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Impact of stereoacuity on simulated cataract surgery ability


Background and objectives

There exists a long-standing perception that diminished stereoacuity has a detrimental effect on microsurgical ability and skills acquisition. This has potential implications on the enrolment of surgical trainees into ophthalmology and other microsurgery specialities. However, strong evidence in this area is lacking. This case–control study aims to establish the exact level of stereopsis impairment at which a statistical drop in surgical performance occurs.


Fifty participants were enrolled from the University of Dundee Medical School and the NHS Tayside Foundation Doctor programme. Participants were assessed for their stereopsis level before completing an orientation module on an ophthalmic surgical simulator. They were then required to repeat a task four times. Automated and objective performance levels were recorded and analysed.


Nineteen (38%) had stereopsis lower than the defined normal of 60 seconds of arc (arcsec). Statistical analysis found no correlation between visual acuity and surgical performance. No statistical difference was found between performance scores and stereoacuities of 30, 60 and 120 arcsec. A statistically significant difference was discovered in the surgical performance of participants with a stereoacuity worse than 120 arcsec (total score = −69.85) as compared to the ones with a stereoacuity of 120 arcsec or better (total score = −42.23) with p = 0.010.


This study provides evidence of a specific level of stereopsis where statistical degradation of surgical performance occurs. The findings of this work may help formulate policy on stereoacuity standards required to commence microsurgical training.

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Fig. 1: A Comparative Analysis of Tissue Injury and Total Score for Participants with Stereoacuity better and worse than <120 seconds of arc.

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  1. Nibourg LM, Wanders W, Cornelissen FW, Koopmans SA. Influence of stereoscopic vision on task performance with an operating microscope. J Cataract Refract Surg. 2015;41:1919–25.

    Article  Google Scholar 

  2. Sachdeva R, Traboulsi EI. Performance of patients with deficient stereoacuity on the EYESi microsurgical simulator. Am J Ophthalmol. 2011;151:427–33.

    Article  Google Scholar 

  3. Bishop PO. Binocular vison. In: Moses RA, Hart WM, editors. Adler’s physiology of the eye: clinical application. St Louis: CV Mosby, 1987. p. 619e89.

  4. Selvander M, Åsman P. Stereoacuity and intraocular surgical skill: effect of stereoacuity level on virtual reality intraocular surgical performance. J Cataract Refract Surg. 2011;37:2188–93.

    Article  Google Scholar 

  5. Piano ME, Tidbury LP, O’Connor AR. Normative values for near and distance clinical tests of stereoacuity. Strabismus. 2016;24:169–72.

    Article  Google Scholar 

  6. Wong NW, Stokes J, Foss AJ, McGraw PV. Should there be a visual standard for ophthalmologists and other surgeons? Postgrad Med J. 2010;86:354–8.

    Article  Google Scholar 

  7. Royal College of Ophthalmologists. Royal College of 2020.

  8. American Academy of Ophthalmology. American Academy of 2020.

  9. Robaei D, Huynh SC, Kifley A, Gole GA, Mitchell P. Stereoacuity and ocular associations at age 12 years: findings from a population-based study. J Am Assoc Pediatr Ophthalmol Strabismus. 2007;11:356–61.

    Article  Google Scholar 

  10. VRMagic. EYESi ophthalmic surgery simulator user guide. Mannheim: VRMagic; 2006. p. 58e9.

  11. Simons K. A comparison of the Frisby, Random-Dot E, TNO, and Randot circles stereotests in screening and office use. Arch Ophthalmol. 1981;99:446–52.

    CAS  Article  Google Scholar 

  12. Waqar S, Williams O, Park J, Modi N, Kersey T, Sleep T. Can virtual reality simulation help to determine the importance of stereopsis in intraocular surgery? Br J Ophthalmol. 2012;96:742–6.

    Article  Google Scholar 

  13. Dutton J, Watkins A, Henderson J, Burgess FR, Tint NL, Dhillon B, et al. Influence of stereopsis on the ability to perform simulated microsurgery. J Cataract Refract Surg. 2020;46:549–54.

    Article  Google Scholar 

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We would like to acknowledge the funding from the Royal College of Surgeons Edinburgh.

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Correspondence to S. Burgess.

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Burgess, S., Kousha, O., Khalil, M. et al. Impact of stereoacuity on simulated cataract surgery ability. Eye 35, 3116–3122 (2021).

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