Construction, Validation and Application of a Low-Cost Simulator for Teaching Retinal Photography to Medical Students

• Grant number: 24/16042-9
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• Start date: March 01, 2025
• End date: January 31, 2029
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Alessandra Mazzo
• Grantee: Luís Expedito Sabage
• Host Institution: Hospital de Reabilitação de Anomalias Craniofaciais (HRAC). Universidade de São Paulo (USP). Bauru , SP, Brazil

Abstract

Rationale and Objectives: The retina serves as a reflection of the systemic microcirculation, offering a potential avenue for non-invasive assessment. However, in medical practice, its evaluation is predominantly limited to the domain of ophthalmologists. The use of low-cost portable simulators can facilitate medical education, which may result in more effective initial management and appropriate referral of patients with retinal diseases. In response to this need, this study aims to develop, validate, and apply a new device and teaching tool for fundoscopy and retinal photography that is accurate, cost-effective, simple to produce, and, most importantly, readily available, allowing for its use in clinical practice with telemedicine to screen for systemic diseases.Methods: This project will be carried out at FMBRU-USP in four stages. Stage 1, technological development study, which will entail the fabrication of an eyeball simulator utilizing a 3D printer, incorporating a dioptric system and retinal illustration for instructional purposes. Stage 2: methodological study to validate the simulator through analysis by experts and the target audience (medical students) using questionnaires relating to the low-cost framework, adaptation to reality, and usability. Stage 3, experimental study and qualitative study of the simulator's application and efficacy within an educational context. In the experimental study, students will be randomly assigned to one of three groups: Intervention Groups 1 and 2 and Control Group. Group 1 will receive training with the simulator that was built, while Group 2 will receive training with a commercially available simulator. Following this, the three groups will examine patients in the outpatient clinic using a smartphone and a 20D lens, with supervision provided by preceptors at all times. At the completion of the study, an evaluation and perception questionnaire will be administered to the students, preceptors and patients. The qualitative study will evaluate the perceptions of the students and patients. Stage 4, a cross-sectional observational study carried out in the riverside community of Calama in Rondônia with the aim of mapping the prevalence of diabetic retinopathy in the community using telemedicine. A photo of the posterior pole of each eye of 98 patients diagnosed with type 2 diabetes mellitus will be obtained using the photography technique developed. These images will be transmitted virtually to a specialist for evaluation and classification according to the severity of diabetic retinopathy. In instances where it is required, all patients will be duly referred to the public health system. This project will be submitted to the HRAC-USP Ethics Committee. Quantitative data will be evaluated separately, respectively, using parametric and non-parametric tests and factorial correspondence analysis. Qualitative data will be analyzed using Iramutec® software based on Reinert's analysis. The results will be presented in the form of a scientific report.