Effects of Sleep Deprivation, Non-Dominant Hand Employment, Caffeine and Alcohol Intake During Surgical Performance: Lessons Learned From the Retina Eyesi Virtual Reality Surgical Simulator

PURPOSE: Determine whether real-life surgical experience correlates with scores on a retina virtual simulator and the effects of various challenges on surgical performance. METHODS: The study was performed using the Eyesi Surgical Simulator, a virtual reality retina surgical simulator. Residents, fellows, and retina staff were assessed on surgical simulations to determine surgical skills. Participants were assigned baseline scores on speed, efficiency of movement, and ability to avoid retinal damage. After receiving their baseline scores, participants were challenged to use their non-dominant hand or to use the simulator after sleep deprivation or the intake of caffeine or alcohol. RESULTS: At baseline, junior residents had an average score of 943; senior residents, 1045; retina fellows, 1153; and surgical retina staff, 1161. A 12.5% overall improvement in scores was achieved when comparing baseline 1 to baseline 2; a major improvement was recorded in residents (14.5%) compared with fellows and retina staff (9.97%). A statistically significant difference was observed between residents and fellows (P = 0.027), as well as between residents and retina staff (P = 0.04). A significant decrease in performance (15.7%) was observed when the non-dominant hand was used (P = 0.043). Performance after sleep deprivation and alcohol intake decreased, but not with a statistically significant difference (P = 0.6 and P = 0.5, respectively). A trend toward increasing performance was observed after caffeine intake (6.1%; P = 0.06). CONCLUSIONS: The retina virtual simulator is a novel teaching tool for retinal surgery. A significant association was observed between real surgical experience and the retina surgery virtual simulator results based on surgical experience. TRANSLATIONAL RELEVANCE: An association between real surgical experience and retina surgery virtual simulator results was demonstrated. A complete training program with a cut-off threshold score should be validated for retina training programs.