Ophthalmology Research Articles

Where We Are Now: A Survey Exploring Colombian Ophthalmic Surgeons\' Attitudes on Performing Immediate Sequential Bilateral Cataract Surgery

Where We Are Now: A Survey Exploring Colombian Ophthalmic Surgeons\' Attitudes on Performing Immediate Sequential Bilateral Cataract Surgery

Correlation between parameters influencing skill acquisition in cataract surgery simulation

Introduction The EyeSi (Haag-Streit, Manheim, Germany) cataract surgery simulator is the most commonly used virtual reality simulator internationally to train Ophthalmology registrars. It consists of a Cataract Challenge Course (CCC), which is a virtual reality simulation (VRS) of cataract surgery. In this study, we aimed to determine any correlation between the parameters measured on the EyeSi virtual reality cataract surgery simulator and if they can predict the progression of microsurgical skill acquisition and development amongst ophthalmology trainees. Methods Data on the performance of 56 Ophthalmology trainees (training ophthalmic surgeons) at the Royal Victorian Eye and Ear Hospital were analysed from 2018 to 2022. The trainees ranged from first to fourth year of training. Analysed parameters included Initial Task Performance, Time to Gate (the time to reach a threshold score – 50% in this case), and Peak Performance. Relationships between the parameters were analysed with Pearson r, and the significance of the difference between correlations was analysed with the psych package in R. Results The strongest correlation was found between initial and peak performance (r = 0.810), which was significantly greater than the correlation between Initial Task Performance and Time-to-Gate (r = 0.553, p = 0.03). Time-to-Gate was weakly correlated with Peak Performance (r = 0.475). The average total training time was 1123 minutes, ranging from 252 to 2039, and the mean peak CCC score was 442, ranging from 166 to 496. Conclusions Time-to-Gate, Initial Task Performance and Peak Performance are interlinked, indicating that trainees with the highest initial performance remain ahead in ability and can progress through VRS training more rapidly. Data also indicated that the EyeSi platform ultimately prioritizes a wide range of skills over mastery of a few – as participants who spend longer on ‘perfecting’ each stage of the simulator are not truly rewarded points-wise in comparison to those who rush through stages, as rushing through stages grants trainees a far higher overall score for each section (with one’s score ideally being a numeric representation of one’s ‘ability’). Consequently, the authors believe that virtual reality systems play a crucial role in training surgical registrars. However, their scoring systems should focus on skill mastery to facilitate maximal acquisition of skills.

560-P: Optimizing Vision Care for Diabetes Patients—Interprofessional Initiatives to Combat Clinical Inertia in the Management of Diabetic Retinopathy and Diabetic Macular Edema

560-P: Optimizing Vision Care for Diabetes Patients—Interprofessional Initiatives to Combat Clinical Inertia in the Management of Diabetic Retinopathy and Diabetic Macular Edema

Factors Influencing Vision Health and Eye Care among Older Adults in Northeast Tennessee.

The purpose of this study was to examine the factors associated with vision impairment (VI), age-related eye disease (ARED), and frequency of eye examinations among older adults. A cross-sectional study (N = 166) was designed to identify barriers in vision and eye care services among adults 50 years and older in four counties in Appalachian Tennessee. Surveys were administered in March 2023. Simple and multiple logistic regression analyses were used to determine the risk factors of VI and ARED and the frequency of eye examinations. In two out of the three regression models, predictors such as traveling >10 mi to an eye care provider, barriers to eye care, and a lack of exposure to eye health information emerged as significant factors. Individuals who traveled >10 mi to an eye care provider were more than twice as likely than individuals who traveled shorter distances to have VI and not maintain routine eye care (adjusted odds ratio [AOR] 2.69, 95% confidence interval [CI] 1.08-6.75; AOR 2.82, 95% CI 1.05-7.55, respectively). Reporting barriers to eye care doubled the odds of ARED (AOR 2.33, 95% CI 1.02-5.34) and substantially increased the odds of reporting a 3-year or longer interval since the last eye examination (AOR 7.45, 95% CI 1.85-29.96) compared with having no barriers to eye care. Moreover, limited exposure to eye health information tripled the odds of VI (AOR 3.26, 95% CI 1.15-9.24) and not maintaining routine eye care (AOR 3.07, 95% CI 0.97-9.70) compared with more exposure to eye health information. Other predictors also were uncovered in the analysis. This study contributes to the scarce literature on risk factors associated with vision health among older adults in Appalachia.

Flipped Classroom Based on Outcomes-Based Education Improves Student Engagement and Clinical Analysis Competence in Undergraduates Ophthalmology Clerkship.

To investigate the effectiveness of flipped classrooms (FC) based on outcomes-based education (OBE) on clinical ophthalmology clerkships. Ninety-nine undergraduates were non-randomly assigned to the FC based on the OBE (FC-OBE) group or traditional lecture (TL) group in the ophthalmology clerkship. Pre- and post-tests were performed to assess student learning outcomes. Anonymous questionnaires were collected to compare students' attitudes and classroom engagements between the two groups. More participants agreed FC-OBE was helpful in developing teamwork ability and knowing the work standard. Teaching staff in the FC-OBE classroom received higher evaluations. More participants in the FC-OBE group had higher classroom engagement in skills and emotions than in the TL group. The post-class test scores, mainly case analysis scores were higher in the FC-OBE group than in the TL group. FC-OBE classroom improves student engagement and clinical analysis competence in undergraduate ophthalmology clerkship.

Approaches for delivery of refractive and optical care services in community and primary care settings.

Uncorrected refractive error is a leading cause of vision impairment which, in most cases, can be managed with the appropriate spectacle correction. In 2021, the World Health Assembly endorsed a global target of a 40-percentage-point increase in effective coverage of refractive error by 2030. To achieve this global target, equitable access to refractive and optical services within community and primary care settings needs to be strengthened. This review will inform the development of technical guidance to support improvements in the testing and correction of refractive error among World Health Organization (WHO) member states. To determine the range of approaches for delivery of refractive and optical care services in community and primary care settings, and the methods employed for their evaluation. We searched CENTRAL, MEDLINE, Embase and Global Health databases, grey literature, and annual reports and websites of relevant organizations involved in eye-care delivery from January 2002 to November 2022 to identify approaches for refractive and optical service delivery. We included observational and interventional studies, reviews, and reports from relevant organizations related to delivering refractive services and optical services for preschool and school-aged children and adults in community and primary care settings published between January 2002 and November 2022. We searched for studies and reports published within the last 20 years because vision impairment due to uncorrected refractive error has only recently become a public health and eye health priority, therefore we did not expect to find much relevant literature until after 2002. Two review authors screened titles, abstracts and full texts, and extracted data. We resolved any discrepancies through discussion. We synthesized data, and presented results as tables, figures, and case studies. This project was led by the World Health Organization (WHO) Vision and Eye Care Programme. We identified 175 studies from searches of databases and grey literature, 146 records from company reports, and 81 records from website searches of relevant organizations that matched our inclusion criteria. Delivery approaches for refractive and optical services in community care included school-based, pharmacy, and outreach models, whereas primary care approaches comprised vision centre, health centre, and a combination of vision or health centre and door-to-door delivery. In community care, school-based and outreach approaches were predominant, while in primary care, a vision-centre approach was mainly used. In the WHO African region, the school-based and outreach approaches were mainly reported while, in the Americas, the outreach approach was mostly used. Very few approaches for service delivery were reported in the WHO Eastern Mediterranean region. Prominent gaps exist in the evaluation of the approaches, and few studies attempted to evaluate the approaches for delivery of refractive and optical care services. We comprehensively describe a range of approaches for delivery of refractive and optical services in community and primary care. Further evaluation of their effectiveness will better inform the application of these service-delivery approaches. The study outcomes will help guide WHO member states in strengthening refractive and optical services at community and primary care levels. This scoping review was supported by the Vision and Eye care Programme, World Health Organization and ATscale Global Partnership. The protocol of this scoping review was published in the Open Source Framework.

Ergonomic benefit using heads-up display compared to conventional surgical microscope in Japanese ophthalmologists.

Occupational musculoskeletal disorders are prevalent in ophthalmic surgeons and can impact surgeons' well-being and productivity. Heads-up displays may reduce ergonomic stress compared to conventional microscopes. This cross-sectional, non-interventional study compared ergonomic experience between heads-up display and conventional ocular microscopes. The study protocol was approved by the independent ethics committee and nonprofit organization MINS Institutional Review Board. An online questionnaire was distributed to a sample of ophthalmic surgeons in Japan with experience operating with heads-up display. The questionnaire captured surgeon-specific variables, the standardized Nordic Musculoskeletal Questionnaire, and custom questions to compare heads-up display and conventional microscope and understand long-term impacts of musculoskeletal disorders. Analysis was conducted on responses from 67 surgeons with a mean 25 years of practice and 2.7 years using heads-up display. Many surgeons agreed or strongly agreed that heads-up display reduced the severity (40%) and frequency (40%) of pain and discomfort, improved posture (61%), and improved overall comfort (61%). Of respondents who experienced asthenopia (n = 59) or pain/discomfort during operation (n = 61), 54% reported improvement in asthenopia and 72% reported feeling less pain/discomfort since using heads-up display. Overall, 69% reported preference for heads-up display. This study provides novel data on musculoskeletal disorders and the long-term impacts of ergonomic strain reported by ophthalmologists building on existing literature demonstrating ergonomic and other advantages of heads-up display. Future studies with objective ergonomic assessment are warranted to validate these findings.

Perceptions of vision care following neurological impairment: a qualitative study

BackgroundVisual impairment is a common consequence of neurological impairments, and can impact a person’s ability to undertake everyday tasks, affecting their confidence and mental health. Previous qualitative research in the UK has shown inequalities to exist where patients are accessing vision care after stroke, but little is known around the experiences of accessing vision care following other neurological impairments, and a lack of national guidelines prevent standardised care planning. The aim of this qualitative study is to explore the perceptions of vision care after neurological impairment, and to identify possible inequalities and support mechanisms, where it has been possible to access vision care.MethodsUniversity ethical approval was obtained, and adults with a visual impairment as a result of a neurological impairment were offered an in-depth interview to explore their vision care experiences. Data were collected between April and November 2021 and analysed using iterative, thematic analysis (TA), informed by a social constructionist ideology.ResultsSeventeen participants were recruited. Three overarching themes were conceptualised in relation to the participants’ perception of vision care: Making sense of the visual impairment; The responsibility of vision care; and Influential factors in care quality perception.ConclusionInequalities were noted by participants, with most reporting a lack of suitable vision care offered as part of their neurological rehabilitation. Participants were thus burdened with the task of seeking their own support online, and encountered inaccurate and worrying information in the process. Participants noted changes in their identity, and the identity of their family carers, as they adjusted to their vision loss. The findings from this research highlight a need for clinicians to consider the long-term impact of vision loss after neurological impairment, and ensure patients are provided with adequate support and information, and appropriate referral pathways, alleviating this patient burden.

Combined Use of Amniotic Membrane and Pyo-Bacteriophage in Clinical Ophthalmology

Combined Use of Amniotic Membrane and Pyo-Bacteriophage in Clinical Ophthalmology

Benchmarking deep models on retinal fundus disease diagnosis and a large-scale dataset

Retinal fundus imaging contributes to monitoring the vision of patients by providing views of the interior surface of the eyes. Machine learning models greatly aided ophthalmologists in detecting retinal disorders from color fundus images. Hence, the quality of the data is pivotal for enhancing diagnosis algorithms, which ultimately benefits vision care and maintenance. To facilitate further research in this domain, we introduce the Eye Disease Diagnosis and Fundus Synthesis (EDDFS) dataset, comprising 28,877 fundus images. These include 15,000 healthy samples and a diverse range of images depicting various disorders such as diabetic retinopathy, age-related macular degeneration, glaucoma, pathological myopia, hypertension retinopathy, retinal vein occlusion, and Laser photocoagulation. In addition to providing the dataset, we propose a Transformer-joint convolution network for automated eye disease screening. Firstly, a co-attention structure is integrated to capture long-range attention information along with local features. Secondly, a cross-stage feature fusion module is designed to extract multi-level and disease-related information. By leveraging the dataset and our proposed network, we establish benchmarks for disease screening and grading tasks. Our experimental results underscore the network’s proficiency in both multi-label and single-label disease diagnosis, while also showcasing the dataset’s capability in supporting fundus synthesis. (The dataset and code will be available onhttps://github.com/xia-xx-cv/EDDFS_dataset.)

In Vivo Optical Coherence Elastography Unveils Spatial Variation of Human Corneal Stiffness.

The mechanical properties of corneal tissues play a crucial role in determining corneal shape and have significant implications in vision care. This study aimed to address the challenge of obtaining accurate in vivo data for the human cornea. We have developed a high-frequency optical coherence elastography (OCE) technique using shear-like antisymmetric (A0)-mode Lamb waves at frequencies above 10 kHz. By incorporating an anisotropic, nonlinear constitutive model and utilizing the acoustoelastic theory, we gained quantitative insights into the influence of corneal tension on wave speeds and elastic moduli. Our study revealed significant spatial variations in the shear modulus of the corneal stroma on healthy subjects for the first time. Over an age span from 21 to 34 (N = 6), the central corneas exhibited a mean shear modulus of 87 kPa, while the corneal periphery showed a significant decrease to 44 kPa. The central cornea's shear modulus decreases with age with a slope of -19 +/- 8 kPa per decade, whereas the periphery showed non-significant age dependence. The limbus demonstrated an increased shear modulus exceeding 100 kPa. We obtained wave displacement profiles that are consistent with highly anisotropic corneal tissues. Our approach enabled precise measurement of corneal tissue elastic moduli in situ with high precision (<7%) and high spatial resolution (<1 mm). Our results revealed significant stiffness variation from the central to peripheral corneas. The high-frequency OCE technique holds promise for biomechanical evaluation in clinical settings, providing valuable information for refractive surgeries, degenerative disorder diagnoses, and intraocular pressure assessments.

Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review.

The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.

Addressing Disparities in Vision Health and Eye Care in the US

Health disparities are a prevalent issue that continues to affect health outcomes. In ophthalmology, these disparities affect eye care utilization increasing the burden of eye care disorders and vision impairment/loss. Various factors contribute to disparities in vision care. They include age, gender, socioeconomic status, geographic location, and race and ethnicity. These factors make it difficult for people affected by eye conditions to access care. Addressing these disparities can help to increase eye care utilization and improve patient outcomes. Some measures that can address these disparities and increase utilization are providing patient education, increasing insurance coverage, implementing community-based eye care programs, using teleophthalmology, providing transport services, providing reminder alerts, and creating community centres that are federally funded among others. This review seeks to identify measures that can help to address disparities in vision and eye care in the US. The review also identifies drivers of health disparities in vision health and how they affect the ability to access care.

Eye Care in Federally Qualified Health Centers

PurposeTo understand the availability of vision care provided within Federally Qualified Health Centers (FQHCs) in 2017 versus 2021, and to assess whether differences exist in neighborhood-level demographic factors and social risk factors (SRFs) between FQHCs based on the availability of eye care services. DesignSecondary data analysis of the Health Resources and Services Administration (HRSA) FQHC data and 2017-2021 American Community Survey neighborhood SRFs. ParticipantsFQHCs in 2017 and 2021. MethodsPatient and neighborhood characteristics for each SRF were summarized. Differences in FQHCs providing and not providing vision care were compared via Wilcoxon Mann–Whitney tests for continuous measures and chi-square tests for categorical measures. Logistic regression models were used to test the associations between neighborhood measures and FQHCs providing vision care, adjusted for patient characteristics. Main Outcome MeasuresOdds ratios (ORs) with 95% confidence intervals for neighborhood-level predictors of FQHCs providing vision care services. ResultsOverall, 28.5% of FQHCs (n=375/1318) provided vision care in 2017 vs. 32% (n=435/1362) in 2021 with some increases and decreases in both the number of FQHCs and those with and without vision services. Only 2.6% of people who accessed FQHC services received eye care in 2021. Among the 435 FQHCs that provided vision care in 2021, 27.1% (n=118) had added vision services between 2017 and 2021, 71.5% (n=311) had been offering vision services since at least 2017, and 1.4% were newly established. Logistic regression models demonstrated FQHCs providing vision care in 2021 were more likely to be in neighborhoods with higher percentage of Hispanic/Latino individuals (OR=1.08, 95% CI=1.02-1.14, p=0.0094), Medicaid-insured individuals (OR=1.08, 95% CI=1.02-1.14, p=0.0120), and no car households (OR=1.07, 95% CI=1.01-1.13, p=0.0142). However, FQHCs with vision care, compared to FQHCs without vision care, served a lower percentage of Hispanic/Latino individuals (27.2% vs. 33.9%, p=0.0007), Medicaid-insured patients (42.8% vs. 46.8%, p<0.0001), and patients living at/below 100% of the federal poverty line (61.3% vs. 66.3%, p<0.0001). ConclusionsVision care services are available at few FQHCs, localized to a few states. Expanding access to eye care at FQHCs would meet patients where they seek care to mitigate vision loss to underserved communities.

Continued care and provision of glasses are necessary to improve visual and academic outcomes in children: Experience from a cluster-randomized controlled trial of school-based vision screening

ObjectiveTo assess the effectiveness of a kindergarten vision screening program by randomly assigning schools to receive or not receive vision screening, then following up 1.5 years later.MethodsFifty high-needs elementary schools were randomly assigned to participate or not in a vision screening program for children in senior kindergarten (SK; age 5‒6 years). When the children were in Grade 2 (age 6‒7 years), vision screening was conducted at all 50 schools.ResultsContrary to expectations, screened and non-screened schools did not differ in the prevalence of suspected amblyopia in Grade 2 (8.6% vs. 7.5%, p = 0.10), nor prevalence of other visual problems such as astigmatism (45.1% vs. 47.1%, p = 0.51). There was also no difference between screened and non-screened schools in academic outcomes such as the proportion of children below grade level in reading (33% vs. 29%) or math (44% vs. 38%) (p = 0.86). However, more children were wearing glasses in screened than in non-screened schools (10.2% vs. 7.8%, p = 0.05), and more children reported their glasses as missing or broken (8.3% vs. 4.7%, p = 0.01), suggesting that SK screening had identified successfully those in need of glasses. Examination of individual results revealed that 72% of children diagnosed and treated for amblyopia in SK no longer had amblyopia in Grade 2.ConclusionThe prevalence of amblyopia and other visual problems was not reduced in Grade 2 by our SK vision screening program, perhaps because of poor treatment compliance and high attrition. The results suggest that a single screening intervention is insufficient to reduce visual problems among young children. However, the data from individuals with amblyopia suggest that continuing vision care and access to glasses benefits children, especially children from lower socioeconomic class.

Exploring Pediatric Vision Care: Insights from Five Years of Referral Cases in the UCI Eye Mobile and Implications of COVID-19.

To analyze referral rates, patient demographics, referral indications, and the impact of socioeconomic factors on ocular health from the University of California Irvine (UCI) Eye Mobile for Children, particularly during the coronavirus disease 2019 (COVID-19) pandemic. A retrospective chart review was performed on de-identified records of children examined on the UCI Eye Mobile. GraphPad Prism 10.0.0 and Python software were used for statistical analyses. In the academic years from 2018 to 2022, 3,619 children received comprehensive eye examinations on the UCI Eye Mobile. Among them, 76 were referred to a pediatric ophthalmologist. The majority of these children were Hispanic (72.6%, 54 of 74), followed by Asian (10.9%, 8 of 74). A significant proportion (82.9%, 63 of 76) attended school districts with median incomes below that of Orange County. Statistically significant differences were found in age (P = .001; pre-COVID: 3.98 ± 1.08 years vs COVID: 5.75 ± 2.92 years) and gender (P = .023; pre-COVID female: 31 of 41 vs COVID female: 15 of 32) between the pre-COVID and COVID years. Additionally, there were significant differences in the proportion of children with hyperopia with astigmatism between the pre-COVID and COVID years (P = .044; pre-COVID: 23 of 40 vs COVID: 12 of 35). The most common indications for ophthalmologist referrals were for strabismus evaluation/treatment (28.9%, 22 of 76), followed by abnormal cup-to-disc ratio (21.1%, 16 of 76). The study highlights the pivotal role of the UCI Eye Mobile for children in identifying ocular conditions needing referrals to subspecialty care. The majority of children needing these referrals attended schools in lower economic communities. Additionally, the COVID-19 pandemic appears to have influenced the demographic and clinical characteristics. [J Pediatr Ophthalmol Strabismus. 20XX:X(X):XXX-XXX.].

Three Eye and Vision Care History Organizations: Their Emphases, Activities, and How to Get Involved

This paper describes three organizations devoted to various aspects of the history of eye and vision care. The Optometric Historical Society, founded in 1969, strives to promote the study, documentation and appreciation of optometry history. The Ophthalmic Antiques International Collectors’ Club, founded in 1982, and the Ocular Heritage Society, founded in 1984, are societies of collectors of vision aids and other objects related to eye and vision care, and they work to promote the study of ophthalmic antiques.

EXAMINING THE DECREASE IN SYMPTOMS IN PATIENTS WITH DACRYOCYSTORHINOSTOMY BOTH WITH AND WITHOUT SILICON INTUBATION A RANDOMIZED CONTROLLED TRIAL

Objective: To determine if dacryocystorhinostomy or silicon intubation is more effective in treating nasolacrimalduct obstructionStudy Design: A Randomized Controlled Trial StudyPlace and duration of study: This research was conducted over a six-month period, from October 9, 2021, to April 9,2022, at the Department of Clinical Ophthalmology, Khyber Girls’ Medical College, Hayatabad Medical Complex(HMC), Peshawar.Materials and Methods: The study comprised 446 patients with nasolacrimal duct blockage (NLDO). Eachpatient was split up into two cohorts. Group A had cryocystorhinostomy (DCR) with silicon intubation, whereasGroup B underwent DCR without intubation.Results: The average age of the sample was 35.1 + 9.2 years. The mean age of Group B was 35.2 + 9.1 years,whereas the mean age of Group A was 34.9 + 9.3 years (p 0.730). Group A consisted of 61.9% males and groupB had 56.5% males (p 0.248). The average number of days that symptoms persisted was 11 + 3.2 days in group Aand 10.4 + 2.9 days in group B (p 0.082). As determined by the overall remission of symptoms, group A’s efficacywas 79.4% at follow-up, whereas group B’s was 69.5% (p 0.017).Conclusion: For those with NLDO, silicon intubation significantly boosts the efficacy of DCR when compared toDCR without intubation.Key Words: Nasolacrimal duct obstruction, dacryocystorhinostomy, intubation, silicon, and efficacy.

Enhancing Vision Care through Psychological Assessment in Sub-Saharan Africa: An Overview

Enhancing Vision Care through Psychological Assessment in Sub-Saharan Africa: An Overview

Simulation-based training for intraoperative posterior capsule rupture management: an analysis of nontechnical skills development and the relationship between technical and nontechnical skills.

To analyse development of individual nontechnical skills (NTS) domains after undertaking a previously developed simulation-based training model and analyse the relationship between technical skills (TS) and NTS in ophthalmic surgery. The simulation-based training model involved a cataract surgery case complicated by intraoperative posterior capsule rupture. Cataract surgeons underwent the simulation twice, separated by a training intervention. Two blinded independent experts assessed participants' NTS using HUFOES, NOn-Technical Skills for Surgeons (NOTSS), and the OSATS global rating scale for TS. Paired t-tests assessed differences in individual NTS domains, with p < 0.05 indicating significance. The Pearson Product Moment Correlation Coefficient was used to assess the correlation between scores from each scoring system. All NTS domains within HUFOES and NOTSS demonstrated statistically significant improvements secondary to the training intervention. Positive correlations were demonstrated between HUFOES and OSATS scores in the pre- and post-training simulations, r = 0.870 (p < 0.001) and r = 0.861 (p < 0.001), respectively. Positive correlations were also demonstrated between NOTSS and OSATS scores in pre- and post-training simulations, r = 0.849 (p < 0.001) and r = 0.757 (p = 0.001), respectively. Positive correlations were demonstrated between HUFOES and NOTSS scores; r = 0.979 (p < 0.001) (n = 17) and r = 0.959 (p < 0.001) for pre- and post-training simulations, respectively. All NTS domains contained within HUFOES and NOTSS demonstrated significant increases following the completion of the simulation-based training model. Positive correlations exist between an ophthalmic surgeon's TS and NTS. This is the first study to report these findings within ophthalmic surgery.