COMMENTARY

Changing Medical Education With 3D Printing

Brianne N. Hobbs, OD

Disclosures

January 15, 2016

3D Printed Reproductions of Orbital Dissections: A Novel Mode of Visualising Anatomy for Trainees in Ophthalmology or Optometry

Adams JW, Paxton L, Dawes K, Burlak K, Quayle M, McMenamin PG
Br J Ophthalmol. 2015;99:1162-1167

Enduring the unmistakable scent of formaldehyde during gross anatomy lab has long been a rite of passage in medical education. Hours spent shivering in a frigid laboratory were required to master the nuances of human anatomy.

Specifically, ocular anatomy training has depended on the use of cadavers or the eyes of sheep or cows, but there are ethical, financial, and practical concerns regarding the use of preserved specimens. Plastic models of the eye exist but are often highly stylized and very expensive. In the clinical setting, explaining ocular pathology to patients also can be challenging because high-quality models of the eye that accurately represent the eye and orbit are difficult to find. The need for a better way of teaching ocular anatomy is apparent.

A relatively new technology, 3D printing, offers an alternative to traditional cadaver-based anatomy training. 3D printing uses a digital image to create a three-dimensional print of the object. Horizontal layers are printed sequentially and the edges are blended to generate the final 3D print. This innovative method of printing is revolutionizing many areas of the medical field.

In fact, 3D printed eyewear is now commercially available and 3D-printed contact lenses are in development. 3D prints generated during surgical planning highlight subtle distinctions in the patient's individual anatomy, which can affect the surgical approach. Viable retinal cells of rats have been printed, providing hope that perhaps human retinal cells may be printed with the same technique.

Clearly, the promise of 3D printing is not limited to anatomy education alone.

Study Summary

A group of researchers sought to generate 3D prints of orbital dissections of adequate quality for the training of ophthalmologists and optometrists.

Initially, orbital dissections were prepared featuring the classic views: superior, lateral, and medial. Next, a 3D handheld scanner created a surface mesh of the human orbit prosections. This scanner had a resolution of 0.1 mm, point accuracy up to 0.03 mm, and was capable of capturing details of both shape and color. All of the external surfaces of the prosections were scanned and a digital file was created. Important features such as nerves and muscles were highlighted using enhanced color in the 3D digital file to facilitate learning.

The researchers used a 3D Systems Z650 printer, which is one of many commercially available 3D printers. This printer is capable of printing 390,000 possible shades. The build speed of 28 mm/hr allowed the 3D orbit prints to be generated in approximately 3 hours, with a slice thickness of 0.1 mm.

The 3D prints were deemed "highly realistic" by the researchers and offered enhanced visualization of the delicate nerves that are often difficult to identify in traditional orbital dissections, such as the trochlear and nasociliary nerves. The ophthalmic artery and its branches were also identifiable on the 3D orbit prints.

The researchers concluded that the 3D prints were of sufficient quality for the instruction of medical undergraduates, ophthalmology trainees, and allied health professionals. The majority of the structures listed in the curriculum standards of the Royal Australian and New Zealand College of Ophthalmologists were readily distinguishable on the models, including the vasculature and innervation of the orbit, the extraocular muscles with insertions and origins, periorbital structures with the internal carotid arteries and paranasal sinuses, and the first six cranial nerves.

Viewpoint

3D orbit printing is an innovative strategy to enhance the education of medical students and patients.

The ability to produce low-cost, detailed models of the orbit would be an important advancement in the training of ophthalmology and optometry students, eliminating many of the concerns associated with the use of cadavers. Access to high-quality learning materials would be more obtainable for clinicians who wish to review anatomy but do not have access to a cadaver laboratory.

Clinically, patients would benefit from 3D prints because a better understanding of basic ocular anatomy facilitates better comprehension of ocular pathology.

The color-enhancing properties of 3D digital files would probably make 3D anatomical prints superior to tissue specimens because the distinctions between structures can be highlighted.

Offering alternatives to traditional modes of healthcare education is just one way that 3D printing is changing the landscape of eye care.

Abstract

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