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Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 6. The impact of EyeSi virtual reality training on complications rates of cataract surgery performed by first and second year trainees
  1. John D Ferris1,
  2. Paul H Donachie2,
  3. Robert L Johnston1,
  4. Beth Barnes2,
  5. Martina Olaitan2,
  6. John M Sparrow3
  1. 1 Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
  2. 2 The Royal College of Ophthalmologists’ National Ophthalmology Database, London, UK
  3. 3 Ophthalmology, Bristol Eye Hospital, Bristol, UK
  1. Correspondence to John D Ferris, Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham GL53 7AN, UK; john.ferris2{at}


Objective To investigate the impact of EyeSi surgical simulators on posterior capsule rupture (PCR) rates of cataract surgery performed by first and second year trainee surgeons.

Design A Royal College of Ophthalmologists’ National Ophthalmology Database audit study of first and second year surgeons’ PCR rates over seven consecutive National Health Service (NHS) years. Participating centres were contacted to ascertain the date when their surgeons had access to an EyeSi machine and whether this was on-site or off-site. Operations were classified as before, after or no access to EyeSi.

Setting The study took place in 29 NHS Ophthalmology Units in a secondary care setting.

Results Two-hundred and sixty five first and second year trainee surgeons performed 17 831 cataract operations. 6919 (38.8%) operations were performed before access to an EyeSi, 8648 (48.5%) after access to an EyeSi and 2264 (12.7%) operations by surgeons with no access to an EyeSi. Overall, there was a 38% reduction in the first and second year surgeon’s unadjusted PCR rates from 4.2% in 2009 to 2.6% in 2015 for surgeons with access to an EyeSi, and a 3% reduction from 2.9% to 2.8% for surgeons without access to an EyeSi. The overall first and second year unadjusted PCR rates for before, after and no access to EyeSi were 3.5%, 2.6% and 3.8%, respectively. The decrease in the with-access to an EyeSi group PCR rate was similar for surgeons with access to an EyeSi ‘on site’ or ‘off site’.

Conclusions First and second year trainee surgeons’ unadjusted PCR rates have decreased since 2009 which has significant benefits for patients undergoing cataract surgery. This 38% reduction in complication rates aligns with the introduction of EyeSi simulator training.

  • treatment surgery
  • public health
  • medical education

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  • Presented at This work was presented as a poster at the Royal College of Ophthalmologists Annual Congress in May 2018.

  • Contributors JDF designed the study, wrote the manuscript and is responsible for the overall content. PHD provided statistical analysis and contributed to the writing of the manuscript. RLJ designed the study and contributed to creation of the NOD. BB and OO contributed to compiling the NOD data. JMS contributed to compiling the NOD data and the writing of the paper.

  • Funding This study was supported through The Healthcare Quality Improvement Partnership (HQIP) commissioned Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database Audit, which is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and the Clinical Outcomes Programme (COP). PHD, RLJ, BB, MO and JMS had financial support from HQIP, the submitted work being a ‘spin-off’ analysis from the National Cataract Audit. RLJ owned a stake in and worked as a Medical Director for Medisoft Ophthalmology Limited. The authors have no other financial relationships with any organisation that might have an interest in the submitted work and no other relationships or activities that could appear to have influenced the submitted work. The views expressed are those of the author(s) and not necessarily of the NHS, HQIP, RCOphth or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval is not required for National Ophthalmology Database studies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon request.

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