Usefulness of Structured Video Indirect Ophthalmoscope-Guided Education in Improving Resident Ophthalmologist Confidence and Ability

Jayanth Sridhar; Abtin Shahlaee; Sonia Mehta; Ehsan Rahimy; Sunir J Garg; Brenton D Finklea; James P Dunn; Allen Chiang

doi:10.1016/j.oret.2016.12.010

Usefulness of Structured Video Indirect Ophthalmoscope-Guided Education in Improving Resident Ophthalmologist Confidence and Ability

Ophthalmol Retina. 2017 Jul-Aug;1(4):282-287. doi: 10.1016/j.oret.2016.12.010. Epub 2017 Feb 13.

Authors

Jayanth Sridhar¹, Abtin Shahlaee², Sonia Mehta², Ehsan Rahimy³, Sunir J Garg², Brenton D Finklea², James P Dunn², Allen Chiang²

Affiliations

¹ The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; Bascom Palmer Eye Institute, University of Miami, Miami, Florida. Electronic address: jsridhar@med.miami.edu.
² The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania.
³ The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; Palo Alto Medical Foundation, Palo Alto, California.

PMID: 31047513
DOI: 10.1016/j.oret.2016.12.010

Abstract

Purpose: To evaluate the usefulness of the video indirect ophthalmoscope (VIO) to improve resident ophthalmologist skill with indirect ophthalmoscopy (IO) and scleral depression (SD).

Design: Prospective, randomized, double-arm interventional study.

Participants: Ten ophthalmology residents were enrolled in an educational program using the Heine Video Omega 2C VIO (Heine USA Ltd, Dover, NH) and served as the study group. Ten other experience-matched ophthalmology residents functioned as the control group.

Methods: At baseline, all study and control residents completed surveys assessing their subjective comfort and skill with IO. Each resident also completed a standardized full IO examination with SD that was recorded using the VIO. Each resident in the study group received 3 monthly 1-hour teaching sessions using the VIO. Surveys and recorded standardized examinations were repeated for all residents after the 3-month period. Both baseline and final examination videos were graded using a standardized grading scale by 3 independent retina faculty members masked to the identities of the residents and timing of the examination.

Main outcome measures: Improved visualization of the peripheral retina (ora serrata) as evaluated by masked graders was the primary outcome measure. Improved examination efficiency grade was the secondary outcome measure.

Results: Both the study group and the control group had significant improvement in ability to examine the peripheral retina and ora serrata compared with baseline (P = 0.02 and P = 0.03, respectively). The study group also showed significantly improved examination efficiency compared with baseline, which was not noted in the control group (P = 0.01 and P = 0.53, respectively). The study group self-reported significantly improved confidence in the ability to identify retinal tears, whereas the control group did not (P = 0.003 and P = 0.08, respectively). Study group participants also reported significantly improved ability to recognize retinal holes (P = 0.003), subretinal fluid (P = 0.02), and vitreoretinal tufts (P = 0.02), whereas the control group did not.

Conclusions: This novel educational study suggests that VIO as part of a structured teaching program may improve resident ophthalmologist confidence and ability with identifying retinal pathologic features using IO with SD.