Evaluation of response variables in computersimulated virtual.pdfVIP

Evaluation of response variables in computer-simulated virtual cataract surgery Per Söderberg*a,b,cNF, Carl-Gustaf LaurellaF, Wamidh Simawia,cNF, Per NordqvistdF, Eva SkarmandF, Leif NordhdF aSt. Eriks Eye Hospital, Karolinska Institutet bDept. of Biomedical Engineering, University of Miami cDept of Ophthalmology, Mälarsjukhuset Eskilstuna dMelerit AB ABSTRACT We have developed a virtual reality (VR) simulator for phacoemulsification (phaco) surgery. The current work aimed at evaluating the precision in the estimation of response variables identified for measurement of the performance of VR phaco surgery. We identified 31 response variables measuring; the overall procedure, the foot pedal technique, the phacoemulsification technique, erroneous manipulation, and damage to ocular structures. Totally, 8 medical or optometry students with a good knowledge of ocular anatomy and physiology but naive to cataract surgery performed three sessions each of VR Phaco surgery. For measurement, the surgical procedure was divided into a sculpting phase and an evacuation phase. The 31 response variables were measured for each phase in all three sessions. The variance components for individuals and iterations of sessions within individuals were estimated with an analysis of variance assuming a hierarchal model. The consequences of estimated variabilities for sample size requirements were determined. It was found that generally there was more variability for iterated sessions within individuals for measurements of the sculpting phase than for measurements of the evacuation phase. This resulted in larger required sample sizes for detection of difference between