Keeping the eye on the ball: Artificial eyes to extend a fundoscopy simulator

Bauer, Daniel; Germano, Miria; Stierlin, Johanna; Schnabel, Kai (2 September 2022). Keeping the eye on the ball: Artificial eyes to extend a fundoscopy simulator (Unpublished). In: 7th Swiss Conference on Standardized Patients and Simulation in Healthcare (SPSIM). Lausanne. 31.08.-02.09.2022.

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The range of commercially available simulators in undergraduate medical skills training is limited. This is especially true for simulators that allow for the integration of own findings, i.e., that do not limit the scope of what can be simulated to what the manufacturers distributed with their simulator. Unfortunately, in assessment settings using one’s own pathologic findings can be of high importance for the case, why one often reverts to the skills being demonstrated on the simulator, but delivers the pathological findings using photography or other media, breaking the simulation’s flow and risking the candidates’ engagement with the scenario. To address this, we set out to expand the scope of our fundoscopy simulator to also depict pathologies of the cornea, sclera, iris, and vitreous body.

We identified and addressed three major challenges. First was the question whether we could build an eye of different modules that could be combined depending on a specific case or build eyes that were case-specific from the start but could be built using less effort and parts. Second, it was decided that corneal lesions should be made in a way that would allow for a positive fluorescein staining. Third and last, the issue arose how to fixate the eye in the simulator so it could be easily installed and removed without risking the simulator’s integrity.

Result

For the initial trials it was found that building case-specific eyes was the preferable approach. While this meant the individual components of the eye could not be assembled at will, it also meant there would be fewer parts and thus less effort for a proof-of-concept pilot. Second, fluorescein staining would be simulated using encapsulated uranine. Lastly, the eye would be fixated in the simulator both from behind, and from the front, e.g., using an orbital prosthetic, further widening the scope of pathologies that can be simulated.

Discussion

There will for some time be the need to further refine the approach taken. Having an ophthalmologist on the team is crucial so that the authenticity of the simulation can be guaranteed, especially relevant in the assessment setting, of course. Future trials could use 3D printing technology to increase standardization.

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