<trinity Sight logo>
<Start of Right to sight video (slightly edited)> [first 30 seconds]
<slide show of African picture (maybe cataracts to be talked over.)
Cataracts are the leading cause of preventable blindness in the world.
According to the World Health Organisation, over 25 million eyes develop visual impairment due
to cataracts every year. Also there are 30 million cataract removal operations needed each year but
only 10 million performed.
Blindness due to cataracts affects 1 in every 200 people in sub Saharan Africa.
Cataracts are a major problem, especially in the developing world.
A cataract is a clouding that develops in the lens of the eye eventually stopping light entering the
eye and causing blindness.
The surgery is an outpatient procedure; the surgeon makes a small incision in the eye and carefully
breaks apart the cataract ensuring not to damage the rest of the eye.
Once removed a new lenses is inserted into the eye allowing the patient to regain their lost sight.
<right to sight logo → right to sight website>
The reason this curable disability is still such a problem is two fold:
Firstly shortage of surgeons available to perform the operations
Secondly lack of people to train new surgeons.
Working with the charity Right to Sight we set out to develop a cost effective surgical simulator.
Existing eye surgery simulators cost €180,000 – making them inaccessible to those in developing
Using Microsoft technology and off the shelf hardware components we have created a training
simulator that costs less than €500 including the pc on which it will operate.
The Cataract Removal Surgery consists of a small number of discrete steps, making it a prime
candidate for simulator training.
Working closely with eye surgeon Dr Kate Colman we modeled the steps required for the surgery.
Then using the XNA framework we built our simulator around these tasks.
Cataract Removal Surgery requires the surgeon to operate without directly looking at their hands.
Our Simulator will help trainees to overcome this dependence, as well as familiarizing them with
the major surgery steps.
The Simulator would also provide a way for trained surgeons to keep their skills sharp when there is
a shortage of Cataract patients – A problem many Cataract surgeons face even in the developed
Currently, a new cataract surgeon's training must be performed almost completely under the
supervision of a trained surgeon. Our Simulator would enable the most time consuming aspects of
the training process to be performed by the trainee alone, freeing up the severely limited resource of
trained surgeons and allowing them to see to a larger number of students.
<slowly un-blur picture of African child smiling>
This project will impact a huge number of people. By increasing the number of trainees the
qualified surgeons can see in the time available we will create a larger number of people able to
perform this operation.
With this in place the number of surgeries performed could be brought closer to the 30 million
needed every year.
The fact that 1 in 200 people in sub Saharan Africa are blind because of cataracts shows just how
many people our project will help.
The theme for this years cup is tied into the UN millennium goals
MDG 1 : Eradicate Extreme Poverty and Hunger
Blind people in Africa find it almost impossible to find work or support and in many cases are
completely dependent on other for their most basic needs.
*MDG 2*: Achieve universal primary education
Approximately 90% of visually impaired children in low-income countries are deprived of
*MDG 4*:Reduce Child Mortality.
Up to 60% of children in low income countries are likely to die within one year of becoming blind.
Moreover, around 500,000 children become blind each year
*MDG 5*: Improve Maternal Health
Seeing how difficult it is for a blind women to survive in Africa. Imagine if that woman is pregnant
*MDG 6*: Combat HIV/AIDS, malaria and other diseases
Cataract related blindness is a serious and wide spread disease which this project can alleviate.
*MDG 8*: Develop a global partnership
Our online community will foster a partnership between trained surgeons and trainees world wide.
As you can see our project to help alleviate cataract relates blindness clearly helps achieve these
In creating this simulator we used a wide range of technologies
(text in bold is shown on screen)
Our project was built using the dot net framework and is designed to run on a windows PC,
meaning people around the world will be able use our surgical simulator.
Visual Studio 2008/XNA 3.0
<video of code being edited in vis studio>
Visual studio was our development environment of choice throughout the project, as the simulator
is written in C#.
XNA is a tool set and a run time environment for creating computer games for the PC and X box
360.Although XNA is designed primarily for creating games, we felt it was a useful platform on
which to develop our surgical simulator. It allowed us to easily manage our content, for example
sound effects and models. We were also able to utilize it to create our simulators virtual world and
to detect interactions, such as collisions, between the objects in this world.
<model rotating in blender.>
All the Levels in our simulator are fully modeled in 3-D and for this we used Blender – an open-
source, cross platform development suite for 3-D content creation.
SilverLight & Expression Studio
As our project revolves around the training of cataract surgeons, we have been developing an online
community website and forum in tandem with the simulator itself, to enable trainee surgeons to
interact and receive help and advice wherever they are in the world. For this we used Microsoft
Expression Studio and Silverlight as well as Internet Forum Software.
Our simulator features a scoring system which can be connected to a world wide server to allow
trainees to get an idea of how they are progressing and to let surgeon monitor which trainees are
ready to move onto the next stage of training. This scoring system runs on a windows server with an
Motion Sensitive Controller
Our simulator uses a Motion Sensitive Controller as its user interface device. By using it in
combination with a small LED array , of our own design, it lets us transfer the users real life
movements into the same movements in the simulator world. Currently we are using Nintendo Wii-
motes for our motion sensitive controllers but are planning to transfer to the soon to be released
gametrack freedom cotrollers for the increased precision and control they’ll offer us.
As soon as we began work on this project, several of the Nintendo Wiimotes shortcomings
immediately became apparent to us. The Wiimote is quite a good pointer, but it was never designed
to accurately measure its 3d spatial coordinates in a virtual world, which is what we required for
This is the main menu of our surgical simulator from here you can select levels, access the options
menu, view the ranking systems and find more information on the charity we have been working
The first level represents Capsulorrhexis. This is the point in the surgery where a small incision is
made in the lens capsule and then gripping is a small circular hole is torn in it to allow easy access
to the cataract. In the simulator the user must grab the upper ball and pull it towards the center point
marked by the other sphere, frequently releasing it in order to get a circular tear. This is one of the
trickiest steps in the surgery and is a very delicate procedure.
The second level represents creating a scleral tunnel under the cataract. This lifts the cataract away
from the eye allowing it to be removed without damaging the eye below it. This is done using a
round edged blade in a sweeping motion to create the cut. Using our simple maze, the user gets
used to the sweeping motion needed by the surgery while also making sure to keep vertical
movement to a minimum to ensure the patients eye is not damaged.
The third level represents phaco grooving. The cataract must be broken into small pieces before it
can be removed by the phaco tool. This is done by carving a cross shaped groove in the cataract
allowing it to be easily snapped. The user must keep the tools inside the 2 incisions in the eye while
making the groove. As the cataract is no longer rooted to the eye it can now be rotated freely,
allowing the user to better access the parts of the cataract furthest from the incisions.
The fourth level shows the final aspiration of the remaining cataract through the small vacuum in
the phaco tool. In a similar vein to the previous level the user must remove the cataract pieces using
the phaco tool, while rotating the cataract to remove the furthest pieces.
Each user has a profile which saves their top score in each level. Also locally the top 10 scores on
each level are stored one a ranking table which is viewable from the ranking selection on the main
menu. Each unit can also connect to a centralised server which has the top 10 world wide scores for
each discipline. When ever the unit connects to the server before pulling down the top 10 scores the
list is checked against the units local scores and and updates the server list if necessary.
The options menu lets the user switch the controls to a left handed version and to change the
difficulty level of the training levels. This is done by scaling the distances received by the motion
sensitive controller to increase or decrease the size of the eye relative to the users movement.
(effectiveness, need information from Princeton.)
Despite using the Nintendo Wii mote as our motion sensitive controller, we have been looking into
other potential controller as we feel we could do with a more sensitive measurement of the users
movements. One of the controllers we have been looking at is the game trek freedom. At the time of
filming this is still unreleased but its is designed to give accurate real world position first and act as
a pointer second, the opposite of the Wii mote. Also it is compatible with the X box which would
further decrease the cost of one of our simulator set ups. Another option is the just announced
Project Natal. If this were sensitive enough, we could do away with bulky controllers and have the
trainees using similarly sized and shaped tools and just track the movements made by their hands
When you first start the simulator you are brought to the main menu. From here there are multiple
The trainee may choose a specific aspect of the surgery on which to train;
Adjust the simulator options; view the simulator rankings to gauge their improvement relative to
Or find out more about the charity Right to Sight.
Once in the options menu it’s possible to set the default controller for left or right handed users
And select the level of difficulty at which you wish to train. Once satisfied the trainee may confirm
The ranking section allows trainee surgeons to monitor their progress relative to both other students
and trained surgeons.
This is separated into the different surgery tasks, and saves the progress between training sessions.