Tactile Feedback in Cataract and Retinal Surgery: A Survey-Based Study
2008, Volume 1, Number 2 79 Introduction Medical and surgical simulations play an increasingly important role in the training of medical personnel. Various surgical subspecialties have developed virtual reality simulators to help trainees acquire practical knowledge and skills before, or to supplement, actual performance in the operating room [1-5]. Historically, ophthalmology residents have practiced their surgical techniques on animal or donor eyes prior to operating on patients. With advances in computer technology, however, virtual reality simulators for cataract and vitreoretinal surgery have been developed [6-10], pro-viding tools that allow trainees to make mistakes without risk to patients, to acquire skills in an organ-ized manner, and to create a personalized curriculum that suits the learner's needs. Ophthalmic surgery requires both visual and tactile feedback, although our understanding of the relative importance of these two components is incomplete. Laurell and colleagues reported that phacoemulsifica-tion is a procedure that is largely dependent on visual input, with tactile feedback playing a minor role, and suggested that these characteristics make phacoemul-sification relatively easy to simulate [9]. In a study of the EYESI simulator (VR Magic, Germany) for vitre-oretinal surgery, the authors acknowledged the need to incorporate tactile feedback into the system, al-though they did not specifically address the impor-tance of visual versus tactile feedback in retinal sur-gery [10]. Similarly, Verma and associates also raised the importance of integrating haptic feedback into their vitreoretinal surgery simulator [8]. Better char-acterizing the relative importance of visual and tactile feedback in different types of ocular surgery will help refine virtual reality tools. The purpose of this study was to assess eye surgeons' subjective reports of the overall importance of visual and tactile feedback, to evaluate at which steps of surgery tactile feedback is Tactile Feedback in Cataract and Retinal Surgery: A Survey-Based Study Nancy Huynh, MD 1 , Mona Akbari 2,3 , and John I. Loewenstein, MD 1,4* 1 Harvard Medical School, Boston, MA 2 Harvard School of Public Health, Boston, MA 3 Columbia University College of Physicians & Surgeons, New York, NY 4 Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA * Corresponding Author & e-mail: John_Loewenstein@meei.harvard.edu Abstract To evaluate the perceived importance of tactile feedback and visualization in performing surgery among cataract and vitreoretinal surgeons using an online survey. A nine-question, survey-based questionnaire was developed and sent to members of the Retina Society, Ameri-can Academy of Ophthalmology, and New England Ophthalmological Society. Participants were asked to rate the impor-tance of tactile feedback and visualization in cataract and retinal surgery. On a rating scale of 1 to 5, with 5 being most important, visualization was rated with an average score of 4.97 + 0.24 and 4.94 + 0.39 among cataract and vitreoretinal surgeons, respectively. For tactile feedback, the average ratings by cataract and vitreoretinal surgeons were 3.72 + 1.05 and 3.26 + 1.36, respectively. There was a statistically significant dif-ference (=0.03) with respect to tactile feedback between cataract and retinal surgeons. Tactile feedback appears to play an important role in cataract and retinal surgery. Integration of haptic inter-faces to existing virtual simulators may provide a more realistic operative experience. Accepted for publication May 20, 2008 Revision received August 11, 2008 2008; 1:79-85 Available via open-access on the web at http://www.academic-ophthalmology.com The author(s) have no personal financial interest in any of the products or technologies cited herein. 2008