gms | German Medical Science

Purpose: Objective quality assessment of the capsulorhexis using the novel, smartphone-based augmented reality (AR) MicroREC tool by Custom Surgical GmbH.

Setting: Prospective, single-center wetlab study at the Department of Ophthalmology, University Hospital Munich.

Methods: Smartphones with a MicroREC app installed are attached to a Zeiss microscope via a light beam splitter. The app processes the live image of the microscope. Silicone eye models and real instruments are used. Each participant performs 8 capsulorhexes. The app detects the limbus in real-time, calculates the center of the eye model and projects a capsulorhexis overlay to the live screen. Four groups are included with 5 participants each: trainees with AR support; trainees with support by an experienced cataract surgeon; trainees without support; experienced cataract surgeons with AR support. The created capsulorhexes are evaluated based on roundness, centration offset, diameter and the AR usage intensity, if available to the participant.

Results: The expected outcome will indicate that trainees that were supported by the AR tool underwent an improvement across the measured metrics superior to that of the unsupported trainees. The learning curves of the groups are expected to diverge after the first 2 procedures. The first 2 procedures serve as habituation period for the trainees, during which their focus will be more directed to getting used to the microscope and tools. Thereafter, they will be able to benefit from the augmented reality guidance to speed up their skill enhancement. An open question is whether the AR-supported group will match or outperform the trainee group with expert guidance.

Conclusions: Smartphone-based AR simulators are a promising development for microsurgery training. They provide a cheaper setup compared to alternative Virtual Reality (VR) simulators, with the extra benefit of providing realistic haptic feedback. Some hurdles for the final implementation of the proposed setup are the dependency on processing capabilities of specific smartphone models, and the need for the trainee to look away from the oculars and towards the smartphone screen to see the guidance markers.

Financial Disclosure: MDR: Investigator-initiated trial (IIT), no direct financial support; AF, SB: Chief Executive/Chief Product Officer Custom Surgical; DM: Share holder of Custom Surgical; SP, PSG: No financial disclosure; MWJ: Investigator-initiated trial (IIT); MicroRec software and hardware are provided by Custom Surgical at no cost, no direct financial support