Virtual-reality surgery simulator aids vitreoretinal and cataract surgery training

National Retina Institute teams up with aviation industry to enhance the benefit of the system.

Issue: December 1, 2005

ByBob Kronemyer

A virtual-reality training system for intraocular surgery has the potential to revolutionize the way ophthalmic residents and fellows are trained, according to one academic official. Another is working with the aviation industry to make the system even more valuable.

“Medical training can be very challenging and can also be extremely risky, especially in a surgical specialty, so we are constantly looking for new ways that residents can gain surgical skills in a safe and predictable environment,” said Mark F. Torres, MD, a lieutenant colonel and assistant chief of ophthalmology at Madigan Army Medical Center in Tacoma, Wash., in an interview with Ocular Surgery News. “In the past, the approach has been to basically work yourself up to a level where you’re ready to do your first surgery on your first patient, which can be a great leap of faith. The VRmagic simulator enhances the process of preparing a surgical resident for his first surgical experience by providing more skills and confidence.”

The VRmagic Virtual Reality Ophthalmic Surgery Computer Simulator was developed by VRmagic to address the need for efficient training, and objective assessment in ophthalmic surgery. The system for vitreoretinal and cataract surgery training consists of a simulator platform, surgical interfaces and simulation software modules.

Dr. Torres and his colleagues were first introduced to the surgical simulation system at a medical conference where they test-drove the technology. Madigan Army Medical Center installed the system in September. The technology recreates a surgical environment through virtual reality.

“The system actually requires you to look through a device which simulates a surgical microscope,” Dr. Torres said. “It is almost like getting a real-time surgical view of the intraocular environment.”

Peeling a membrane

Real-time surgical procedures can be simulated, such as epiretinal membrane peeling. “If you accidentally nick a blood vessel, it will bleed,” Dr. Torres said. In addition to simulating vitreoretinal procedures, the system can mimic anterior segment procedures such as cataract surgery. Exchanging the surgery interface takes only seconds, he said.

The computer simulator also has skills exercises (eg, placing a rectangle in a circle inside the eye). The system has the ability to grade an individual on his surgical skills, such as time to complete a procedure and the accuracy of maneuvers.

The virtual image can also be displayed on a computer monitor, so teachers and others can watch what a student or resident is doing. “We’re currently using the VRmagic simulator to teach basic rudimentary surgical skills to residents,” Dr. Torres said. “But we’re also using it as refresher training for staff and allowing staff to sharpen their existing surgical skills.”

Using the system is fun, he said. “It’s like a video game. Residents enjoy interacting with the simulator. This technology has the opportunity of perhaps revolutionizing the way we conduct medical training, at least in the surgical subspecialties. There is no risk to a live patient.”

Real-time surgical procedures can be simulated, such as epi-retinal membrane peeling.

ILM peel as seen through the simulator.

Vitreous base shave as seen through the simulator.

Physicians learning the VRmagic Simulator in the wet lab.

Images: Oculus Inc.

High fidelity

Personnel at the National Retina Institute in Washington have been using the VRmagic computer simulator for about 2 years now.

“We acquired the system because it offers high-fidelity simulation of surgical procedures,” said the institute’s executive director Bert M. Glaser, MD. “It allows surgeons to perform difficult cases many times. For instance, you can do 100, 200 or 300 epiretinal membrane peeling procedures before you ever perform your first real case. There is nothing you can touch. It is all virtual. But the system simulates the dimensions and components of the eye extraordinarily well.”

Fellows at the National Retina Institute primarily use the simulator for retinal surgery. Some training programs are self-tutored, while in others an instructor watches a video screen and provides feedback, he said.

“The simulator itself is a really neat video game, so to speak,” Dr. Glaser said. “However, without adding a significant curriculum and significant other factors, the system really doesn’t reach all the goals we have to fully train retinal surgeons.”

Aviation input

Dr. Glaser has spearheaded a project with the aviation industry to enhance training with the VRmagic simulator.

“We want to incorporate what the aviation industry has learned over the past 30 years about using simulators in aviation,” Dr. Glaser said. “To do this properly, you need to assess all the tasks in every surgical procedure. Those tasks can then be broken down into scorable components. This allows trainees a gated progression. You would not be able to progress to the next level until you mastered all the tasks in the current level.”

Dr. Glaser and his associates have developed a program called the Task Assessment Based Skills and Competency Training Program (TASC). “This makes the simulator much more effective,” he said.

A session with the VRmagic simulator normally lasts between 30 and 60 minutes. “It is an intensive training program. It takes 2 years to complete,” Dr. Glaser said. “Right now, we’re engaged in extensive studies to determine how the surgical simulator really impacts training. I think, overall, it really does impact training extremely positively. I believe the system makes training much more effective and more efficient.”

For Your Information:
Mark F. Torres, MD, can be reached at Ophthalmology Department, Madigan Army Medical Center, Tacoma, WA 98431; 253-968-1473; fax: 253-968-1451; e-mail: torchmd@aol.com. Dr. Torres has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
Bert M. Glaser, MD, can be reached at National Retina Institute, 901 Dulaney Valley Road, Towson, MD 21204; 410-337-4500; fax: 410-339-7326; e-mail: bglaser@bmgnri.com. Dr. Glaser has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

For more information on the VRmagic computer simulator, contact Tom Weatherby at Oculus, Inc., 2125 196th St. S.W., Suite 112, Lynnwood, WA 98036; 425-670-9977; fax: 425-670-0742; e-mail: tweatherby@oculususa.com.

Bob Kronemyer is an OSN Correspondent based in Elkhart, Ind.