New Technology Mimics Cataract Surgery in Risk-Free Setting

Eye surgeons-in-training at the North Shore-LIJ Health System are now using new, state-of-the-art technology that simulates cataract surgery and other procedures, allowing doctors to develop and practice their surgical skills without risk to patients.

Jonathan Jonish, MD, a fourth-year ophthalmology resident practices cataract surgery using simulator technology while Carolyn Shih, MD, director of simulator training and co-director of refractive surgery at North Shore-LIJ, reviews his technique.

With the use of advanced computer software and three-dimensional cameras, the simulator gives surgeons the feeling that they are experiencing real intraocular (inside the eye) surgery. During simulated surgery, ophthalmology residents manipulate realistic, handheld instruments that are inserted into an artificial eye. The motion of the instruments and the orientation of the eye are picked up by highly sensitive sensors and transmitted to a computer, which renders the virtual operation scenario into the simulator’s microscope.

“This technology is similar to flight training simulation required for pilots,” said Ira Udell, MD, chairman of ophthalmology at LIJ Medical Center and North Shore University Hospital (NSUH). “Simulation is a helpful adjunct that allows new surgeons to enhance their skills, in addition to training with an experienced surgeon in the operating room.”

The virtual reality simulator produces a realistic surgical environment, said Dr. Udell. “The system creates surgical scenarios that ophthalmology residents must tackle, taking them from basic to the most advanced skills, and tracks and scores their progress.”

Carolyn Shih, MD, co-director of refractive surgery at North Shore-LIJ and director of simulator training in the Department of Ophthalmology, said the new simulator helps residents hone their surgical skills and other abilities.

“Cataract surgery could be 100 steps from beginning to end,” said Dr. Shih. “The simulator breaks down learning into modules, allowing residents to practice microsurgical techniques, sharpen fine motor skills and practice becoming ambidextrous before getting into the human eye.”

Cataract surgery is one of the safest procedures performed in this country, but for surgeons working in a tiny four millimeter space, one wrong move can mean damage to the cornea or another complication. The delicate procedure to remove a clouded lens in the eye and inject an acrylic replacement lens requires surgical precision and a high level of dexterity.

“The simulator will reduce errors and can improve surgical outcomes,” said Steven Rubin, MD, chief of pediatric ophthalmology and strabismus at NSUH and ophthalmology residency program director.

Until recently, most ophthalmology residents at North Shore-LIJ were trained in a wet lab environment where they practiced sutures and other surgical techniques on animal eyes, in addition to being supervised by a senior ophthalmologist in the operating room, explained Dr. Rubin. “The simulator is a huge advantage in training because it provides a risk-free learning opportunity and allows us to record and monitor residents’ progression in surgical skills,” he added.

Jonathan Jonisch, MD, a fourth-year resident who is training to become a vitreo-retinal surgeon, said the first operation can be anxiety-provoking because there is only room for one person to be in the eye at one time. “Very few training models exist that can mimic cataract surgery,” said Dr. Jonisch. “The simulator is the closest thing to actual cataract surgery. You can break down different procedures and practice them. The technology allows you to repeat surgical techniques without rush. This will equate to better patient care and outcomes.”

The $160,000 simulation machine, EYESi®, developed by Mannheim, Germany-based VR Magic, is now being used at approximately 40 of the 120 ophthalmology residency programs nationwide and is fast becoming a standard in resident training.

Media Contact: Betty Olt, 516-465-2645, bolt@nshs.edu