Development of Ophthalmic Microsurgery Training in Augmented Reality.

BACKGROUND: Using a group of 23 physician trainees, we investigated whether microsurgery training in an augmented reality (AR) training simulator improves motor skills and whether an intelligent tutoring system (ITS) improves training efficiency. METHODS: Characteristic motor skill steps involved in the peeling of an internal limiting membrane (ILM) were identified and implemented in the AR simulation. For training, implemented steps were either presented in the natural sequence, as in a real ILM surgery, or administered according to the ITS. Participants underwent the training over 5 days for 10 minutes per day. A subgroup of 11 participants performed the 5 microsurgical steps in a natural sequence. The other 12 participants used the ITS method. Motor skill performance was recorded before and after each training session with the AR simulator, and before the first and after the last training session using a method that did not rely on AR. RESULTS: Five steps of the ILM peeling procedure were identified and implemented: insertion of the instrument, flap creation, clockwise peeling, counterclockwise peeling, and retraction of the instrument. Both training methods significantly improved the motor skills of the participants. In both methods, steep learning progress was found within the first three training sessions. In both methods, motor skills continued to improve on days 4 and 5, but at a slower rate. After the 5 training days, performance was significantly improved, but improvement did not depend significantly on the training method. However, within the first 3 days of training, ITS led to steeper training progress than the natural sequence method. CONCLUSION: It is possible to improve microsurgical motor skills using the implemented AR simulation. Some technical limitations, such as system lag, deserve further improvements. However, the proposed AR solution was highly appreciated by the participants and could help overcome constraints of practice in microsurgical training, such as limited availability of training opportunities or a standardized assessment of motor skill performance.