The SENSIMMER"""""""" Virtual Phaco Trainer for Cataract Surgery is a hardware and software solution aimed at a worldwide market of ophthalmology residency programs (including 118 programs in the US). It is developed by the US small business concern ImmersiveTouch-Sensimmer Inc. (Westmont, IL), in collaboration with the surgery simulation team at the University of Illinois at Chicago (UIC) under PI Prof. Pat Banerjee, president of ImmersiveTouch-Sensimmer. The virtual trainer supports the teaching of cataract surgery by phacoemulsification (""""""""phaco""""""""). Phase I produced a prototype capsulorhexis trainer, now being perfected under an NEI-ARRA supplement. Phase II proposes to create a phacoemulsification trainer and to validate both trainers. Task 1. Validate post-ARRA Phase I capsulorhexis simulator. Validation was not funded in Phase I. Validation aims at showing face, construct, and concurrent validity of capsulorhexis. The scoring system of the capsulorhexis simulator includes the number of separate forceps grabs of the lens capsule membrane during capsulorhexis, the number of hits of the lens with the forceps, and the total time for the capsulorhexis. Qualitative factors such as optimal size and shape of the capsular tear and avoidance of errors such as radial tear, corneal incision stress, and corneal touches have recently been added. A system for scoring live operative performance and relating this to simulator performance still needs to be devised and validated. Task 2. Develop a Phase II capsulorhexis simulator. The Phase I simulator aims to simulate only a single standard case of capsulorhexis for verification. Commercialization will require a Phase II capsulorhexis simulator for individual patient variations. Patient variations can affect the visibility or accessibility of the anterior capsule and the rhexis edge (corneal opacity, vitreous opacity, deep set eye, anterior chamber depth, cortical cataract) as well as the mechanical stability or material properties of the eye and lens capsule (involuntary eye movement, posterior synechia = iris attached to lens, weak zonules, high vitreous pressure, capsular thickness and fragility in young vs. old, calcified plaque on anterior capsule). Task 3. Develop a phacoemulsification simulator. The trainee uses both hands and both feet: right hand = phaco handpiece;left hand = nucleus manipulator;right foot = phaco pedal;left foot = microscope adjustment. Real foot pedals (e.g., Alcon) will be used, and the phaco foot pedal will control three modes of the virtual phaco tip: (1) irrigation;(2) irrigation + aspiration;(3) irrigation + aspiration + ultrasound power. The SENSIMMER will simulate the phaco tip in virtual reality and model the instrument handle by the handle of the SensAble Phantom Omni haptic robot. The trainer will be capable of simulating standard surgical techniques (e.g., phaco chop;divide and conquer) and unusual clinical cases (e.g., weak zonules). The trainee will learn to control the rate of both fluid flow and ultrasonic power. Task 4. Validate the phacoemulsification simulator. Validation will again aim at demonstrating face, construct, and concurrent validity, as defined above. This will require developing scoring systems for both simulated and live phacoemulsification. The scoring system for simulated phacoemulsification will include factors such as total time for the operation, efficiency of instrument tip handling as measured by total tip path length, and appropriate use of phaco power settings to avoid thermal damage to the cornea.

Public Health Relevance

ImmersiveTouch-Sensimmer, Inc. develops innovative augmented virtual reality software SENSIMMER"""""""" for surgical training of residents in such fields as neurosurgery and ophthalmology. In collaboration with the University of Illinois at Chicago, the Partnership proposes to develop and commercialize its training modules for cataract surgery. Following STTR Phases I and II, the SENSIMMER Virtual Phaco Trainer will include well developed modules for the two most difficult part-tasks of cataract surgery: capsulorrhexis and phacoemulsification.

National Institute of Health (NIH)
National Eye Institute (NEI)
Small Business Technology Transfer (STTR) Grants - Phase II (R42)
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Special Emphasis Panel (ZRG1-ETTN-E (12))
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Wujek, Jerome R
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Immersivetouch, Inc.
United States
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Sikder, Shameema; Tuwairqi, Khaled; Al-Kahtani, Eman et al. (2014) Surgical simulators in cataract surgery training. Br J Ophthalmol 98:154-8
Banerjee, P Pat; Edward, Deepak P; Liang, Shun et al. (2012) Concurrent and face validity of a capsulorhexis simulation with respect to human patients. Stud Health Technol Inform 173:35-41