Step-by-Step Overview
Learn how to explore the various environments and tools in the AAO VR Education app
Embedded Files
This guide will explain what the AAO VR Education simulation entails, help you understand the expected outcomes, and become aware of potential complications or adverse events (AEs) you'll encounter in the interactive steps.
Atrium
Atrium
Screensharing:
Use the screensharing feature to display screens from your desktop into the atrium environment. Instructions will be provided upon selecting this feature.
Content Hub:
Use the Content Hub to review a variety of ophthalmic video, image, and 3D assets in the VR environment.
Accessing the ROP Procedure:
To engage with the Retinopathy of Prematurity (ROP) procedure, enter Room 1.
Screen Sharing
Screen Sharing
Screen sharing is possible for the host (or first person inside the atrium). Once the host has activated the screen sharing panel, it is possible for all users to share screens.
Users will need to navigate to the Fundamental Surgery Dashboard to share screens.
The ROP Diagnosis and Treatment Simulator
The ROP Diagnosis and Treatment Simulator
Once the disclaimer has been accepted, you will have the option to begin using the simulation.
Practice Mode:
In practice mode you can freely choose between the three available modules; Diagnosis, Laser Photocoagulation, and Intravitreal Injection. While using practice mode you will have additional guidance on completing the procedure correctly.
Assessment Mode:
In assessment mode you are presented with a randomized patient case that you will correctly diagnose and manage. Additional guidance is limited in this mode, and we advise using it only after practicing at least a few times in Practice Mode.
The NICU
The NICU
All procedures take place in the simulated neonatal intensive care unit (NICU). In this room you can position yourself around the baby, use all relevant tools, and also make notes on your case on the whiteboard.
Video Guidance
Video Guidance
The AAO VR experience features a library of learning resources which can be easily accessed from the NICU. As you advance in the diagnosis or treatment procedures, a pop-up will advise you if content is available for you to review. You can press the 'Player' button next to the instruction board to summon the video player, or to dismiss guidance altogether.
The Perfect Position
The Perfect Position
Three key areas have been marked around the patient to help you complete the procedure from the best positions. You can "snap" into one of these areas simply by moving to them using the stick on your controller.
You can also automatically return to the marked area on the right from anywhere in the room by pulling the controller stick back towards yourself.
PRO TIP: Adjusting Table Height
PRO TIP: Adjusting Table Height
Table height can be adjusted using the tool adjacent to the bassinet. This is useful if you decide to complete the procedure seated or you would like to achieve a closer vantage point in certain modules.
Wearing the Indirect Ophthalmoscope
Wearing the Indirect Ophthalmoscope
At the beginning of the examination modules, or during the procedures, you will be prompted to wear the indirect ophthalmoscope. The object is available on the table next to the patient and will glow once it's ready to be used.
The ophthalmoscope can be placed on your head using the "grip" buttons and motioning toward your head. It can be taken off by doing the same in reverse, reaching for your head and gripping.
Users should take off the indirect ophthalmoscope before advancing through steps to avoid missing any textual or other guidance on screen.
Using the Scleral Depressor and Handheld BIO Lens
Using the Scleral Depressor and Handheld BIO Lens
The scleral depressor can be picked up and used with either hand. Manipulation of the eye is possible by making contact with the surface until a slight vibration is felt. Vibration strength will increase if the tool advances further into the eye than intended.
Depression of the eye is possible by making contact with the eye and subtly pushing the depressor into the eye.
The handheld lens can be picked up and used with either hand.
Alignment can be achieved by hovering directly over the baby and placing the lens at the correct distance from the baby's eye until the view is magnified sufficiently.
PRO TIP: Dampening and Locking
PRO TIP: Dampening and Locking
To decrease the difficulty of the procedure, you have the option to "dampen" the tool in your hand, effectively making it slow down and easier to manipulate. You can do this by pressing the X or A button on your controller.
Alternatively, you can also "lock" the tool in your hand with the Y or B button, which will set the tool in space until you unlock it again..
We encourage you to use dampening and locking to more easily manipulare the tools and learn the procedures, especially early in your VR experiences.
PRO TIP: Magnified View
PRO TIP: Magnified View
To enter the magnified view follow these steps:
Place the indirect ophthalmoscope on your head.
Achieve optimal alignment with head position, the lens, and the baby's eye.
Lock the lens into place using Y or B button.
Once the above criteria are met, you'll notice a magnified view of the retina and you'll be able to more accurately perform an exam.
Examination
Examination
To examine the retina, use the scleral depressor, handheld BIO lens, and indirect ophthalmoscope together. As you move around the baby using preset positions and view the retina, a visual guidance map updates with tiny white dots indicating areas you've examined. The aim is to see the entire retina and fully cover the visual guidance map with the dots.
Note that during Assessment mode, you'll need to view the entire retina without help from the visual guidance map.
Procedure: Laser
Procedure: Laser
Laser photocoagulation involves using the scleral depressor, handheld BIO lens, and a laser-enabled indirect ophthalmoscope. As in the examination, you'll move around the baby using preset positions to view the retina. A visual guidance map shows which areas you've lasered, updating with tiny white dots. The goal is to treat all target areas on the retina and fully cover the visual guidance map.
Note that during the Assessment mode, lasering is conducted without help from the visual guidance map.
In Practice mode, the retina map will show a zone that should not be targeted with laser treatment. This zone is represented with orange bars, generally over the central area of the retina.
In Assessment mode, the safety zone is removed and you will need to evaluate the retina more carefully to determine where to avoid lasering.
PRO TIP: Laser Console and Firing
PRO TIP: Laser Console and Firing
The laser console must be set up correctly before trying to laser the eye, and the settings can be customized to change duration and interval of the laser.
The laser can be fired in a single shot (tap the trigger on either hand) or continuously (hold the trigger on either hand).
Optimal alignment is required to fire the laser.
Procedure: Injection
Procedure: Injection
Intravitreal injection requires the use of a cotton-tipped applicator, caliper, and a pre-filled syringe. You'll move around the baby using preset positions to find a comfortable spot. A visual guidance map provides a cross-section of the eye, updating in real-time to show your needle depth.
The aim is to accurately mark the eye with the caliper first, and then to insert the syringe needle at the correct angle and depth.
In the Assessment mode, tips on the insertion angle will not be available.
PRO TIP: The Needle Cross-section
PRO TIP: The Needle Cross-section
The needle can be picked up and used with either hand.
Be sure to insert the needle at an angle and use the supporting 2D cross-section of the eye to visualize and guide the needle depth.
Final Results
Final Results
Upon completing either practice mode or assessment mode, you will be shown a very top level overview of your performance. This can be displayed in more detail by navigating to the AAO VR Data Dashboard. You can learn more about how scores and performance are assessed in the Frequently Asked Questions.
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