INVENTION OF A NOVEL, REALISTIC OPHTHALMIC BLOCK SIMULATOR FOR OPHTHALMOLOGY
TRAINEES
Published 2025
- 29th ESCRS Winter Meeting
Reference: FP01.09
| Type: Free Paper
| DOI:
10.82333/jsgp-zy04
Authors:
Elizabeth Wen Ling Lim* 1
, Jessica Qian Hui Choo 1
, Royston Kian Yu Tan 2
, Jordan Adele Lee 3
, Chelsea Qiu Lin Tan 4
, Shamira Perera 5
1Singapore National Eye Centre,Singapore,Singapore, 2Singapore Eye Research Institute,Singapore,Singapore, 3Sunshine Coast Hospital and Health Service,Brisbane,Australia, 4Ministry of Health Holdings,Singapore,Singapore, 5Singapore National Eye Centre,Singapore,Singapore;Singapore Eye Research Institute,Singapore,Singapore
Purpose
Ophthalmology trainees currently learn to perform ophthalmic blocks by watching
seniors, then attempting them directly on patients. This can be stressful for the
trainee and expose the patient to higher risks of complications. The aim of this study
is to invent a novel peribulbar simulator that is realistic and anatomically accurate.
Our secondary aim is to evaluate this simulator in improving the confidence and
accuracy of peribulbar blocks given by ophthalmology residents.
Setting
Singapore National Eye Centre
Methods
We collaborated with Singapore General Hospital 3D Design and Printing centre to
design a realistic and functional orbital structure. We also searched and tested out
different materials to simulate different components of the orbit – periorbital tissue,
eyeball, conjunctiva and facial tissue.
After creating our simulator, we conducted a supervised training workshop using this
simulator on ophthalmology residents and administered questionnaires before and
after the workshop. We evaluated (i) resident self-assessed confidence and
competence, (ii) in the operating room, supervisor attending’s assessment of
akinesia after block performed by resident, and their confidence and competence in
the resident, (iii) accuracy of 5 peribulbar blocks performed on the simulator.
Results
The bony orbit was 3D printed based on a real-life Asian orbit CT scan image series
using transparent epoxy resin to allow for direct visualisation of the needle path.
Different components of the model were made using readily available and easily
replaceable materials as similar to the human orbit as possible. Facial skin was
simulated using silicone, conjunctiva was simulated using Tegaderm and periorbital
tissue was simulated using slime. The eyeball was simulated using a metal ball with
some padding to simulate a normal eye – it can be replaced with different sized
metal balls to simulate different axial lengths of the eye (e.g. in myopic eyes).
All residents who participated in this simulator training felt that this would help them
avoid complications in performing a peribulbar block (n = 8). Residents ranked
themselves more confident (7.57±1.27 to 8.57±1.13, p=0.018) and competent
(7.71±0.95 to 8.43±0.98, p=0.047) (n=7) after the workshop. While consultants also
found an improvement in akinesia after blocks given by residents, felt that residents
were more competent and felt more confident in their skills, these variables did not
demonstrate a statistically significant difference. There was improved mean accuracy
in blocks performed on the simulator after training with the simulator (4.17±1.27 to
4.83±0.389, n=12, p=0.054). There were no penetrating injuries on patients in our
training group.
Conclusion
This novel ophthalmic block simulator is realistic, anatomically accurate, simple, low
cost, and provided direct visualisation of the needle within the orbit. Our pilot study
also showed that this simulator is effective in helping trainees gain competence and
confidence in performing blocks.