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International Council of Ophthalmologys Ophthalmology Surgical Competency Assessment Rubrics (ICO-

OSCAR)

The International Council of Ophthalmologys Ophthalmology Surgical Competency Assessment Rubrics (ICO-

OSCAR) are designed to facilitate assessment and teaching of surgical sill!"#$Surgical procedures are broen 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 sill! 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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8igure $

ICO-Ophthalmology Surgical Competency Assessment Rubric Extracapsular Cataract Extraction (ICO-OSCARECCE)9ate ::::::::::Resident ::::::::::::/&aluator :::::::::::

;o&ice

(score < $)

*eginner

(score < =)

Ad&anced *eginner

(score < 5)

Competent

(score < 7)

;ot

applicable!9one by

preceptor(score< 1)

"9raping >nable to start draping %ithout

help! 9rape needs to be redone!

9rapes %ith minimal &erbal instruction!

Incomplete lash co&erage!

ashes mostly co&ered# drape is at most

minimally obstructing &ie%!

ashes completely co&ered and clear of

incision site# drape not obstructing &ie%!

$/ye position and stability >nable to stabili?e eye in good

position!Achie&es acceptable eye position andstability %ith some difficulty!

Achie&es good eye position and stability! 0recisely and consistently stabili?es eyein good position!

=

Scleral access @

Cauteri?ation

>nable to successfully accesssclera! Cauteri?ation insufficient

or e'cessi&e both in intensity andlocali?ation!

Accesses sclera but %ith difficulty andhesitation! Cauteri?ation insufficient or

e'cessi&e in location or intensity!

Achie&es good scleral access %ith milddifficulty! Adeuate cauteri?ation!

0recisely and deftly accesses sclera!Appropriate and precise cauteri?ation!

5Scleral or Corneo-scleral

Incision

Inappropriate incision depth#

location# and si?e!

Only one of the follo%ing is done

correctly4 incision depth# location or si?e!

Only t%o of the follo%ing are done

correctly4 incision depth# location or si?e!

ood incision depth# location and si?e!

7 ,iscoelastic4 Appropriate>se and Safe Insertion

>nsure of %hen# %hat type and

ho% much &iscoelastic to use!

+as difficulty or multipleunsuccessful attempts at

accessing anterior chamber

through paracentesis!

Reuires minimal instruction! no%s

%hen to use but administers incorrect

amount or type!

Reuires minimal instruction! >ses at

appropriate time! Administers adeuate

amount and type! Cannula tip in goodposition!

,iscoelastics are administered in

appropriate amount and at the

appropriate time %ith cannula tip clearof lens capsule and endothelium %ith no

instruction!

B Anterior Capsulotomy

A%%ard or rough mo&ements

of cystitome# digging too deep ortoo superficial# lens mo&ement

endangers ?onules# poor controlriss radiali?ation!9ifficulty

initiali?ing and eeping flape&erted!

/ither a%%ard or rough mo&ements of

cystitome but not both2 depth of attemptsadeuate but not optimal# some lens

mo&ement# intermittent poor control ofcapsulotomy! .inor difficulty e&erting

the flap!

entle but imprecise mo&ements of

cystitome2 depth of attempts adeuate butmay not be optimal OR some lens

mo&ement OR intermittent poor control ofcapsulotomy!

entle precise mo&ements of cystitome2

depth and control correct forappropriately si?ed capsulotomy!

6 ound /nlargement

Inappropriate %ound architecture

andDor si?e# iris is damaged

during the maneu&er! Incomplete

enlargement# loss of tissue plane#

residual strands across incision!

Iris prolapse# leaage %ith local pressure!

0ro&ides poor surgical access to and

&isibility of capsule and bag!

.ay be mild leaage# allo%s adeuate

e'traction of nucleus! Incision edges not

parallel!

*e&eled precise parallel incision edges#

no iris prolapse# allo%s easy e'traction

of nucleus!

3;ucleus +ydrodissection

Rough and incompletehydrodissection of lens-capsular

adhesions pre&enting lens

rotation or e'traction# not

recogni?ed by surgeon!

+ydrodissection is rough or incompletebut able to recogni?e and correct %ith

multiple attempts!

+ydrodissection and lens mobili?ation isimprecise but accomplished in one to se&eral

attempts %ithout assistance!

0recise and controlled hydrodissection!

E ;ucleus /'traction

Attempt causesradiali?ation of

capsulorrhe'is or tear in posterior

capsule2 unable to hold and

e'tract lens nucleus!

.o&ements coordinated but still unable to

e'tract nucleus!

>ncoordinated and imprecise mo&ements

but %ith successful lens nucleus e'traction!

;ucleus remo&ed %ith de'terity# %ell

controlled mo&ements and techniue!

"1 Irrigation and AspirationTechniue

reat difficulty introducing the

aspiration tip under the anterior

.oderate difficulty introducing aspiration

tip under anterior capsule and maintaining

.inimal difficulty introducing the aspiration

tip under the anterior capsule# aspiration

Aspiration tip is introduced under the

free border of the anterior capsule in

$

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ith Adeuate Remo&alof Corte'

capsule# aspiration hole position

not controlled# cannot regulateaspiration flo% as needed# cannot

peel cortical material adeuately#engages capsule or iris %ith

aspiration port!

hole up position# attempts to aspirate

%ithout occluding tip# sho%s poorcomprehension of aspiration dynamics#

cortical peeling is not %ell controlled#Fery and slo%# capsule potentially

compromised! 0rolonged attempts resultin minimal residual cortical material!

hole usually up# corte' %ill engaged for =B1

degrees# cortical peeling slo%# fe% technicalerrors# minimal residual cortical material!

Some difficulty in remo&ing sub-incisionalcorte'!

irrigation mode %ith the aspiration hole

up# Aspiration is acti&ated in Fust enoughflo% as to occlude the tip# efficiently

remo&es all corte'# The cortical materialis peeled gently to%ards the center of the

pupil# tangentially in cases of ?onular%eaness! ;o difficulty in remo&ing

sub-incisional corte'!

""ens Insertion# Rotation#

and 8inal 0osition ofIntraocular ens

>nable to insert IO! Insertion and manipulation of IO is

difficult# eye handled roughly# anterior

chamber not stable# repeated attempts

result in borderline incision for implanttype! Repeated hesitant attempts result in

lo%er haptic in the capsular bag# upper

haptic is rotated into place!

Insertion and manipulation of IO is

accomplished %ith minimal anterior

chamber instability# incision Fust adeuate

for implant type# the lo%er haptic is placedinside the capsular bag %ith some difficulty#

upper haptic is rotated into place!

Insertion and manipulation of IO is

performed in a deep and stable anterior

chamber and capsular bag# %ith incision

appropriate for implant type! The lo%erhaptic is smoothly placed inside the

capsular bag2 the upper haptic is rotated

or gently bent and inserted into place!

"$ound Closure4 Suture

handling @ 0lacement

Cannot reliably load suture!Instruction is reuired 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!

Some difficulty loading and placingsutures# often in %rong tissue plane#

resuturing may be needed!

Sutures not radial or appropriately spaced!

Able to load sutures consistently! Stitchesare placed %ith minimal difficulty usually in

correct tissue plane!

Sutures mostly radial and of adeuate length

and space bet%een sutures!

;o difficulty loading or placing suturesconsistently in correct tissue plane!

All sutures radial and of adeuate length

and space bet%een sutures!

"= ound Closure4 Suturetying @ not rotation

>nable to get tension correct#

multiple corneal striae present#incorrect number of thro%s#

nots often not buried!

>ne&en suture tension# some corneal

striae# number of thro%s usually correct#most nots buried!

Sutures tied tight enough to maintain the

%ound closed# may ha&e slight cornealdistortion# rare not not buried adeuately!

;o corneal striae!

Sutures are tied tight enough to maintain

the %ound closed# but not too tight as toinduce astigmatism! All nots buried!

"5

ound Closure4

&iscoelastic remo&al#

%ound hydration# %ound

security

>nable to remo&e &iscoelastics

thoroughly! >nable to mae

incision %ater tight or does not

chec %ound for seal! Improper

final IO0!

Guestionable %hether all &iscoelastics are

thoroughly remo&ed# /'tra maneu&ers are

reuired to mae the incision %ater tight

at the end of the surgery! .ay ha&e

improper IO0# but recogni?es possibility!

Viscoelastics are adeuately remo&ed afterthis step %ith some difficulty! The incision

is checed and is %ater tight or needs

minimal adFustment at the end of the

surgery! .ay ha&e improper IO0 but

recogni?es and treats IO0!

Viscoelastics are thoroughly remo&edafter this step# the incision is checed

and is %ater tight at the end of the

surgery! 0roper final IO0!

!lobal In"ices

"7

ound ;eutrality and

.inimi?ing /ye Rollingand Corneal 9istortion

;early constant eye mo&ementand corneal distortion!

/ye often not in primary position#freuent distortion folds!

/ye usually in primary position# mildcorneal distortion folds occur!

The eye is ept in primary positionduring the surgery! ;o distortion folds

are produced! The length and location ofincisions pre&ents distortion of the

cornea!

"B /ye 0ositioned Centrallyithin .icroscope ,ie%

Constantly reuires

repositioning!

Occasional repositioning reuired! .ild fluctuation in pupil position! The pupil is ept centered during the

surgery!

"6 ConFuncti&al and CornealTissue +andling

Tissue handling is rough and

damage occurs!

Tissue handling borderline# minimal

damage occurs!

Tissue handling appropriate but potential for

damage e'ists!

Tissue is not damaged nor at ris by

handling!

"3 Intraocular SpatialA%areness

Instruments often in contact %ith

capsule# iris or cornealendothelium!

Occasional accidental contact %ith

capsule# iris and corneal endothelium!

Rare accidental contact %ith capsule# iris

and corneal endothelium!

;o accidental contact %ith capsule# iris

or corneal endothelium!

"E Iris 0rotectionIris constantly at ris# handled

roughly!

Iris occasionally at ris! ;eeds help in

deciding %hen and ho% to use hoos# ring

or other methods of iris protection!

Iris generally %ell protected! Slight

difficulty %ith iris hoos# ring# or other

methods of iris protection!

Iris is uninFured! Iris hoos# ring# or

other methods are used as needed to

protect the iris!

=

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$1 O&erall Speed and8luidity of 0rocedure

+esitant# freuent starts and

stops# not at all fluid! Caseduration greater than B1 minutes!

Occasional starts and stops# inefficient

and unnecessary manipulations common#case duration about B1 minutes!

Occasional inefficient andDor unnecessary

manipulations occur# case duration about 57minutes!

Inefficient andDor unnecessary

manipulations are a&oided# case durationis appropriate for case difficulty! In

general# =1 minutes should be adeuate!

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