Table 2.
Nonrandomized trials evaluating efficacy of surgical simulators in improving surgical performance on real patients.
| Study | Design (OCEBMa level) | Comparison or control group | Outcome measure | Participants and cataract surgeries, (n) | Findings |
| Thomsen (2017a) [28] | Cohort (2b) | Before EyeSi use | OSACSSb | Cataract surgeons (19) | Novices and less-experienced surgeons showed significant improvements in the operating room (32% and 38% improvement, P=.008 and P=.018 respectively) after EyeSi training |
| La Cour (2019) [29] | Cohort (2b) | Before EyeSi use | OSACSS | Cataract surgeons (19) | EyeSi training resulted in significantly improved surgical performance in less-experienced surgeons. Skill-transfer between modules was not demonstrable |
| Roohipoor (2017) [30] | Cohort (2b) | N/Ac | GRASISd | Ophthalmology residents (30) | Significant correlations between residents’ EyeSi simulator-based scores and their eventual surgery count and GRASIS scores |
| Belyea (2011) [31] | Cohort (3b) | No EyeSi use | Phaco time, percentage power, complications | Surgeries by ophthalmology residents (592) | EyeSi training resulted in significantly lower procedure duration (P=.002), percentage power (P=.001), and nonsignificantly fewer intraoperative complications |
| Pokroy (2013) [32] | Cohort (2c) | No EyeSi use | Incidence of posterior capsule tears, operation duration | Surgeries by ophthalmology residents (1000) | EyeSi training resulted in nonsignificantly fewer posterior capsule tears and shorter learning curves |
| Ferris (2020) [33] | Cohort (2b) | No EyeSi access | Posterior capsule rupture rates | Surgeries by ophthalmology residents (17831) | Residents with EyeSi access had a significant reduction in posterior capsule rupture rates (4.2% vs 2.6%, Difference in Proportions 1.5%, 95% CI 0.5-2.6%, P=.003). Posterior capsule rupture rates significantly lower after access to EyeSi (3.5% to 2.6%, Difference in proportions 0.9%, 95% CI 0.4-1.5%, P=.001) |
| Lucas (2019) [34] | Cohort (2b) | No EyeSi use | Complication rates | Surgeries by ophthalmology residents (140) | EyeSi training resulted in significantly fewer complications (12.86 vs 27.14%, P=.031) |
| Staropoli (2018) [35] | Cohort (2b) | No EyeSi use | Complication rates | Surgeries by ophthalmology residents (955) | EyeSi training resulted in significantly fewer complications (2.4 vs 5.1%, P=.037) |
| McCannel (2013) [36] | Case series (4) | Reduced EyeSi use | Errant continuous curvilinear capsulorhexis rates | Surgeries by ophthalmology residents (1037) | EyeSi training resulted in significantly lower errant continuous curvilinear capsulorhexis rates (5.0 vs 15.7%, P<.001) |
| McCannel (2017) [37] | Case series (4) | Reduced EyeSi use | Vitreous loss rates, retained lens material | Surgeries by ophthalmology residents (1037) | EyeSi training was not associated with lower vitreous loss rates or less retained lens material but was associated with higher vitreous loss in nonerrant CCCse |
aOCEBM: Oxford Centre for Evidence-Based Medicine.
bOSACCS: Objective Structured Assessment of Cataract Surgical Skill Score.
cN/A: not applicable.
dGRASIS: Global Rating Assessment of Skills in Intraocular Surgery.
eCCC: continuous curvilinear capsulorhexis.