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Liu C, Lin J, Wu S, Zhu Y, Zou Y, Zhang Q, Li Z, Zhuo Y, Li Y. Eyesi direct ophthalmoscope simulator: an effective training tool for medical undergraduates. BMC MEDICAL EDUCATION 2024; 24:783. [PMID: 39033099 PMCID: PMC11265108 DOI: 10.1186/s12909-024-05780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training. METHODS Medical undergraduates were randomly assigned to Group A or B (n = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire. RESULTS After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 (P < 0.001) in Group A, but Group B did not demonstrate a significant difference. We also compared undergraduates' tendencies for different learning purposes, 75.59% of participants preferred the Eyesi to TDO as a training tool, and 88.41% of participants were receptive to introducing the Eyesi in training. CONCLUSION According to subjective participant feedback, Eyesi outperformed TDO in fundus observation, operational practice, and theoretical learning. It effectively equips undergraduates with fundus examination skills, potentially promoting the use of direct ophthalmoscopes in primary medical institutions.
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Affiliation(s)
- Canying Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Jicheng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Siting Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yuxian Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Qi Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Yiqing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China.
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Deuchler S, Dail YA, Berger T, Sneyers A, Koch F, Buedel C, Ackermann H, Flockerzi E, Seitz B. Simulator-Based Versus Traditional Training of Fundus Biomicroscopy for Medical Students: A Prospective Randomized Trial. Ophthalmol Ther 2024; 13:1601-1617. [PMID: 38615132 PMCID: PMC11109054 DOI: 10.1007/s40123-024-00944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Simulation training is an important component of medical education. In former studies, diagnostic simulation training for direct and indirect funduscopy was already proven to be an effective training method. In this prospective controlled trial, we investigated the effect of simulator-based fundus biomicroscopy training. METHODS After completing a 1-week ophthalmology clerkship, medical students at Saarland University Medical Center (n = 30) were block-randomized into two groups: The traditional group received supervised training examining the fundus of classmates using a slit lamp; the simulator group was trained using the Slit Lamp Simulator. All participants had to pass an Objective Structured Clinical Examination (OSCE); two masked ophthalmological faculty trainers graded the students' skills when examining patient's fundus using a slit lamp. A subjective assessment form and post-assessment surveys were obtained. Data were described using median (interquartile range [IQR]). RESULTS Twenty-five students (n = 14 in the simulator group, n = 11 in the traditional group) (n = 11) were eligible for statistical analysis. Interrater reliability was verified as significant for the overall score as well as for all subtasks (≤ 0.002) except subtask 1 (p = 0.12). The overall performance of medical students in the fundus biomicroscopy OSCE was statistically ranked significantly higher in the simulator group (27.0 [5.25]/28.0 [3.0] vs. 20.0 [7.5]/16.0 [10.0]) by both observers with an interrater reliability of IRR < 0.001 and a significance level of p = 0.003 for observer 1 and p < 0.001 for observer 2. For all subtasks, the scores given to students trained using the simulator were consistently higher than those given to students trained traditionally. The students' post-assessment forms confirmed these results. Students could learn the practical backgrounds of fundus biomicroscopy (p = 0.04), the identification (p < 0.001), and localization (p < 0.001) of pathologies significantly better with the simulator. CONCLUSIONS Traditional supervised methods are well complemented by simulation training. Our data indicate that the simulator helps with first patient contacts and enhances students' capacity to examine the fundus biomicroscopically.
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Affiliation(s)
- Svenja Deuchler
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany.
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany.
| | - Yaser Abu Dail
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
| | - Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
| | - Albéric Sneyers
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
| | - Frank Koch
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany
| | - Claudia Buedel
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany
| | - Hanns Ackermann
- Institute of Biostatistics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
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DesLauriers AC, Ackah PF, Skidd PM. The Versatile Teaching Eye: an affordable, 3D-printed model eye for simulating ophthalmic examination. Digit J Ophthalmol 2024; 30:22-26. [PMID: 38962668 PMCID: PMC11218838 DOI: 10.5693/djo.01.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Purpose To describe the Versatile Teaching Eye (VT Eye), a 3D-printed model eye designed to provide an affordable examination simulator, and to report the results of a pilot program introducing the VT Eye and an ophthalmic training curriculum at a teaching hospital in Ghana. Methods TinkerCAD was used to design the VT Eye, which was printed with ABS plastic. The design features an adapter that permits use of a smartphone as a digital fundus. We developed a set of digital flashcards allowing for an interactive review of a range of retinal pathologies. An analog fundus was developed for practicing traditional slit lamp and indirect examinations as well as retinal laser practice. The model was used for a period of 2 weeks by ophthalmic trainees at Komfo Anokye Teaching Hospital, Kumasi, Ghana, to practice indirect ophthalmoscopy, slit lamp biomicroscopy, smartphone funduscopy, and retinal image drawing. Results were assessed at by means of a pre-/post-training survey of 6 residents. Results The VT Eye accommodates diverse fundus examination techniques. Its 3D-printed design ensures cost-effective, high-quality replication. When paired with a 20 D practice examination lens, the digital fundus provides a comprehensive, interactive training environment for <$30.00 (USD). This device allows for indirect examination practice without requiring an indirect headset, which may increase the amount of available practice for trainees early in their careers. In the Ghana pilot program, the model's use in indirect examination training sessions significantly boosted residents' confidence in various examination techniques. Comparing pre- and post-session ratings, average reported confidence levels rose by 30% for acquiring clear views of the posterior pole, 42% for visualizing the periphery, and 141% for capturing important pathology using personal smartphones combined with a 20 D lens (all P < 0.05). Conclusions The VT Eye is readily reproducible and can be easily integrated into ophthalmic training curricula, even in regions with limited resources. It offers an effective and affordable training solution, underscoring its potential for global adoption and the benefits of incorporating innovative technologies in medical education.
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Affiliation(s)
| | - Peter F. Ackah
- Department of Ophthalmology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Philip M. Skidd
- Departments of Ophthalmology and Neurology, The University of Vermont, Burlington
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Liao J, Wright RR, Vora GK. The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241245635. [PMID: 38596233 PMCID: PMC11003344 DOI: 10.1177/23821205241245635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges. METHODS A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles. RESULTS Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning. CONCLUSION In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.
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Affiliation(s)
- Jennifer Liao
- Department of Ophthalmology, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Robin Redmon Wright
- Department of Behavioral Sciences and Education, Pennslyvania State University Harrisburg, Middletown, PA, USA
| | - Gargi K Vora
- Department of Ophthalmology, Yale School of Medicine, New Haven, CT, USA
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Gniesmer S, Grisanti S, Kakkassery V, Lommatzsch C, Lüke J, Lüke M, Müller M, Neppert B, Ranjbar M, Grisanti S, Mohi A. [Digital teaching 2020: Online teaching receives a better assessment than face-to-face teaching]. DIE OPHTHALMOLOGIE 2023; 120:538-544. [PMID: 36445474 DOI: 10.1007/s00347-022-01766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Due to the corona pandemic, face-to-face teaching was no longer permitted in the summer semester 2020 and online alternatives were quickly found. OBJECTIVE In our article, we illustrate the switch from face-to-face to online teaching in ophthalmology at the University of Lübeck and compare online teaching with face-to-face teaching. METHODS The central teaching evaluation takes place every semester with a standardized questionnaire. Based on the evaluation of these questions, a direct comparison of the attendance semester of the winter semester 2019/2020 with the online semester of the summer semester 2020 was carried out. RESULTS The structure (p = 0.003), the organization (p = 0.001), the resources made available (p = 0.034), the attendance of the lectures (p < 0.001) and further dates (p = 0.041), the increase in interest (p = 0.039) and learning (p = 0.001) were rated better in the online semester than in the face-to-face semester. Overall, the digital summer semester 2020 (p < 0.01) received a significantly better overall grade than the face-to-face semester in winter 2019/2020. CONCLUSION The structure of our courses has also been proven online. The theoretical content could be excellently mediated; however, practical exercises are not possible online. For the learning of practical skills, face-to-face instruction is still necessary.
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Affiliation(s)
- Stefanie Gniesmer
- Klinik für Augenheilkunde, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, Deutschland.
| | - Swaantje Grisanti
- Klinik für Augenheilkunde, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, Deutschland
| | - Vinodh Kakkassery
- Klinik für Augenheilkunde, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, Deutschland
| | | | - Julia Lüke
- Augenheilkunde am Europaplatz, Trittau, Deutschland
| | | | - Maya Müller
- Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Schweiz
| | | | - Mahdy Ranjbar
- Klinik für Augenheilkunde, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, Deutschland
| | - Salvatore Grisanti
- Klinik für Augenheilkunde, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, Deutschland
| | - Armin Mohi
- Klinik für Augenheilkunde, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, Deutschland
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Douglass A, Cham KM, Jaworski A, Maillet A, Cochrane A, Armitage JA. The Equivalency of the Binocular Indirect Ophthalmoscope Simulator to Peer Practice: A Pilot Study. Optom Vis Sci 2021; 98:1239-1247. [PMID: 34510154 DOI: 10.1097/opx.0000000000001799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Optometric educators are constantly looking for learning and teaching approaches to improve clinical skills training. In addition, the COVID-19 pandemic has made educators scrutinize the time allocated to face-to-face teaching and practice. Simulation learning is an option, but its use must first be evaluated against traditional learning methods. PURPOSE The purpose of this study was to compare the training of binocular indirect ophthalmoscopy skills achieved by students and optometrists through deliberate practice on the Eyesi Indirect Ophthalmoscope simulator with deliberate practice using a peer. METHODS Students and optometrists were randomly allocated to practice on either the simulator or a peer. Binocular indirect ophthalmoscopy performance was assessed using a peer and the simulator as the patients at different time points. Knowledge and confidence were examined before and following all practice sessions using a quiz and survey. RESULTS Significant improvements in binocular indirect ophthalmoscopy performance using either a peer or the simulator as the patient for assessment were seen after 8 hours of student practice (P < .001) and after a half-hour practice time for optometrists (P < .001). There was no significant difference in performance overall between those practicing on a simulator and those practicing on a peer (P > .05). Confidence in ability to perform the technique was lower for students who had practiced on the simulator. CONCLUSIONS The simulator has similar efficacy to peer practice for teaching binocular indirect ophthalmoscopy to students and maintenance of this clinical skill for optometrists. Simulation does not replace the need for peer practice but may be a useful adjunct reducing the face-to-face hours required. These findings present a need for further research regarding diverse applications of the Eyesi Indirect Ophthalmoscope simulator in the curriculum for training optometry students and as a continuing professional development offering for optometrists, given the short exposure duration required to observe a significant improvement in skill.
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Affiliation(s)
| | - Kwang Meng Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Alissa Maillet
- Department of Optometry, Deakin University, Waurn Ponds, Victoria, Australia
| | - Anthea Cochrane
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Banse HE, McMillan CJ, Warren AL, Hecker KG, Wilson B, Skorobohach BJ, Carter RT, Lewin AC, Kondro DA, Ungrin MD, Dorosz SG, Baker RE, Dehghanpir SD, Grandt BB, Hale Mitchell LK, Anderson SJ. Development of and Validity Evidence for a Canine Ocular Model for Training Novice Veterinary Students to Perform a Fundic Examination. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:620-628. [PMID: 33493101 DOI: 10.3138/jvme-2020-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Indirect fundoscopy is challenging for novice learners, as patients are often intolerant of the procedure, impeding development of proficiency. To address this, we developed a canine ocular simulator that we hypothesized would improve student learning compared to live dogs. Six board-certified veterinary ophthalmologists and 19 second-year veterinary students (novices) performed an indirect fundic examination on the model and live dog. Prior to assessment, novices were introduced to the skill with a standardized teaching protocol and practiced (without feedback) with either the model (n = 10) or live dog (n = 9) for 30 minutes. All participants evaluated realism and usefulness of the model using a Likert-type scale. Performance on the live dog and model was evaluated in all participants using time to completion of task, performance of fundic examination using a checklist and global score, identification of objects in the fundus of the model, and evaluation of time spent looking at the fundus of the model using eye tracking. Novices (trained on simulator or live dogs) were compared in fundic examination performance on the live dog and identification of shapes in the model. In general, experts performed the fundic examination faster (p ≤ .0003) and more proficiently than the novices, although there were no differences in eye tracking behavior between groups (p ≥ .06). No differences were detected between training on simulator versus live dog in development of fundoscopy skills in novices (p ≥ .20). These findings suggest that this canine model may be an effective tool to train students to perform fundoscopy.
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Ong CW, Tan MCJ, Lam M, Koh VTC. Applications of Extended Reality in Ophthalmology: Systematic Review. J Med Internet Res 2021; 23:e24152. [PMID: 34420929 PMCID: PMC8414293 DOI: 10.2196/24152] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/19/2020] [Accepted: 04/06/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Virtual reality, augmented reality, and mixed reality make use of a variety of different software and hardware, but they share three main characteristics: immersion, presence, and interaction. The umbrella term for technologies with these characteristics is extended reality. The ability of extended reality to create environments that are otherwise impossible in the real world has practical implications in the medical discipline. In ophthalmology, virtual reality simulators have become increasingly popular as tools for surgical education. Recent developments have also explored diagnostic and therapeutic uses in ophthalmology. OBJECTIVE This systematic review aims to identify and investigate the utility of extended reality in ophthalmic education, diagnostics, and therapeutics. METHODS A literature search was conducted using PubMed, Embase, and Cochrane Register of Controlled Trials. Publications from January 1, 1956 to April 15, 2020 were included. Inclusion criteria were studies evaluating the use of extended reality in ophthalmic education, diagnostics, and therapeutics. Eligible studies were evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence. Relevant studies were also evaluated using a validity framework. Findings and relevant data from the studies were extracted, evaluated, and compared to determine the utility of extended reality in ophthalmology. RESULTS We identified 12,490 unique records in our literature search; 87 met final eligibility criteria, comprising studies that evaluated the use of extended reality in education (n=54), diagnostics (n=5), and therapeutics (n=28). Of these, 79 studies (91%) achieved evidence levels in the range 2b to 4, indicating poor quality. Only 2 (9%) out of 22 relevant studies addressed all 5 sources of validity evidence. In education, we found that ophthalmic surgical simulators demonstrated efficacy and validity in improving surgical performance and reducing complication rates. Ophthalmoscopy simulators demonstrated efficacy and validity evidence in improving ophthalmoscopy skills in the clinical setting. In diagnostics, studies demonstrated proof-of-concept in presenting ocular imaging data on extended reality platforms and validity in assessing the function of patients with ophthalmic diseases. In therapeutics, heads-up surgical systems had similar complication rates, procedural success rates, and outcomes in comparison with conventional ophthalmic surgery. CONCLUSIONS Extended reality has promising areas of application in ophthalmology, but additional high-quality comparative studies are needed to assess their roles among incumbent methods of ophthalmic education, diagnostics, and therapeutics.
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Affiliation(s)
- Chee Wui Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marcus Chun Jin Tan
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Michael Lam
- Department of Ophthalmology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Iskander M, Ogunsola T, Ramachandran R, McGowan R, Al-Aswad LA. Virtual Reality and Augmented Reality in Ophthalmology: A Contemporary Prospective. Asia Pac J Ophthalmol (Phila) 2021; 10:244-252. [PMID: 34383716 PMCID: PMC9167643 DOI: 10.1097/apo.0000000000000409] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Most published systematic reviews have focused on the use of virtual reality (VR)/augmented reality (AR) technology in ophthalmology as it relates to surgical training. To date, this is the first review that investigates the current state of VR/AR technology applied more broadly to the entire field of ophthalmology. METHODS PubMed, Embase, and CINAHL databases were searched systematically from January 2014 through December 1, 2020. Studies that discussed VR and/or AR as it relates to the field of ophthalmology and provided information on the technology used were considered. Abstracts, non-peer-reviewed literature, review articles, studies that reported only qualitative data, and studies without English translations were excluded. RESULTS A total of 77 studies were included in this review. Of these, 28 evaluated the use of VR/AR in ophthalmic surgical training/assessment and guidance, 7 in clinical training, 23 in diagnosis/screening, and 19 in treatment/therapy. 15 studies used AR, 61 used VR, and 1 used both. Most studies focused on the validity and usability of novel technologies. CONCLUSIONS Ophthalmology is a field of medicine that is well suited for the use of VR/AR. However, further longitudinal studies examining the practical feasibility, efficacy, and safety of such novel technologies, the cost-effectiveness, and medical/legal considerations are still needed. We believe that time will indeed foster further technological advances and lead to widespread use of VR/AR in routine ophthalmic practice.
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Affiliation(s)
- Mina Iskander
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
| | - Titilola Ogunsola
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
| | - Rithambara Ramachandran
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
| | - Richard McGowan
- Department of Epidemiology and Health Promotion, NYU College of Dentistry, New York, New York, US
| | - Lama A. Al-Aswad
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
- Department of Population Health, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, US
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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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[Combination of simulation-based and online learning in ophthalmology : Efficiency of simulation in combination with independent online learning within the framework of EyesiNet in student education]. Ophthalmologe 2021; 119:20-29. [PMID: 33449201 PMCID: PMC7809651 DOI: 10.1007/s00347-020-01313-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/17/2022]
Abstract
Hintergrund Die Ophthalmoskopie ist Bestandteil des medizinischen Curriculums, jedoch das Vermitteln der Inhalte oft unbefriedigend, da ein systematisches Lernen von Pathologien und deren Behandlungen dadurch erschwert ist, dass oftmals das passende Patientengut nicht zur Verfügung steht und dadurch gesunde Studenten einander untersuchen müssen. Aus diesem Grund haben wir eine Online-Plattform entwickelt, die in Kombination mit simulationsgestütztem Training sowohl das eigenständige als auch das angeleitete Lernen von Untersuchungsmethoden und Pathologien ermöglicht. Ziel der Arbeit Ziel der vorliegenden Arbeit war, ein Format für die Verbesserung der Lehre der direkten und indirekten Ophthalmoskopie im Studierendenunterricht zu evaluieren. Dabei wurden praktische Übungen an Virtual-Reality-basierten Simulatoren mit neu entwickelten und an den Lehrkatalog angepassten theoretischen Inhalten in der Online-Plattform EyesiNet verschränkt. Material und Methoden Die Studierenden bearbeiteten am ersten sowie am letzten Praktikumstag zufällig ausgewählte Fälle, die ihnen von den Eyesi Direct- und Eyesi Indirect-Simulatoren präsentiert wurden. Zwischen diesen beiden Einheiten konnten sie sich auf freiwilliger Basis mit den theoretischen Grundlagen typischer ophthalmologischer Krankheitsbilder im EyesiNet beschäftigen. Ergebnisse Eyesi Direct: Die Bewertung des Simulators ergab am ersten Praktikumstag für beide Gruppen keinen signifikant unterschiedlichen Wissensstand (p = 0,29). In der Gruppe OHNE Training (n = 54) ergab sich am letzten Praktikumstag mit p = 0,02 eine signifikante Verbesserung dieser Bewertung, jedoch mit einer geringen Effektgröße von 0,1. In der Gruppe MIT Training (n = 32) konnte mit p = 0,0004 eine hoch signifikante Verbesserung mit einer Effektgröße von 0,3 nach Rosenthal festgestellt werden. Eyesi Indirect: Die simulatorgestützte Bewertung ergab am ersten Praktikumstag keinen signifikanten Unterschied im Wissensstand der beiden Gruppen (p = 0,1). Nach dem Training schnitten zwar beide Gruppen etwas besser ab, jedoch ohne signifikanten Unterschied (OHNE Training p = 0,41/MIT Training p = 0,17). Diskussion Die Online-Plattform EyesiNet unterstützt beim Erlernen der wichtigsten Erkrankungsbilder. Lerninhalte werden reproduzierbar und auf für alle Lernenden standardisierte Weise zur Verfügung gestellt. Die Fertigkeiten der direkten Ophthalmoskopie sind hierbei deutlich schneller als die der indirekten Ophthalmoskopie zu erlernen.
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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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Succar T, Grigg J, Beaver HA, Lee AG. Advancing ophthalmology medical student education: International insights and strategies for enhanced teaching. Surv Ophthalmol 2020; 65:263-271. [DOI: 10.1016/j.survophthal.2019.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/06/2019] [Accepted: 08/16/2019] [Indexed: 11/29/2022]
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Deuchler S, Wagner C, Schill M, Schöne B, Scherer D, Singh P, Kohnen T, Koch FHJ. Unusual Primary Ocular Manifestation of Sarcoidosis. Case Rep Ophthalmol 2019; 10:205-212. [PMID: 31692537 PMCID: PMC6760357 DOI: 10.1159/000501302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022] Open
Abstract
A 23-year-old male patient presented with very mild visual disturbances, but a distinct prominence of the optic discs, more pronounced in the right than in the left eye. The ophthalmic symptoms initially seemed trivial, but a large-scale interdisciplinary workup later identified them as the presenting symptoms of sarcoidosis affecting lung and eyes. A standard steroid monotherapy successfully caused regression of the ophthalmic findings.
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Affiliation(s)
- Svenja Deuchler
- Retina and Vitreous Unit, University Eye Clinic, Frankfurt, Germany
| | | | | | | | | | - Pankaj Singh
- Retina and Vitreous Unit, University Eye Clinic, Frankfurt, Germany
| | | | - Frank H J Koch
- Retina and Vitreous Unit, University Eye Clinic, Frankfurt, Germany
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