International Council of Ophthalmologys Ophthalmology Surgical Competency Assessment Rubrics (ICOOSCAR)

The International Council of Ophthalmologys Ophthalmology Surgical Competency Assessment Rubrics (ICOOSCAR) are designed to facilitate assessment and teaching of surgical s ill!"#$ Surgical procedures are bro en do%n to indi&idual steps and each step is graded on a scale of no&ice# beginner# ad&anced beginner and competent! A description of the performance necessary to achie&e each grade in each step is gi&en! The assessor simply circles the obser&ed performance description at each step of the procedure! The ICO-OSCAR should be completed at the end of the case and immediately discussed %ith the student to pro&ide timely# structured# specific performance feedbac ! These tools %ere de&eloped by panels of international e'perts and are &alid assessments of surgical s ill! Thus far# ICO-OSCARs ha&e been produced for e'tracapsular cataract e'traction# small incision cataract surgery and phacoemulsification! Similar tools for strabismus surgery and lateral tarsal strip surgery are nearly complete! The plan is to produce a toolbo' of ICO-OSCARs for each ophthalmic subspecialty!

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ICO-Ophthalmology Surgical Competency Assessment Rubric Extracapsular Cataract Extraction (ICO-OSCAR ECCE)
9ate :::::::::: Resident :::::::::::: /&aluator :::::::::::
9raping ;o&ice (score < $) *eginner (score < =) Ad&anced *eginner (score < 5) Competent (score < 7) ;ot applicable! 9one by preceptor (score< 1)

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>nable to start draping %ithout 9rapes %ith minimal &erbal instruction! help! 9rape needs to be redone! Incomplete lash co&erage! Achie&es acceptable eye position and stability %ith some difficulty!

-ashes mostly co&ered# drape is at most minimally obstructing &ie%! Achie&es good eye position and stability! Achie&es good scleral access %ith mild difficulty! AdeAuate cauteri?ation!

-ashes completely co&ered and clear of incision site# drape not obstructing &ie%! 0recisely and consistently stabili?es eye in good position! 0recisely and deftly accesses sclera! Appropriate and precise cauteri?ation!

/ye position and stability >nable to stabili?e eye in good position! Scleral access @ Cauteri?ation

>nable to successfully access Accesses sclera but %ith difficulty and sclera! Cauteri?ation insufficient hesitation! Cauteri?ation insufficient or or e'cessi&e both in intensity and e'cessi&e in location or intensity! locali?ation!

Scleral or Corneo-scleral Inappropriate incision depth# Incision location# and si?e!

Only one of the follo%ing is done Only t%o of the follo%ing are done correctly4 incision depth# location or si?e! correctly4 incision depth# location or si?e! ReAuires minimal instruction! >ses at appropriate time! Administers adeAuate amount and type! Cannula tip in good position!

(ood incision depth# location and si?e!

>nsure of %hen# %hat type and ReAuires minimal instruction! )no%s ho% much &iscoelastic to use! %hen to use but administers incorrect ,iscoelastic4 Appropriate +as difficulty or multiple amount or type! >se and Safe Insertion unsuccessful attempts at accessing anterior chamber through paracentesis! A% %ard or rough mo&ements /ither a% %ard or rough mo&ements of of cystitome# digging too deep or cystitome but not both2 depth of attempts too superficial# lens mo&ement adeAuate but not optimal# some lens Anterior Capsulotomy endangers ?onules# poor control mo&ement# intermittent poor control of ris s radiali?ation! 9ifficulty capsulotomy! .inor difficulty e&erting initiali?ing and eeping flap the flap! e&erted! Inappropriate %ound architecture Iris prolapse# lea age %ith local pressure! andDor si?e# iris is damaged 0ro&ides poor surgical access to and during the maneu&er! Incomplete &isibility of capsule and bag! Cound /nlargement enlargement# loss of tissue plane# residual strands across incision!

,iscoelastics are administered in appropriate amount and at the appropriate time %ith cannula tip clear of lens capsule and endothelium %ith no instruction!

(entle but imprecise mo&ements of (entle precise mo&ements of cystitome2 cystitome2 depth of attempts adeAuate but depth and control correct for may not be optimal OR some lens appropriately si?ed capsulotomy! mo&ement OR intermittent poor control of capsulotomy! .ay be mild lea age# allo%s adeAuate e'traction of nucleus! Incision edges not parallel! *e&eled precise parallel incision edges# no iris prolapse# allo%s easy e'traction of nucleus!

E "1

Rough and incomplete +ydrodissection is rough or incomplete +ydrodissection and lens mobili?ation is 0recise and controlled hydrodissection! ;ucleus +ydrodissection hydrodissection of lens-capsular but able to recogni?e and correct %ith imprecise but accomplished in one to se&eral adhesions pre&enting lens multiple attempts! attempts %ithout assistance! rotation or e'traction# not recogni?ed by surgeon! Attempt causes radiali?ation of .o&ements coordinated but still unable to >ncoordinated and imprecise mo&ements ;ucleus remo&ed %ith de'terity# %ell capsulorrhe'is or tear in posteriore'tract nucleus! but %ith successful lens nucleus e'traction! controlled mo&ements and techniAue! ;ucleus /'traction capsule2 unable to hold and e'tract lens nucleus! Irrigation and Aspiration (reat difficulty introducing the .oderate difficulty introducing aspiration .inimal difficulty introducing the aspiration Aspiration tip is introduced under the TechniAue aspiration tip under the anterior tip under anterior capsule and maintaining tip under the anterior capsule# aspiration free border of the anterior capsule in

capsule# aspiration hole position hole up position# attempts to aspirate not controlled# cannot regulate %ithout occluding tip# sho%s poor aspiration flo% as needed# cannot comprehension of aspiration dynamics# Cith AdeAuate Remo&al peel cortical material adeAuately# cortical peeling is not %ell controlled# of Corte' engages capsule or iris %ith Fer y and slo%# capsule potentially aspiration port! compromised! 0rolonged attempts result in minimal residual cortical material! >nable to insert IO-!

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-ens Insertion# Rotation# and 8inal 0osition of Intraocular -ens Cannot reliably load suture! Instruction is reAuired and stitches are placed in an a% %ard# slo%# non-radial fashion %ith much difficulty# consistently in the %rong tissue plane# has to repeat same stitch!

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Cound Closure4 Suture handling @ 0lacement

hole usually up# corte' %ill engaged for =B1 irrigation mode %ith the aspiration hole degrees# cortical peeling slo%# fe% technical up# Aspiration is acti&ated in Fust enough errors# minimal residual cortical material! flo% as to occlude the tip# efficiently Some difficulty in remo&ing sub-incisional remo&es all corte'# The cortical material corte'! is peeled gently to%ards the center of the pupil# tangentially in cases of ?onular %ea ness! ;o difficulty in remo&ing sub-incisional corte'! Insertion and manipulation of IO- is Insertion and manipulation of IO- is Insertion and manipulation of IO- is difficult# eye handled roughly# anterior accomplished %ith minimal anterior performed in a deep and stable anterior chamber not stable# repeated attempts chamber instability# incision Fust adeAuate chamber and capsular bag# %ith incision result in borderline incision for implant for implant type# the lo%er haptic is placed appropriate for implant type! The lo%er type! Repeated hesitant attempts result in inside the capsular bag %ith some difficulty# haptic is smoothly placed inside the lo%er haptic in the capsular bag# upper upper haptic is rotated into place! capsular bag2 the upper haptic is rotated haptic is rotated into place! or gently bent and inserted into place! Some difficulty loading and placing Able to load sutures consistently! Stitches ;o difficulty loading or placing sutures sutures# often in %rong tissue plane# are placed %ith minimal difficulty usually in consistently in correct tissue plane! resuturing may be needed! correct tissue plane! All sutures radial and of adeAuate length Sutures not radial or appropriately spaced! Sutures mostly radial and of adeAuate length and space bet%een sutures! and space bet%een sutures!

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>nable to get tension correct# multiple corneal striae present# Cound Closure4 Suture incorrect number of thro%s# tying @ )not rotation nots often not buried! >nable to remo&e &iscoelastics thoroughly! >nable to ma e incision %ater tight or does not chec %ound for seal! Improper final IO0!

>ne&en suture tension# some corneal Sutures tied tight enough to maintain the Sutures are tied tight enough to maintain striae# number of thro%s usually correct# %ound closed# may ha&e slight corneal the %ound closed# but not too tight as to most nots buried! distortion# rare not not buried adeAuately! induce astigmatism! All nots buried! ;o corneal striae! Guestionable %hether all &iscoelastics are Viscoelastics are adeAuately remo&ed after thoroughly remo&ed# /'tra maneu&ers are this step %ith some difficulty! The incision reAuired to ma e the incision %ater tight is chec ed and is %ater tight or needs at the end of the surgery! .ay ha&e minimal adFustment at the end of the improper IO0# but recogni?es possibility! surgery! .ay ha&e improper IO0 but recogni?es and treats IO0! /ye often not in primary position# freAuent distortion folds! /ye usually in primary position# mild corneal distortion folds occur! Viscoelastics are thoroughly remo&ed after this step# the incision is chec ed and is %ater tight at the end of the surgery! 0roper final IO0!

"5

Cound Closure4 &iscoelastic remo&al# %ound hydration# %ound security !lobal In"ices

"7

;early constant eye mo&ement Cound ;eutrality and and corneal distortion! .inimi?ing /ye Rolling and Corneal 9istortion /ye 0ositioned Centrally Constantly reAuires Cithin .icroscope ,ie% repositioning! ConFuncti&al and Corneal Tissue handling is rough and Tissue +andling damage occurs! Instruments often in contact %ith Intraocular Spatial capsule# iris or corneal A%areness endothelium! Iris constantly at ris # handled Iris 0rotection roughly!

"B "6 "3 "E

Occasional repositioning reAuired! Tissue handling borderline# minimal damage occurs! Occasional accidental contact %ith capsule# iris and corneal endothelium!

The eye is ept in primary position during the surgery! ;o distortion folds are produced! The length and location of incisions pre&ents distortion of the cornea! .ild fluctuation in pupil position! The pupil is ept centered during the surgery! Tissue handling appropriate but potential for Tissue is not damaged nor at ris by damage e'ists! handling! Rare accidental contact %ith capsule# iris ;o accidental contact %ith capsule# iris and corneal endothelium! or corneal endothelium! Iris is uninFured! Iris hoo s# ring# or other methods are used as needed to protect the iris!

Iris occasionally at ris ! ;eeds help in Iris generally %ell protected! Slight deciding %hen and ho% to use hoo s# ring difficulty %ith iris hoo s# ring# or other or other methods of iris protection! methods of iris protection!

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O&erall Speed and 8luidity of 0rocedure

+esitant# freAuent starts and Occasional starts and stops# inefficient Occasional inefficient andDor unnecessary Inefficient andDor unnecessary stops# not at all fluid! Case and unnecessary manipulations common# manipulations occur# case duration about 57 manipulations are a&oided# case duration duration greater than B1 minutes! case duration about B1 minutes! minutes! is appropriate for case difficulty! In general# =1 minutes should be adeAuate!

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