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

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.