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Gurnani B, Kaur K, Kumar M. Innovative inexpensive wet-lab training model for practicing keratoplasty during COVID-19 pandemic. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ruiss M, Kronschläger M, Schlatter A, Dechat T, Findl O. Comparison of methods to experimentally induce opacification and elasticity change in ex vivo porcine lenses. Sci Rep 2021; 11:23406. [PMID: 34862438 PMCID: PMC8642470 DOI: 10.1038/s41598-021-02851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
At the moment, cataract, which is the opacification of the eye's lens, can only be treated by surgery. In order to develop and test new pharmacological treatment strategies for the disease, there is a need for an appropriate in vitro model using ex vivo animal lenses. In this study, porcine lenses were incubated in either culture medium, glucose, triamcinolone acetonide, sodium chloride, hydrogen peroxide, sodium selenite, neutral buffered formalin, or were exposed to microwave heating to experimentally induce lens opacification. Changes in the lens morphology, weight, size, and elasticity were monitored 7 days after treatment. The fastest induction of dense opacification was seen in lenses exposed to sodium chloride, neutral buffered formalin, and microwave heating. No change in the size and weight of the lenses were detected, whereas loss in elasticity could be detected in lenses treated with formalin solution or microwave heating. Thus, neutral buffered formalin- and microwave-treated ex vivo porcine lenses seem to be a suitable model for mature cataracts, whereas hypertonic sodium chloride may be useful for studies on osmolarity-induced lens opacification.
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Affiliation(s)
- Manuel Ruiss
- Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Martin Kronschläger
- Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Heinrich-Collin-Straße 30, 1140, Vienna, Austria.
| | - Andreas Schlatter
- Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Thomas Dechat
- 1st Medical Department, Hanusch Hospital, Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1140, Vienna, Austria
| | - Oliver Findl
- Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
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Pujari A, Saluja G, Bhaskaran K, Modaboyina S, Asif MI, Agarwal T, Sharma N, Titiyal JS. Animal and cadaver human eyes for residents' surgical training in ophthalmology. Surv Ophthalmol 2021; 67:226-251. [PMID: 33992664 DOI: 10.1016/j.survophthal.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/19/2022]
Abstract
In ophthalmology residency programs surgical training plays a vital role in creating confident and skillful surgeons. As almost all ophthalmic surgery needs microscope training, creating a well-taught environment for hand-eye coordination, ocular tissue handling, and anticipation of complications is essential. Wet lab training with animal or cadaver human eyes offers diverse possibilities. We conducted a thorough literature search on various databases to identify the existing literature on wet labs. The results revealed constructive efforts for training novice surgeons in all surgical ophthalmology subspecialties. Wet lab models were initially used only to practice cataract surgery; however, now various complex ocular procedures can be practiced. Ocular surface, corneal, iris, lenticular, scleral, vitreoretinal, extraocular, eyelid, and other adnexal surgeries were reproduced and mastered in many ways. Importantly, with repeated surgical practice, residents gained an increasing level of confidence with enhanced surgical accuracy. In addition, we propose a few novel techniques of various other procedures.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Gunjan Saluja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Karthika Bhaskaran
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sujeeth Modaboyina
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Mishra D, Bhatia K, Verma L. Essentials of setting up a wet lab for ophthalmic surgical training in COVID-19 pandemic. Indian J Ophthalmol 2021; 69:410-416. [PMID: 33463600 PMCID: PMC7933840 DOI: 10.4103/ijo.ijo_3298_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Wet labs are an extremely important training tool, especially in times of a global COVID-19 pandemic, where surgical training can be minimal. They help the trainee learn and practice in a risk-free environment, without an imminent of a complication or failure, also allowing them the chance to execute the steps of a surgery repeatedly. We summarize all the key ingredients required from setting up a wet lab to improve the surgical skill of the trainees. The review also discusses various eyeball fixating devices, preparation of the eye for various types of ocular surgeries, and the role of simulation-based training in today's scenario.
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Affiliation(s)
- Deepak Mishra
- Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Karan Bhatia
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
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Lee R, Raison N, Lau WY, Aydin A, Dasgupta P, Ahmed K, Haldar S. A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology. Eye (Lond) 2020; 34:1737-1759. [PMID: 32203241 PMCID: PMC7609318 DOI: 10.1038/s41433-020-0832-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/23/2019] [Accepted: 01/05/2020] [Indexed: 12/27/2022] Open
Abstract
To evaluate all simulation models for ophthalmology technical and non-technical skills training and the strength of evidence to support their validity and effectiveness. A systematic search was performed using PubMed and Embase for studies published from inception to 01/07/2019. Studies were analysed according to the training modality: virtual reality; wet-lab; dry-lab models; e-learning. The educational impact of studies was evaluated using Messick's validity framework and McGaghie's model of translational outcomes for evaluating effectiveness. One hundred and thirty-one studies were included in this review, with 93 different simulators described. Fifty-three studies were based on virtual reality tools; 47 on wet-lab models; 26 on dry-lab models; 5 on e-learning. Only two studies provided evidence for all five sources of validity assessment. Models with the strongest validity evidence were the Eyesi Surgical, Eyesi Direct Ophthalmoscope and Eye Surgical Skills Assessment Test. Effectiveness ratings for simulator models were mostly limited to level 2 (contained effects) with the exception of the Sophocle vitreoretinal surgery simulator, which was shown at level 3 (downstream effects), and the Eyesi at level 5 (target effects) for cataract surgery. A wide range of models have been described but only the Eyesi has undergone comprehensive investigation. The main weakness is in the poor quality of study design, with a predominance of descriptive reports showing limited validity evidence and few studies investigating the effects of simulation training on patient outcomes. More robust research is needed to enable effective implementation of simulation tools into current training curriculums.
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Affiliation(s)
- Roxanne Lee
- GKT School of Medical Education, King's College London, London, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, King's College London, London, UK
| | - Wai Yan Lau
- School of Medicine, St George's, University of London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, UK
| | - Shreya Haldar
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK.
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Pandey SK, Sharma V. Cataract surgery training during ophthalmology residency in India: Challenges and how to overcome them? Indian J Ophthalmol 2018; 65:1279-1280. [PMID: 29208806 PMCID: PMC5742954 DOI: 10.4103/ijo.ijo_1032_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Suresh K Pandey
- SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
| | - Vidushi Sharma
- SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
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Sengupta S, Dhanapal P, Nath M, Haripriya A, Venkatesh R. Goat's eye integrated with a human cataractous lens: A training model for phacoemulsification. Indian J Ophthalmol 2016; 63:275-7. [PMID: 25971179 PMCID: PMC4448247 DOI: 10.4103/0301-4738.156937] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A relatively simple and inexpensive technique to train surgeons in phacoemulsification using a goat's eye integrated with a human cataractous nucleus is described. The goat's eye is placed on a bed of cotton within the lumen of a cylindrical container. This is then mounted on a rectangular thermocol so that the limbus is presented at the surgical field. After making a clear corneal entry with a keratome, the trainer makes a 5–5.5 mm continuous curvilinear capsulorhexis in the anterior lens capsule, creates a crater of adequate depth in the cortex and inserts the human nucleus within this crater in the goat's capsular bag. The surgical wound is sutured, and the goat's eye is ready for training. Creating the capsulorhexis with precision and making the crater of adequate depth to snugly accommodate the human nucleus are the most important steps to prevent excessive wobbling of the nucleus while training.
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Thomsen ASS, Subhi Y, Kiilgaard JF, la Cour M, Konge L. Update on simulation-based surgical training and assessment in ophthalmology: a systematic review. Ophthalmology 2015; 122:1111-1130.e1. [PMID: 25864793 DOI: 10.1016/j.ophtha.2015.02.028] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 11/17/2022] Open
Abstract
TOPIC This study reviews the evidence behind simulation-based surgical training of ophthalmologists to determine (1) the validity of the reported models and (2) the ability to transfer skills to the operating room. CLINICAL RELEVANCE Simulation-based training is established widely within ophthalmology, although it often lacks a scientific basis for implementation. METHODS We conducted a systematic review of trials involving simulation-based training or assessment of ophthalmic surgical skills among health professionals. The search included 5 databases (PubMed, EMBASE, PsycINFO, Cochrane Library, and Web of Science) and was completed on March 1, 2014. Overall, the included trials were divided into animal, cadaver, inanimate, and virtual-reality models. Risk of bias was assessed using the Cochrane Collaboration's tool. Validity evidence was evaluated using a modern validity framework (Messick's). RESULTS We screened 1368 reports for eligibility and included 118 trials. The most common surgery simulated was cataract surgery. Most validity trials investigated only 1 or 2 of 5 sources of validity (87%). Only 2 trials (48 participants) investigated transfer of skills to the operating room; 4 trials (65 participants) evaluated the effect of simulation-based training on patient-related outcomes. Because of heterogeneity of the studies, it was not possible to conduct a quantitative analysis. CONCLUSIONS The methodologic rigor of trials investigating simulation-based surgical training in ophthalmology is inadequate. To ensure effective implementation of training models, evidence-based knowledge of validity and efficacy is needed. We provide a useful tool for implementation and evaluation of research in simulation-based training.
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Affiliation(s)
- Ann Sofia S Thomsen
- Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark; Centre for Clinical Education, Centre for HR, Capital Region of Denmark, Copenhagen, Denmark.
| | - Yousif Subhi
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark, Copenhagen, Denmark
| | | | - Morten la Cour
- Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark
| | - Lars Konge
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark, Copenhagen, Denmark
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Abellán E, Calles-Vázquez MC, Cadarso L, Sánchez FM, Usón J. [Design and validation of a simulator for training in continuous circular capsulotomy for phacoemulsification]. ACTA ACUST UNITED AC 2013; 88:387-92. [PMID: 24060302 DOI: 10.1016/j.oftal.2013.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 01/21/2013] [Accepted: 01/25/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To design and validate a simulator for learning and training in the capsulorhexis technique. METHODS The system consists of a methacrylate support inclined 15° for the surgeon's hand, an area of commercially available aluminum foil, and another one of similar characteristics, where the student performs the technique through some slots that are previously made in the support. In order to evaluate the feasibility of this simulator, data were collected from 65 ophthalmologists performing the technique during training activities. The ophthalmologists were randomly divided into one group of 30 specialists who start their learning on the eyes of an animal cadaver, and into another of 35 specialists who previously started with this simulator. RESULTS A simulator is developed for training in the capsulorhexis technique. The students from the simulator group achieved a reduction in the use of cadaver eyes, and a higher efficiency in correct capsulorhexis, unlike the group who started directly on the cadaver eyes. CONCLUSIONS This simulator is an innovation in training of the capsulorhexis technique as regards simplicity, cost, and reuse, as compared to other virtual simulators with more expensive computer equipment (CE) equipment that are more difficult to transport. It is an important step prior to the use of cadaver parts and experimental animals, decreasing the number of both, and therefore the teaching costs.
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Affiliation(s)
- E Abellán
- Departamento de Microcirugía, Centro de Cirugía de Mínima Invasión Jesús Usón, Cáceres, España.
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Pereira FA, Werner L, Milverton JE, Coroneo MT. Miyake-Apple posterior video analysis/photographic technique. J Cataract Refract Surg 2009; 35:577-87. [DOI: 10.1016/j.jcrs.2008.11.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/17/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
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