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The effect of a virtual reality training curriculum on consistency of performance (part of the international forum for ophthalmic simulation studies)

Poster Details

First Author: J.Wawrzynski UK

Co Author(s):    J. Lamparter   P. Sullivan   F. O'Sullivan   S. Jones   P. Smith   G. Saleh

Abstract Details


Junior trainees have been shown to perform the least consistently in cataract surgery. This study evaluates the level of skills transfer of a structured, sequential, customized virtual reality training syllabus on ophthalmic surgeons during their first year of cataract training. It also assesses whether the training program can increase consistency of performance in novice ophthalmic surgeons.


Moorfields Eye Hospital in London, UK.


Trainees with less than two hours intraocular and simulator experience in their first year of ophthalmology undertook a structured, sequential, customized, virtual reality cataract training program developed through the International Forum of Ophthalmic Simulation. Three repetitions of four previously validated generic 3-dimensional and cataract-specific, static and dynamic simulator tasks (1 cracking and chopping, 2 intracapsular navigation training, 3 anti-tremor training, 4 capsulorhexis) were performed before and after trainees conducted the actual training syllabus. A maximum score of 100 could be achieved for each of the four tested tasks, resulting in maximum pre- and post-course scores of 400. Statistical significance between pre-course scores and post-course scores were evaluated with the Wilcoxon sign-rank test and served as a measure of skills transfer. The difference in standard deviation (variability) between the three entry and three exit examinations served as a measure of consistency of performance and was calculated using a non-parametric t-test.


The median pre-course score of 101.50/400 (IQR 58.75-145.75) was significantly improved after completing the training program ((post-course score: 302/400, range: 266.25-343), p<0.001). While improvement was evident and found to be statistically significant in all parameters, greatest improvements were found for capsulorhexis and anti-tremor training ((Capsulorhexis: pre-course score: 0/100, range: 0-4.5; post-course score: 81/100, range: 13-87.75; p=0.002), (anti-tremor training: pre-course score: 0/100, range: 0-0; post-course score: 80/100, range: 60.25-91.50; p=0.001)). Improvements were lower for cracking and chopping training (pre-course score: 57/100, range: 14-91.5; post-course score: 96/100, range: 94-98; p=0.001) and for intracapsular navigation training (pre-course score: 36.5/100, range: 17-54.75; post-course score: 302/400, range: 266.25-343; p=0.001) An increase in consistency of performance was only found for the previously demonstrated easier tasks (1 cracking and chopping, 2 intracapsular navigation training; p≤0.001, respectively). The more demanding tasks (3 anti-tremor training, 4 capsulorhexis), showed a trend to reduced consistency, but without statistical significance (p=0.22 and p=0.80, respectively). This reflected consistently low scores at entry whose consistency improved sporadically after training.


A structured, sequential, customized virtual reality training syllabus enhances technical aptitude and numerical scores in novice cataract surgeons, thus demonstrating skills acquisition. Virtual reality training at the earliest stage of ophthalmic surgical training may, therefore, be of benefit. However, performance remains variable with technically complex tasks. Caution should be employed when looking at a single result as a metric of aptitude. FINANCIAL INTEREST: NONE

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