Use of Machine Learning to Assess Cataract Surgery Skill Level With Tool Detection


To develop a method for objective analysis of the reproducible steps in routine cataract surgery.


Prospective study; machine learning.


Deidentified faculty and trainee surgical videos.


Consecutive cataract surgeries performed by a faculty or trainee surgeon in an ophthalmology residency program over 6 months were collected and labeled according to degrees of difficulty. An existing image classification network, ResNet 152, was fine-tuned for tool detection in cataract surgery to allow for automatic identification of each unique surgical instrument. Individual microscope video frame windows were subsequently encoded as a vector. The relation between vector encodings and perceived skill using k-fold user-out cross-validation was examined. Algorithms were evaluated using area under the receiver operating characteristic curve (AUC) and the classification accuracy.

Main outcome measures:

Accuracy of tool detection and skill assessment.


In total, 391 consecutive cataract procedures with 209 routine cases were used. Our model achieved an AUC ranging from 0.933 to 0.998 for tool detection. For skill classification, AUC was 0.550 (95% confidence interval [CI], 0.547-0.553) with an accuracy of 54.3% (95% CI, 53.9%-54.7%) for a single snippet, AUC was 0.570 (0.565-0.575) with an accuracy of 57.8% (56.8%-58.7%) for a single surgery, and AUC was 0.692 (0.659-0.758) with an accuracy of 63.3% (56.8%-69.8%) for a single user given all their trials.


Our research shows that machine learning can accurately and independently identify distinct cataract surgery tools in videos, which is crucial for comparing the use of the tool in a step. However, it is more challenging for machine learning to accurately differentiate overall and specific step skill to assess the level of training or expertise.

Financial disclosures:

The author(s) have no proprietary or commercial interest in any materials discussed in this article.


AUC, area under the receiver operating characteristic curve; Artificial intelligence; CI, confidence interval; Cataract surgery; Education.

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