Simulator Improves Resident Training for Cataract Surgery

Fran Lowry

October 25, 2011

October 25, 2011 (Orlando, Florida) — Practice makes perfect. And when it comes to learning how to do cataract surgery, practicing on a surgical simulator instead of on a live human being can make learning the procedure easier for the resident and ultimately safer for the patient, researchers said here at the American Academy of Ophthalmology 2011 Annual Meeting.

Scott W. Yeates, MD, from Case Western Reserve University School of Medicine, Cleveland, Ohio, presented data that showed that EYESi training reduced the time spent doing cataract surgeries and the number of intraoperative complications associated with the procedure.

"The simulator is a way to get the resident ready to start operating on human eyes. They can learn the steps, they can learn the microsurgical techniques, before actually operating on patients," Dr. Yeates told Medscape Medical News. "It's a way to...make your mistakes early, in a controlled environment, where there will be no bad consequences."

In the study, he and his team compared operative times and complications for cataract surgeries completed by resident surgeons before and after simulator training. The simulator that was used was the EYESi, manufactured by VR Magic, Mannheim, Germany.

"Our hospital recently acquired the EYESi and we wanted to see if it made a difference, because it is expensive," Dr. Yeates explained.

To do so, they reviewed the records of phacoemulsification cataract procedures by fourth-year residents. In all, 345 cases were performed by 6 residents without simulator training and 492 procedures were performed by 5 residents with simulator training.

The first 40 cases of each surgeon were compared to reduce bias due to unequal surgery numbers, Dr. Yeates said.

The researchers found that after simulator training, surgical times decreased significantly — from 48 to 39 minutes (P < .01) — for all surgeries, and decreased from 51 to 46 minutes for the first 40 surgeries (P < .03).

Additionally, intraoperative complications significantly decreased after simulator training. The rate of complications went from 13% before simulator training to 8% after training (P = .23).

After simulator training, surgeons were able to do procedures faster than they did before training.

"EYESi allowed us to work faster, so we could, on average, add 1 extra case a day, which for our population and for our resident training was great," Dr. Yeates noted. "You get a certain number of days and if you can get more cases done per day, this is a real boost to our training. We were also able to do more cases in total. We had a backlog of cases and we were able to get through them faster."

The next step, he said, is to look at outcomes after simulator training.

"In this study, we just looked at things that happened in the operating room, but what really matters to the patients is how well they are able to see, how long they're on drops, and if there are other complications down the road, so we plan to study this," he said.

Dr. Yeates himself has trained on the EYESi and endorses it as a way to learn in a safe environment.

"In my own experience, and speaking with all the people who have trained on it, it has been helpful. The attendings who have supervised residents before and after the simulator training also anecdotally say that it has been helpful."

"This study confirms findings in other fields that simulator training improves surgical results and is better both for the resident and the patient," Herb Kaufman, MD, from Louisiana State University in Baton Rouge, Louisiana, commented to Medscape Medical News.

"Even though the residents were not randomised, and those who got simulator training might have been better or more skillful to start, the conclusions appear valid and important in improving patient outcomes and resident training," Dr. Kaufman, who was not part of the study, said.

Dr. Yeates and Dr. Kaufman reported no relevant financial relationships.

American Academy of Ophthalmology (AAO) 2011 Annual Meeting: Abstract PO32. Presented October 23, 2011.

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