A UH College of Optometry student practices examining the retina of a virtual patient with an Eyesi ophthalmoscope in the new Optometric Clinical Skills Simulation Lab. (Credit: David Gee)
A UH College of Optometry student practices examining the retina of a virtual patient with an Eyesi ophthalmoscope in the new Optometric Clinical Skills Simulation Lab. (Credit: David Gee)

Virtual Patients Come Alive in New Simulation Lab at University of Houston

Virtual Patients Come Alive in New Simulation Lab at University of Houston

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This fall, University of Houston (UH) optometry students began hands-on training in a first-of-its-kind simulation lab that offers them 24/7 access to virtual patients. The Optometric Clinical Skills Simulation Lab, which will better prepare students to administer patient care when they start clinical rotations, is the only one at an optometric program in the country and the largest in the world.

“When students come in this room and see the technology they’re blown away,” said assistant professor Heather Anderson, who led the initiative to bring the simulation lab to the UH College of Optometry. “The simulators have two components. The patient interface is a smooth black sheet of plastic with a 3-D face, and that face turns into the patient you’re examining. The simulators take on the demographics of whatever cases are programmed into the computer, so now we can have the students examine elderly eyes, diseased eyes and eyes from all different ethnicities.”

This is done through an augmented headband-mounted light that’s used to obtain a view of the retina through a handheld lens in a procedure called indirect ophthalmoscopy. It’s the same headband worn by professionals, but instead of having plain oculars to look through, it has LED screens mounted in it to create the images of the lifelike patients. The other component of the simulators is a touchscreen computer that brings up the different patient cases and faces. All images are based on actual clinical cases, so the images the students see are derived from real patient retinal photographs.

In the traditional academic setting, students use each other as patients during their earliest lessons in optometry. Typically, though, they have healthy retinas, so students aren’t getting real-world exposure to diseases until they start with clinical rotations. Additionally, teaching students how to detect disease in the back of the eye requires the patient be dilated. It becomes difficult for a student ‘patient’ to be dilated frequently when they need to go home and study, since dilation lasts several hours.

With this technology, students gain 24/7 access to dilated patients and can examine the retinas of these virtual patients any time they want. Another benefit is that students traditionally have been taught disease through photographs, textbooks and computer images and not physically examining patients with these diseases until they get to the clinic. This technology enables them to go through the physical examination process to see diseased eyes and better prepare for that detection before they’re administering patient care.

“When you look through the LED screens, you see a patient that’s blinking and moving their eyes and looking back at you with the ethnicity and age of the patient you’re examining,” Anderson said. “The simulators are very realistic in that they do get tired. They’ll blink and close their eyes if you remain in one position with the light for too long and don’t give them breaks. They respond the way a patient would, so if you spend too much time exposing the retina to the light, you’ll even see a tear come down the cheek of the virtual patient.”

The curriculum built into the software is extensive. Students are quizzed after each exercise and cannot progress to another case until they’ve mastered the previous level. The simulation equipment maps out the parts of the retina the students have looked at, so now their professors are able to objectively quantify how successful students have been in examining 100 percent of the retina.

This gives faculty an objective way to analyze a student’s progress. In current practice, when students are learning these techniques, their professors are looking over their shoulders in a little mirror that reflects what the students see. It can be difficult to quantify how fully the student has examined the retina.

In addition to the simulators now being able to tell faculty how much of the retina students examined, they also reveal how much time it took them. This allows faculty to know if students are doing an efficient exam that would be acceptable to a patient’s comfort. Another evaluation tool used in conjunction with these simulators is a series of multiple choice questions about each case as to whether or not students correctly identified the pathology and then identified the correct treatment strategy.

“Many of the diseases we’re looking for have dimension to them, so if you look in a patient’s eye that is simulating a retinal detachment, you can see the depth of the retina floating as it’s detached,” Anderson said. “It’s very realistic. Seasoned doctors have gone in to examine the equipment and say it feels so natural. You put the headband on and feel like you’re examining an actual patient.”

The 10 Eyesi ophthalmoscopes—five each of both the direct and indirect models—are designed to train for the examination of the retina and were designed by ophthalmologists and simulation technology experts in Germany at VRMagic, a provider of virtual reality medical training simulators for eye care professionals.

Joining Anderson in the effort to bring the Eyesi system to UH were assistant professor David Berntsen and clinical associate professor Amber Gaume-Giannoni. With this new technology, students gain exposure to more than 200 clinical cases of pathology built in to the patient simulators. This mode of education capitalizes on the philosophy of pattern recognition to identify disease presentation and gives all students an equal opportunity to gain exposure to a variety of eye conditions.

To start with, second-year optometry students are using the lab during the fall 2014 semester and then first- year students will be given access in spring 2015. Ultimately, students will be able to benefit from the simulators through all four years of their time at the optometry college, as well as during their residencies.

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