Novel open-source 3D-printed eye mount (TEMPO) for the ophthalmology wet lab.

OBJECTIVE: Procuring an affordable eye mount that can stabilise a cadaveric eye and simulate a patient's normal facial contours represents an ongoing challenge in the ophthalmology simulation wet lab, with notable limitations to all currently available commercial options. This project uses computer-assisted design and three-dimensional (3D)-printing techniques to tackle these challenges for ophthalmologic surgical training. METHODS AND ANALYSIS: Proof-of-concept study. Using Autodesk Fusion 360, we designed and 3D-printed a modular device that consists of 11 pieces forming a head structure. Standard OR tubing and syringes were adapted to create an adjustable-suction system to affix cadaveric eyes. Further modular inserts were customised to house non-cadaveric simulation eyes. RESULTS: Three-dimensional eye mount for procedures in ophthalmology (TEMPO) reliably fixed a cadaveric eye in stable position throughout surgical manipulation. Trainees were able to drape and practice appropriate hand positioning while corneal suturing. Overall, this model was affordable, at a cost of approximately $C200 to print. The modular nature renders individual pieces convenient for replacement and customisable to simulate regional anatomical variation and accommodate non-cadaveric eyes. CONCLUSIONS: TEMPO represents an affordable, high-fidelity alternative to existing commercially available eye mounts. It reliably fixates cadaveric and simulation eyes and provides an enhanced surgical training experience by way of its realistic facial contours. It is released as an open-source computer-aided design file, customisable to interested trainees with appropriate software and 3D-printing capacity.

A Novel Combination Point-of-View (POV) Action Camera Recording to Capture the Surgical Field and Instrument Ergonomics in Oculoplastic Surgery.

PURPOSE: To evaluate a novel combination head-mounted/chest-mounted point-of-view recording system for oculoplastic surgical procedures. METHODS: The point-of-view head camera captures the surgical field, while the point-of-view chest camera captures a wide field of view to record instrument ergonomics. Various methods of recording were trialed. RESULTS: The head camera with a narrow field of view was better for recording fine details of the surgical field. The chest camera recording a wide field of view was optimal for recording hand positions. Stereoscopic recording of the instrument ergonomics was helpful in relaying the relative positions of the surgeon's hands and instruments. CONCLUSIONS: Point-of-view cameras are cost-effective means of recording oculoplastics procedures. The authors feel simultaneously recording the surgeon's ergonomics and the corresponding instrument movements within the surgical field, from the "surgeon's view", will augment surgical education.

A comparison of methods used to evaluate mobility performance in the visually impaired.

PURPOSE: To compare three different approaches to measuring mobility performance when evaluating the visually impaired. METHODS: 488 participants, including 192 glaucoma, 112 age-related macular degeneration, 91 diabetic retinopathy and 93 healthy volunteers, completed the Assessment of Disability Related to Vision (ADREV) mobility course. The performance of participants on the mobility course was evaluated by noting errors made and time required for completion. Errors noted and time taken were compared using multivariate logistic regression to determine which measurement better differentiated patients with visual disease from healthy volunteers. Multivariate logistic regression was also used to evaluate the combined metric of ADREV errors divided by time to determine its ability to discriminate participants with visual disease from healthy volunteers. RESULTS: Errors noted and time taken while ambulating through the standardised mobility course shared a weak but statistically significant association (Pearson's r=0.36, p<0.05). After controlling for demographic and medical comorbidities, logistic regression analysis revealed that errors noted were better at discriminating individuals with visual disease from healthy volunteers (OR 2.8-4.9, 95% CI 1.5 to 10.3) compared with the time taken for mobility course completion (OR 1.1, 95% CI 1.0 to 1.2). These findings were consistent across all comparisons between healthy volunteers and participants with each type of visual impairment. Finally, the combined metric of ADREV errors divided by time was far more predictive of visual disease compared with either time taken or errors noted during mobility testing (OR 11.0-17.7, 95% CI 3.6 to 77.1). CONCLUSIONS: A validated scoring system based on errors is more effective when assessing visual disability during mobility testing than recording the time taken for course completion. The combined metric of ADREV errors noted divided by time taken was most predictive of all the methods used to evaluate visual disability during mobility testing.

The assessment of disability related to vision performance-based measure in diabetic retinopathy.

PURPOSE: To validate a third-generation performance-based measure of visual function titled "Assessment of Disability Related to Vision" (ADREV) in a study population of patients with diabetic retinopathy. DESIGN: Prospective, cross-sectional study. METHODS: Patients with nonproliferative or proliferative diabetic retinopathy, free from ocular comorbidity, were recruited from a single institute and completed the ADREV, the 25-Item National Eye Institute Visual Functioning Questionnaire (VFQ-25), and a clinical ophthalmic examination. Correlation, regression, and bootstrap analysis were conducted to determine the relationship between ADREV scoring and each of the study's clinical and self-report measures of visual ability, while controlling for potential confounders. RESULTS: Ninety-one patients with diabetic retinopathy completed the study and analysis showed that the ADREV total and subscale scores shared a stronger relationship with the clinical measures of visual function than did the VFQ total and subscale scores. Regression analysis revealed that binocular visual acuity, contrast sensitivity, and better eye visual field were the best predictors of ADREV performance. CONCLUSIONS: The ADREV performance measure is a valid instrument for the assessment of disability related to vision in patients with diabetic retinopathy. Furthermore, the assessments provided by ADREV were more related to traditional clinical indicators of visual impairment than were the results of the self-report measure, specifically the VFQ-25.

Performance-based measures of visual function.

Review of the substantial literature reveals that the importance of performance-based measures of visual function is becoming increasingly recognized. Alone, or in combination with other assessment modalities, they have been shown to provide a reliable and valid means of evaluating visual ability. Further, they have been demonstrated to predict outcomes better than self-report or clinical measures alone.

Assessing age-related macular degeneration with the ADREV performance-based measure.

PURPOSE: To validate a new third-generation performance-based measure titled the "assessment of disability related to vision" (ADREV) in a study population of individuals with age-related macular degeneration. METHODS: Patients with either exudative or nonexudative age-related macular degeneration, but without ocular comorbidity, completed the ADREV, the 25-item National Eye Institute's visual functioning questionnaire, and a range of clinical assessments. Correlations were calculated between the data provided by the ADREV, visual functioning questionnaire, and clinical ophthalmic measures. Regression and bootstrap analysis were preformed to determine the relative relationship between specific clinical measures and ADREV performance, while controlling for a range of potentially confounding factors. RESULTS: One hundred twelve patients completed the study and correlative analysis showed that ADREV total and subscale scores were more related to nearly all measures of clinical ophthalmic status in comparison with the data provided by the visual functioning questionnaire. Significant correlative relationships between ADREV and visual functioning questionnaire scores showed moderate to high correlation. Central visual acuity and contrast sensitivity shared the strongest association with performance of activities. CONCLUSIONS: The ADREV is a valid instrument for the assessment of visual disability in patients with age-related macular degeneration. Furthermore, the data provided by this performance measure had stronger relationships with clinical indicators of visual impairment in comparison with self-report.