VR and AR Reshape Ophthalmic Surgical Training
Virtual reality (VR) and augmented reality (AR) technologies are changing the way ophthalmologists are trained in cataract, retinal, and other microsurgical procedures, according to a recent review published in Clinical Ophthalmology.
The review examined the growing use of VR and AR in ophthalmic surgical education and assessed current technologies used to support surgical training. It also identified areas necessitating further assessment.
The paper, titled “Virtual Reality in Ophthalmic Surgical Education: Current Innovations and Future Perspectives,” was authored by researchers from Oregon Health & Science University, Florida Atlantic University, and the Veterans Affairs Portland Health Care System in the United States.
The review reported that traditional ophthalmic surgical training relies largely on wet-lab practice using model or cadaver eyes, followed by supervised surgery on live patients. These methods have been used extensively in surgical education but can necessitate considerable resources. The review also noted that complication risks may be higher when surgeons are at the beginning of their learning curve.
Virtual reality systems were described as delivering a structured environment in which ophthalmology residents can practise surgical techniques without relying on live patients. The review examined a range of platforms, including specialist ophthalmic simulators and consumer VR devices.
Among the systems assessed were Haag-Streit’s Eyesi simulator, HelpMeSee and the Alcon Fidelis platform. Consumer technologies reviewed included Apple Vision Pro and Meta Quest devices.
The review identified Eyesi as the most established ophthalmic surgical simulator. According to the paper, the platform has been adopted by residency programmes worldwide and is supported by a substantial body of evidence. Studies referenced in the review associated the simulator with improved surgical performance, greater trainee confidence and reduced complication rates.
The review also examined evidence relating to the HelpMeSee platform. Studies cited in the paper found that trainees using the simulator made significantly fewer surgical errors during manual small-incision cataract surgery (MSICS) training. The platform was also reported to distinguish between beginner and expert surgeons.
The review found that newer technologies are extending the range of available training tools. One example involved using the Apple Vision Pro with ZEISS Surgery Optimiser software. The system allows users to review recordings of cataract procedures in three dimensions. The review noted that this approach closely resembles viewing surgery through a surgical microscope.
Formal validation studies for the technology were reported to be limited. However, the review noted that the system allows residents to examine their own procedures and observe surgeries performed by experienced surgeons in a three-dimensional environment.
Applications developed for Meta Quest devices were also examined. RetinaVR, a platform created for vitreoretinal surgery training, was reported to have shown preliminary evidence of construct validity. Findings from the review indicated that experienced surgeons achieved better results than novice users on measures of exactness and safety.
The review also discussed the American Academy of Ophthalmology’s VR Education app. The application enables trainees to practise diagnosing and managing retinopathy of prematurity within a virtual environment.
Cost was identified as a factor affecting access to training technologies. The review noted that dedicated simulators such as Eyesi can cost more than A$235,000. Consumer devices, including Apple Vision Pro and Meta Quest, were identified as lower-cost alternatives for training institutions.
The paper also examined the potential application of artificial intelligence in VR-based surgical education. According to the review, AI systems could automatically assess surgical performance, identify complications, and provide feedback using data from surgical recordings.
The review noted that many emerging technologies continue to lack solid validation studies and long-term clinical outcome data. It stated that larger studies and standardised evaluation methods are needed to assess these platforms more fully.
The authors reported that immersive technologies are assuming a larger role in ophthalmic education. The review stated that some VR platforms have exhibited promising validity, while evidence for other technologies remains limited.
The paper also discussed the possible integration of machine learning analytics and advanced three-dimensional surgical environments capable of emulating complex intraoperative scenarios, including shallow chambers and zonular dialysis.
The review concluded that VR-based technologies are expanding within ophthalmic surgical education and that continued validation will be important in assessing their effectiveness and wider application in training programmes worldwide.
