The authors have no financial interest in the subject matter of this e-poster M. K. Kummelil, S. Nagappa, A. Shetty, A. Braganza Cataract and Refractive Surgery Services, Narayana Nethralaya, Post-Graduate Institute of Ophthalmology Bangalore, India. Enhancing Phaco Training Outcomes

To document the impact of the ICO OSCAR rating system on the outcomes of an intense 2 week structured phaco training with wet lab support. Purpose

Methods Trainees joining for the 2 week phaco training program were assessed and feedback was provided by using the ICO-OSCAR rating system. The primary outcome measure was the reduction in the intraoperative complications during the training period. The secondary outcome measure was the number of steps completed independent of the preceptor

The Program Pre-screening of candidates – Equipment & surgical skills – Pre-selection of cases for immediate post-training surgery Intense 2 week Cognitive Skills Training – Supervised by senior surgeons – Intra-operative videos analyzed – ICO-OSCAR phaco rating used for feedback Post training support – Onsite – Tele-Surgical Support

Cognitive Skills Training ListenLecture Videos UnderstandDiscussion Observing senior surgeons PracticeWet Lab: Model & Animal Eye Surgical simulators & Biofeedback ApplySupervised step-wise hands on surgery

Mean ICO OSCAR scores + SD (max=100) = Stepwise mean ICO OSCAR scores + SD (max=5) Draping Nucleus: Cracking or Chopping With Safe Phacoemulsification of Segments Incision & Paracentesis Irrigation and Aspiration Technique With Adequate Removal of Cortex Viscoelastic Lens Insertion, Rotation, and Final Position of Intraocular Lens Capsulorrhexis: Commencement of Flap & follow-through Wound Closure (Including Suturing, Hydration, and Checking Security) Capsulorrhexis: Formation and Circular Completion Wound Neutrality and Minimizing Eye Rolling and Corneal Distortion Hydrodissection: Visible Fluid Wave and Free Nuclear Rotation Eye Positioned Centrally Within Microscope View Phacoemulsification Probe & Second Instrument: Insertion Into Eye Conjunctival and Corneal Tissue Handling Phacoemulsification Probe & Second Instrument: Effective Use & Stability Intraocular Spatial Awareness Nucleus: Sculpting or Primary Chop Iris Protection Nucleus: Rotation and Manipulation Overall Speed and Fluidity of Procedure

Training results Nature of feedback Regular & Historic controls ICO-OSCAR No. of candidates64 No. cases during training12080 No. of cases after trainingData incomplete68 % completed as phaco<30%>90% Complication rateApprox 8-10%< 5%

POST TRAINING: TELE – SURGICAL SUPPORT Camera – Without beam splitter – Compatible to all microscopes – USB recording to a laptop Technology – Video digital conversion → Real time video streaming (3G) → ipad → senior consultant comments → 2 way audio

Conclusion Improved surgical competence of the trainees Improved completion of cases Lower complication rates Achieved by: – Intense structured phaco training with wet lab support – ICO OSCAR based intra & post training feedback