Can simulators be applied to improve cataract surgery training: a systematic review

Methodological quality of the review: Low confidence

Author: Ahmed TM, Hussain B, Siddiqui MAR.

Region: Not stated

Sector: Service delivery

Subsector: Quality of clinical care

Equity focus: Not stated

Review type: Other review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable

Background:
Surgery as a field was quick to realise the potential of simulation training and was drawn to the possibility of practising complex procedures without risk to patients. In recent years, many studies on the use of virtual reality simulators in ophthalmic surgery have been undertaken. Studies on simulated cataract surgeries have primarily attempted to either demonstrate construct validity of the EyeSi ophthalmic surgical simulator or attempted to demonstrate meaningful skill transfer from the EyeSi to real-life cataract surgery.

Objectives:
This review assesses studies currently available that have evaluated the use of simulators in cataract surgery training.

Main findings:
A total of 10 studies, including qualitative results evaluating the simulator and its effect on training, were included in the review. Overall quality of studies was satisfactory. Of the 10 studies, four evaluated the ability of the simulator to accurately discriminate between novice and experienced surgeons, and the ability of the simulator to correlate real life performance with simulation performance. These studies correlated participant scores on the EyeSi with parameters gauging real-life surgical experience of the participants. The remaining six studies assessed the impact that training on the EyeSi had on surgeon performance during real life surgery.

Overall, authors found that four studies reported construct validity of the EyeSi simulator. Six studies demonstrated improved surgical outcomes corresponding to training on the simulator. Authors concluded that current studies on simulation training in cataract surgery all point towards it being an effective training tool with low risk of study biases confounding this conclusion. As technology improves, surgical training must embrace and incorporate simulation technology in training.

Methodology:
Authors conducted a search on PubMed, Embase and Cochrane library databases on November 2019. References of included studies were screened for further potentially relevant studies. Outcomes were classified as skill management, complication rate, skill acquisition and operating time. Study screening and data extraction were conducted by two reviewers independently. Risk of bias was gauged in accordance with the Cochrane Handbook.

Applicability/external validity:
Authors do not discuss the generalisability of findings.

Geographic focus:
Geographic focus of included studies was not reported in the review.

Summary of quality assessment:
Low confidence was attributed to this review, as important limitations were identified. Inclusion criteria of studies was not reported in the review, and methods used to search for literature, screen studies for inclusion and data extraction of included studies were not rigorous enough to ensure that bias was avoided.