Breakthrough Simulator Helps Train Eye Surgeons

Richard Rosen, MD (right) with the EyeSi ophthalmosurgery training simulatorNew York, NY (May 2007) -- The high-tech, minimally invasive techniques used in modern eye surgery to treat cataracts and retinal diseases have rendered the traditional method of training resident surgeons on animal specimens increasingly inadequate.

In just the past few months, however, surgeons in training at The New York Eye and Ear Infirmary have begun to practice with the first-ever ophthalmosurgery training simulator, which uses advanced computer technology to give the surgeon the feel of experiencing real intraocular surgery.

“The simulator is a remarkable breakthrough. It mimics surgery in a way never before achieved in ophthalmology,” said Richard Rosen, MD, director of ophthalmology resident education at The New York Eye and Ear Infirmary. “Unlike other surgical specialties, eye surgery simulation requires that you be able to see through tissue, even peel it back and reveal underlying organs. The simulator accomplishes that in an unprecedented and creative way.”

To remove a cataract, the most common eye operation performed in the United States, surgical residents sit at the training table, gently rest their fingers on an aluminum head and insert a needle-like surgical cutter and forceps into a simulated eye; then, viewing through a microscope and using foot pedals to focus, they use the forceps to carefully peel back the tissue coating the diseased lens. As the image of just-loosened tissue flaps about in the viscous gel that fills the eyeball, the surgeons use a tiny guillotine-like instrument to cut up the tissue. Next, they use an ultrasound needle to sculpt and break apart the spongy textured, diseased lens, which is suctioned out.

The supervising surgeon can observe the operation on a large plasma screen and offer a critique. Meanwhile, the simulator’s software shows the trainee if the cornea has been injured with the forceps (translucent white streaks show the exact location of the injury) or if another surgical error has been made. At the end of the procedure, the computer gives a training score and allows the student to play back the operation to observe and learn.

The new simulator, called EyeSi, has a number of software programs so that residents can practice on more complex diseases such as retinal tears, detachments and macular holes. It refines the hand, eye and foot coordination that goes into real minimally invasive eye surgery before utilizing actual equipment in the operating room.

The simulator is especially helpful in training for the most complex retinal operations because the appearance within the eye is more lifelike. In a specimen (dead pig’s eye) the retina is gray, but transparent in a live eye and the simulator image. With EyeSi software, just as in the real surgical procedure, a resident can remove the gel-like vitreous humor that fills the eyeball, refill it up with air to push back the retinal tear and seal the tear with lasers. There is no way to use modern needle-shaped microsurgical instruments – a tiny water feed, a fiberoptic light pipe and a guillotine-like cutter – inside a dead pig’s eye.

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