Gaze Characteristics Using a Three-Dimensional Heads-Up Display During Cataract Surgery

Area of Science:

• Ophthalmology
• Surgical Education
• Human Factors Engineering

Background:

• 3D heads-up displays (HUDs) are increasingly used in surgery.
• Understanding gaze behavior differences between novice and expert surgeons is crucial for training.
• Eye-tracking technology offers a method to objectively assess surgical visual strategies.

Purpose of the Study:

• To investigate differences in gaze behaviors during simulated cataract surgery using a 3D HUD.
• To correlate gaze patterns with surgical expertise levels (PGY2-4, fellows, attendings).
• To explore the potential of eye-tracking in surgical training.

Main Methods:

• An observational study involving 25 ophthalmologists across different experience levels.
• Participants performed simulated cataract surgery using the NGENUITY 3D HUD with integrated eye-tracking.
• Surgical performance was assessed, and gaze metrics (fixations, saccades) were analyzed.

Main Results:

• Surgical proficiency increased with experience, with attendings showing the highest scores.
• Novice surgeons (PGY2s) exhibited longer fixation durations, longer saccades, and fewer HUD fixations compared to attendings.
• Expert surgeons demonstrated superior capsulorhexis creation, maintained smaller tear angles, and employed a gaze strategy alternating between instruments and surrounding tissue.

Conclusions:

• Expert surgeons utilize a feed-forward visual sampling strategy for enhanced situational awareness and damage minimization.
• Specific techniques like smaller tear angles and proximal tear initiation are associated with expert performance.
• Integrating eye-tracking into surgical training can refine visual-motor strategies for trainees.