates were not lower in those who completed EyeSi capsulorhexis training, but non-errant capsulorhexis associated vitreous loss rates were higher.
Roohipoor
201717 Retrospective study EyeSi Simulator Cataract surgery
Examined the relationship between EyeSi scores of first- year ophthalmology residents and OR performance measures in the final year of residency.
There was a significant correlation between EyeSi scores of first-year ophthalmology residents and OR performance measured in the final year of residency.
Thomsen
201722 Cross-sectional study EyeSi Simulator Cataract surgery
Examined the correlation between different objective measures of cataract surgical performance in a VR environment and in the OR using two objective assessment tools with validity.
There was a correlation between the simulator performance score and the mean Objective Structured Assessment of Cataract Surgical Skill ( OSACSS) score across all experience levels.
Thomsen 201715
Multi-center non- randomized masked
clinical trial EyeSi Simulator
Cataract surgery
Determined the effect of VR proficiency-based training on real cataract surgery performance.
Both novices and intermediates had significant improvements in performance after VR training as judged by 3 independent masked raters using the Objective Structured Assessment of Cataract Surgical Skill (OSACSS).
Ng 201818
cross-sectional
multicenter survey EyeSi Simulator
Cataract surgery
Evaluated the impact that virtual reality training had on residents’ perceived barriers to learning phacoemulsification.
EyeSi simulation training was associated with increased confidence in performing the most difficult tasks perceived during phacoemulsification.
Oflaz 201824
No study design
specified EyeSi simulator
Cataract surgery
Assessed whether cataract surgical simulator performance correlated to real-life surgical experience
A correlation was found between participants’ surgical experience and their scores in the capsulorhexis module.
Jacobsen 201916
Prospective multicenter
study EyeSi Simulator
Cataract surgery
Evaluated the correlation between performance on the EyeSi simulator and real-life cataract surgical performance.
A correlation was found between the EyeSi simulator score and real life performance across all experience levels measured using the Objective Structured Assessment of Cataract Surgical Skill (OSACSS).
Ferris 202020 Audit Study EyeSi Simulator
Cataract surgery
Investigated the impact of cataract training using the EyeSi surgical simulator on posterior capsule rupture rates of first and second year residents over a 7 year period.
Demonstrated an association between the introduction of training with the EyeSi surgical simulator and a reduction in posterior capsule rupture rates during live surgery.
Forslund Jacobsen 202014
Prospective interventional cohort
study EyeSi Simulator Cataract
surgery Developed and investigated an EyeSi simulator-based test for experienced cataract surgeons
Not all of the advanced cataract surgical modules were able to discriminate between different levels of surgical competence.
Vieira 202029 Multicenter cross-
sectional study EyeSi Simulator Dexterity Used the EyeSi simulator to evaluate dexterity among first
year ophthalmology residents Participants completed two series of dexterity tests and findings showed relevant improvement in dexterity.
Modi 201528 No study design
specified EyeSi surgical simulator Surgical performance
Determined whether there is a relationship between learning style and learned surgical performance using a
VR surgical simulator There was no learning style that resulted in better or worse performance on the EyeSi simulator.
Thomsen 201721
Single-center, single- blinded randomized
controlled trial EyeSi surgical simulator
Surgical performance
Explored inter-procedural transfer of surgical skills and assessed whether pretraining in a cataract surgery using the EyeSi simulator would improve vitreoretinal surgery performance on the EyeSi simulator.
Cataract surgery skills obtained through simulator training did not have any measurable effect on resident vitreoretinal performance on the EyeSi simulator.
McGowan 201832
Randomized cross-over
trial EyeSi surgical simulator
Surgical Performance
To determine whether distraction has an effect on surgical performance in expert and novice surgeons using a VR simulator by asking participants questions about a pre- reading task.
The distraction significantly increased the time taken to perform a simulated vitreoretinal surgery task. There was no significant difference found in cognitive task score or surgical task score.
Forslund Jacobsen 202027
Randomized controlled
crossover study EyeSi surgical simulator
Surgical performance
To investigate the difference between manual and robot assisted vitreoretinal surgery using a VR surgical simulator.
Robot assisted vitreoretinal surgery took longer time, but improved precision and limited tissue damage in comparison to manual surgery.
Mellum 202031
No study design
specified EyeSi surgical simulator
Surgical Performance
To investigate the effect of four distracting factors on vitreoretinal surgery using VR simulator. Distractions included auditory stimuli, fasting, sleep interruption, and sleep deprivation
Lower surgical performance was found with all four distracting factors as measured on the virtual simulator
Deuchler 201625
No study design
specified EyeSi Simulator
Vitreoretinal surgery
Investigated the impact of a warm-up session on the EyeSi surgical simulator prior to live surgery.
Warm up on the EyeSi simulator improved the average performance level of all surgeons.
Vergmann
201711 No study design
specified EyeSi Simulator Vitreoretinal
surgery Assessed the validity of the EyeSi simulator for a
vitreoretinal simulation program Validity was found for four of six vitreoretinal modules on the EyeSi simulator
Cissé 201910 Prospective controlled
clinical trial EyeSi Simulator Vitreoretinal surgery
Investigated the construct validity of six vitreoretinal modules on the EyeSi Surgical Simulator which had not
been previously studied. Experienced surgeons achieved significantly higher median scores than novices in four modules.
Jaud 202012
Prospective controlled
interventional study EyeSi Simulator
Vitreoretinal surgery
Designed an evidence-based performance test to assess vitreoretinal surgical skills using the EyeSi simulator and assessed the validity.
The test demonstrated validity as it was able to differentiate between residents and the experienced surgeons.
Surgical Guidance
AR
Pan 202034
No study design
specified AR prototype
Corneal suture guidance
Developed a deep learning framework for AR based DALK surgery navigation to assist surgeons with their suturing process.
The developed framework can achieve accurate detection and real-time tracking of corneal contours.
Delisi 201433 No study design specified
Karl Storz Telecam NTSC camera system attached to a Karl Storz 11264BBU1 flexible hysteroscope, AR accomplished through Direct Linear Transform (DLT)
method Transorbital
surgery
Developed an image-guided system using endoscopic video augmentation and investigated the impact of this AR based system on navigating an endoscope to a specified target region in a series of anthropomorphic
phantom experiments. AR based image guidance improved target identification accuracy and reduced procedure time.
VR
Maloca
201835 No study design
specified HTC Vive, Xindian District,
New Taipei City, Taiwan OCT imaging Feasibility testing of novel VR environment in which to display and interact with OCT data
Participants reported an enjoyable VR-OCT experience.
This is a usable and satisfying technique to view and interact with volumetric OCT data.