ICO-OSCAR scoring for pediatric cataract surgeries performed by pediatric ophthalmology fellows in training-stage of fellowship and quality of surgery

PURPOSE To compare quality of surgical steps in pediatric cataract surgery performed by pediatric ophthalmology fellows in various stages of training by applying the International Council of Ophthalmology-Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR). METHODS Two experienced pediatric ophthalmologists analyzed video recordings of fellows performing pediatric cataract surgery at our institution between August 2019 and March 2020; fellows were scored according to the ICO-OSCAR with respect to the six key surgical step, namely, (1) wound construction, (2) anterior capsulorrhexis, (3) irrigation and aspiration, (4) intraocular lens implantation, (5) primary posterior capsulotomy (PPC)/anterior vitrectomy (AV), and (6) wound suturing. Cohen's kappa was used for inter-rater agreement. Fellows were categorized by months of training as stage 1 (first 6 months), stage 2 (7-18 months), and stage 3 (19-24 months). RESULTS We analyzed 79 procedures performed by 11 pediatric ophthalmology fellows. The inter-rater agreement ranged from 85% to 96%; k ranged from 0.64 to 0.91. Fellows in stages 2 and 3 of their training required less time and demonstrated superior technical proficiency in PPC and AV compared with fellows in stage 1 (median score, 4 vs 3). CONCLUSIONS Objective scoring of cataract surgeries performed by fellows at various stages of training highlighted the steep learning curve for PPC and AV and confirmed that execution improves with experience.