All Publications

  • Assessing Pediatric Perioperative Affect: A Concise Review of Research and Clinically Relevant Scales. Paediatric anaesthesia Yun, R., Hess, O., Kennedy, K., Stricker, P. A., Blake, L., Caruso, T. J. 2022

    View details for DOI 10.1111/pan.14568

    View details for PubMedID 36178764

  • Communication Skills Training Using Remote Augmented Reality Medical Simulation: a Feasibility and Acceptability Qualitative Study. Medical science educator Hess, O., Qian, J., Bruce, J., Wang, E., Rodriguez, S., Haber, N., Caruso, T. J. 2022: 1-10


    Introduction: Augmented reality (AR) has promise as a clinical teaching tool, particularly for remote learning. The Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator with a holographic patient and monitor. The primary aim was to analyze feedback from medical and physician assistant students regarding acceptability and feasibility of the simulator.Methods: Using the CHARM simulator, we created an advanced cardiovascular life support (ACLS) simulation scenario. After IRB approval, preclinical medical and physician assistant students volunteered to participate from August to September 2020. We delivered augmented reality headsets (Magic Leap One) to students before the study. Prior to the simulation, via video conference, we introduced students to effective communication skills during a cardiac arrest. Participants then, individually and remotely from their homes, synchronously completed an instructor-led ACLS AR simulation in groups of three. After the simulation, students participated in a structured focus group using a qualitative interview guide. Our study team coded their responses and interpreted them using team-based thematic analysis.Results: Eighteen medical and physician assistant students participated. We identified four domains that reflected trainee experiences: experiential satisfaction, learning engagement, technology learning curve, and opportunities for improvement. Students reported that the simulator was acceptable and enjoyable for teaching trainees communication skills; however, there were some technical difficulties associated with initial use.Conclusion: This study suggests that multiplayer AR is a promising and feasible approach for remote medical education of communication skills during medical crises.Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01598-7.

    View details for DOI 10.1007/s40670-022-01598-7

    View details for PubMedID 35966166

  • Anesthesiologists With Advanced Degrees in Education: Qualitative Study of a Changing Paradigm. JMIR medical education Aggarwal, A., Hess, O., Lockman, J. L., Smith, L., Stevens, M., Bruce, J., Caruso, T. 2022; 8 (2): e38050


    Anesthesiology education has undergone profound changes over the past century, from a pure clinical apprenticeship to novel comprehensive curricula based on andragogic learning theories. Combined with institutional and regulatory requirements, these new curricula have propagated professionalization of the clinician-educator role. A significant number of clinician-educator anesthesiologists, often with support from department chairs, pursue formal health professions education (HPE) training, yet there are no published data demonstrating the benefits or costs of these degrees to educational leaders.This study aims to collect the experiences of anesthesiologists who have pursued HPE degrees to understand the advantages and costs of HPE degrees to anesthesiologists.Investigators performed a qualitative study of anesthesiologists with HPE degrees working at academic medical centers. Interviews were thematically analyzed via an iterative process. They were coded using a team-based approach, and representative themes and exemplary quotations were identified.Seven anesthesiologists were interviewed, representing diverse geographic regions, subspecialties, and medical institutions. Analyses of interview transcripts resulted in the following 6 core themes: outcomes, extrinsic motivators, intrinsic motivators, investment, experience, and recommendations. The interviewees noted the advantages of HPE training for those wishing to pursue leadership or scholarship in medical education; however, they also noted the costs and investment of time in addition to preexisting commitments. The interviewees also highlighted the issues faculty and chairs might consider for the optimal timing of HPE training.There are numerous professional and personal benefits to pursuing HPE degrees for faculty interested in education leadership or scholarship. Making an informed decision to pursue HPE training can be challenging when considering the competing pressures of clinical work and personal obligations. The experiences of the interviewed anesthesiologists offer direction to future anesthesiologists and chairs in their decision-making process of whether and when to pursue HPE training.

    View details for DOI 10.2196/38050

    View details for PubMedID 35771619

  • Anesthesiologists with Advanced Degrees in Education: A Qualitative Study of a Changing Paradigm Hess, O. M., Daniel, D., Aggarwal, A., Lockman, J., Smith, L. E., Stevens, M., Bruce, J., Caruso, T. LIPPINCOTT WILLIAMS & WILKINS. 2022: 388-389
  • The Rwanda National Blindness Survey: Trends and use of the evidence to change practice and policy AFRICAN VISION AND EYE HEALTH JOURNAL Mathenge, W. C., Hillgrove, T., Gisagara, E., Uwaliraye, P., Hess, O., Byamukama, E., Intili, A., Nyemazi, A., Nkurikiye, J. 2021; 80 (1)
  • Integrated eye tracking on Magic Leap One during augmented reality medical simulation: a technical report BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING Caruso, T. J., Hess, O., Roy, K., Wang, E., Rodriguez, S., Palivathukal, C., Haber, N. 2021; 7 (5): 431-434
  • Integrated eye tracking on Magic Leap One during augmented reality medical simulation: a technical report. BMJ simulation & technology enhanced learning Caruso, T. J., Hess, O., Roy, K., Wang, E., Rodriguez, S., Palivathukal, C., Haber, N. 2021; 7 (5): 431-434


    Augmented reality (AR) has been studied as a clinical teaching tool, however eye-tracking capabilities integrated within an AR medical simulator have limited research. The recently developed Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator. The purpose of this project was to refine the gaze-tracking capabilities of the CHARM simulator on the Magic Leap One (ML1). Adults aged 18 years and older were recruited using convenience sampling. Participants were provided with an ML1 headset that projected a hologram of a patient, bed and monitor. They were instructed via audio recording to gaze at variables in this scenario. The participant gaze targets from the ML1 output were compared with the specified gaze points from the audio recording. A priori investigators planned to iterative modifications of the eye-tracking software until a capture rate of 80% was achieved. Two consecutive participants with a capture rate less than 80% triggered software modifications and the project concluded after three consecutive participants' capture rates were greater than 80%. Thirteen participants were included in the study. Eye-tracking concordance was less than 80% reliable in the first 10 participants. The investigators hypothesised that the eye movement detection threshold was too sensitive, thus the algorithm was adjusted to reduce noise. The project concluded after the final three participants' gaze capture rates were 80%, 80% and 80.1%, respectively. This report suggests that eye-tracking technology can be reliably used with the ML1 enabled with CHARM simulator software.

    View details for DOI 10.1136/bmjstel-2020-000782

    View details for PubMedID 35515734

    View details for PubMedCentralID PMC8936533

  • The Impact of COVID-19 on Missed Ophthalmology Clinic Visits CLINICAL OPHTHALMOLOGY Brant, A. R., Pershing, S., Hess, O., Rooney, D., Goldberg, J., Tabin, G., Wang, S. Y. 2021; 15: 4645-4657


    To measure the COVID-19 pandemic impact on missed ophthalmology clinic visits and the influence of patient and eye disease characteristics on likelihood of missing clinic visits before and during the pandemic.A retrospective observational study analyzing eye clinic patients at a large tertiary care academic institution. We identified patients scheduled for eye care during pre-COVID-19 (January 1-February 29, 2020) and early COVID-19 (March 16-May 31, 2020) time periods. Missed appointment frequency and characteristics were evaluated during each time period. Multivariable logistic regression models were developed to examine adjusted odds of having at least one missed appointment during a given time period. Covariates included age, sex, race/ethnicity, marital status, preferred language (non-English vs English), insurance, distance from clinic, and diagnosis.Overall, 82.0% (n = 11,998) of pre-COVID-19 patients completed all scheduled visits, compared to only 59.3% (n = 9020) during COVID-19. Missed visits increased dramatically in late March 2020, then improved week by week through the end of May 2020. General ophthalmology/cataract and strabismus clinics had the highest rates of missed clinic visits during the COVID-19 period; neuro-ophthalmology, retina, cornea, oculoplastics and glaucoma had the lowest. Females, Blacks, Hispanics, Asians, ages 50+, and married patients had higher adjusted odds of missing clinic visits, both pre-COVID-19 and during COVID-19. Asian, elderly, and cataract patients had the highest adjusted odds of missing clinic visits during COVID-19 and had significant increases in odds compared to pre-COVID-19. Non-married, diabetic macular edema, and wet age-related macular degeneration patients had the lowest adjusted odds of missed visits during COVID-19.Missed clinic visits increased dramatically during the COVID-19 pandemic, particularly among elderly and nonwhite patients. These findings reflect differences in eye care delivery during the pandemic, and they indicate opportunities to target barriers to care, even during non-pandemic eras.

    View details for DOI 10.2147/OPTH.S341739

    View details for Web of Science ID 000730419000002

    View details for PubMedID 34916776

    View details for PubMedCentralID PMC8667753

  • Preoperative and perioperative music to reduce anxiety during first-time phacoemulsification cataract surgery in the high-volume setting: randomized controlled trial. Journal of cataract and refractive surgery Muddana, S. K., Hess, O. M., Sundar, S., Venkatesh, R. 2020


    PURPOSE: To determine if preoperative and perioperative music exposure reduced patient self-rated anxiety and physiologic indicators of stress during first-time phacoemulsification cataract surgery in the high-volume setting.SETTING: Aravind Eye Care System, Pondicherry, India.DESIGN: Prospective single-masked randomized controlled trial.METHODS: Patients were provided music before and during first-time phacoemulsification in one group and patients underwent surgery without music in another group. Measurements of blood pressure, heart rate, respiration rate, and a Likert-scale anxiety rating were collected at preoperative, perioperative, and postoperative time points.RESULTS: 165 patients (aged 53-65) were provided music via a portable MP3 player before and during first-time phacoemulsification, and 165 patients underwent surgery without music. Systolic and diastolic blood pressures were significantly lower in the music intervention group at the postoperative time point, with similar physiologic measures between groups during the perioperative time points. In the preoperative period before music exposure, 62 patients (38%) in the music group reported being very or extremely anxious. After 10 minutes of music exposure, only 7 patients (4%) reported this anxiety level. In the perioperative period, 80 patients (48%) in the intervention group reported feeling not at all or a little anxious, compared to 50 patients (30%) of the control group. In the postoperative period, 139 (84%) music group patients felt not at all or a little anxious after surgery compared with 92 patients (56%) in the control group.CONCLUSION: Marked reductions in self-reported anxiety before, during, and after surgery when exposed to music and a significant decrease in postoperative blood pressure showed music can be an inexpensive and effective solution to improve the patient experience of cataract surgery in the high-volume setting.

    View details for DOI 10.1097/j.jcrs.0000000000000485

    View details for PubMedID 33196574

  • Diagnostic challenges in a case of an isolated third nerve palsy. American journal of ophthalmology case reports Sivakumar, P., Palanive, S., Gochait, D., Hess, O. 2020; 18: 100585


    Neuro-ophthalmic manifestations may be the first and sole presenting feature of a nasopharyngeal carcinoma. Peri-neural spread is an emerging phenomenon that explains the distant spread of tumour cells well beyond the local extent of invasion. This under recognized route of tumour spread often results in delayed diagnosis and reduced life expectancy. The authors report a case of an isolated third nerve palsy as the only initial manifestation of nasopharyngeal carcinoma and emphasize the need for a high index of suspicion.The patient presented with left painful pupil involving complete third nerve palsy. Contrast enhanced imaging was initially deferred due to renal impairment. Plain MRI with MRA brain was normal. Hematology was suggestive of giant cell arteritis which is a rare but well documented cause of painful nerve palsies in the elderly. Unresponsiveness to steroids prompted contrast imaging with a reduced gadolinium dosing and hemodialysis backup which finally revealed a nasopharyngeal carcinoma.This report is the journey of a third nerve palsy from a clinical diagnosis of an aneurysm (pupil involving palsy) to a probable diagnosis of giant cell arteritis (based on hematology) and to a final diagnosis of nasopharyngeal carcinoma (based on contrast imaging and immunohistochemistry)Nasopharyngeal carcinoma can be successfully cured if detected early. This report highlights the various manifestations of nasopharyngeal carcinoma and challenges faced in diagnosing this elusive tumor.

    View details for DOI 10.1016/j.ajoc.2020.100585

    View details for PubMedID 32099933

    View details for PubMedCentralID PMC7031130

  • Knowledge, attitude and practise toward COVID-19 among patients presenting to five tertiary eye care hospitals in South India - A multicentre questionnaire-based survey. Indian journal of ophthalmology Christy, J. S., Kaur, K. n., Gurnani, B. n., Hess, O. M., Narendran, K. n., Venugopal, A. n., Anuja, J. n., Manohar, D. n., Raman, R. n., Venkatesh, R. n. 2020; 68 (11): 2385–90


    The aim of this study was to assess the knowledge, attitude, and practice (KAP) pattern towards COVID-19, among patients presenting to eye care hospitals during the last phase of lockdown period.A multicenter cross-sectional survey was conducted from May 15 to June 15, 2020 in five tertiary eye care hospitals in South India to assess the KAP towards COVID-19. Each of the hospitals belonged to one of the three different zones assigned in India based on number of infections. Red zones represent hotspots and orange/green zones represent regions with medium and lower caseloads, respectively. A validated questionnaire was administered through telephone and responses were recorded on a Google form.Out of the total (n = 6119) participants, 3081 were from hospitals in green zone, 2110 from the orange zone, and 928 from red zone. Majority of participants were above 50 years of age (42%) and 15.54% were illiterate. The mean (percentage) scores of knowledge, attitude, and practice were 21.26 (82%), 9.37 (92%), and 10.32 (86%), respectively. KAP among patients more than 50 years of age and in illiterate individuals was significantly less (P < 0.01) when compared with all other groups. Participants from red zone had a significantly better attitude (P < 0.01) compared to other centers.Although the overall KAP regarding COVID-19 disease was robust (above 80% in all categories) in our participants, the high risk elderly population (>50 years) and illiterate individuals had a significantly lower KAP. These are populations in which education should be emphasized and appropriately delivered as a way to reduce COVID-19 risk.

    View details for DOI 10.4103/ijo.IJO_2522_20

    View details for PubMedID 33120624

  • Artificial Intelligence in Global Ophthalmology: Using Machine Learning to Improve Cataract Surgery Outcomes at Ethiopian Outreaches. Journal of cataract and refractive surgery Brant, A. R., Hinkle, J. n., Shi, S. n., Hess, O. n., Zubair, T. n., Pershing, S. n., Tabin, G. C. 2020


    Differences between target and implanted intraocular lens (IOL) power in Ethiopian cataract outreach campaigns were evaluated and machine learning (ML) applied to optimize IOL inventory and minimize avoidable refractive error. Patients from Ethiopian cataract campaigns with available target and implanted IOL records were identified and the diopter difference between the two measured. A gradient descent (an ML algorithm) was used to generate an optimal IOL inventory and measured the model's performance across varying surplus levels.Only 45.6% of patients received their target IOL power and 23.6% received underpowered IOLs with current inventory (50% surplus). The ML-generated IOL inventory ensured that >99.5% of patients received their target IOL when using only 39% IOL surplus.In Ethiopian cataract campaigns, the majority of patients have avoidable postoperative refractive error secondary to suboptimal IOL inventory. Optimizing IOL inventory using our ML model might eliminate refractive error from insufficient inventory and reduce costs.

    View details for DOI 10.1097/j.jcrs.0000000000000407

    View details for PubMedID 32932371