15 EyeWorld Asia-Pacific | June 2025 CATARACT He added that although the necessary technology has been available for years, its impact on surgical training was initially limited by a scarcity of online content. “Fortunately, this landscape is shifting dramatically,” he said. “An increasing number of surgeons are now using online platforms to share educational materials, enriching the learning experience for their peers.” Anthony Chung, MD, said there are a number of simulation tools available in ophthalmology. He noted the Eyesi (Haag-Streit). “We’ve integrated these types of technologies thoroughly in the field,” he said. Since Dr. Chung has been in practice, he said that the recent trend has been to increase immersion by using virtual reality headsets to create a 3D world that you’re sitting in virtually. “I trained at a time when this had become commonplace for residents to have virtual reality,” Dr. Chung said. He noted that the extent to which these tools are integrated varies widely between programs, but he added that many programs have these simulators as part of the curriculum to gain experience. Jaclyn Haugsdal, MD, also noted some of the available virtual simulators. She mentioned that the Eyesi has been around the longest, and there are newer simulators being developed, such as those from HelpMeSee, Fidelis (Alcon), and FundamentalVR. Some of these are manual small incision cataract simulators, such as HelpMeSee and FundamentalVR, whereas Eyesi and the Fidelis are more focused on phacoemulsification simulation. One of the best features of virtual simulators is their capacity for repetition, Dr. Haugsdal said. “They usually are easy to set up and clean up, and it’s easy to get in many repetitions in a short timeframe without using additional resources or supplies. For beginners, the simulators provide realistic enough feel to help develop the basics of surgical techniques. With the benefit of easy repetition, they can be an excellent resource.” Simulators are also great at teaching hand positioning, moving in the eye, and maintaining centration. Dr. Krad said that in-person residency training is essential for establishing a strong foundation in ophthalmology. “However, my attendings emphasized the importance of lifelong learning, noting that many procedures they currently perform weren’t part of their own residency training,” he said. “While a solid foundation is crucial, digital tools can be incredibly effective for skill development postresidency. Without that strong initial foundation, though, there’s an increased risk of misinterpreting online content, potentially hindering one’s growth.” Dr. Krad said the journey to becoming a proficient surgeon involves building procedural familiarity, developing muscle memory, and gaining confidence. Each repetition, whether in a wet lab, online, or in a virtual environment, helps to reduce a trainee’s anxiety and bolster their confidence, ultimately leading to improved performance under pressure, he said. “A well-rounded training strategy that incorporates multiple modalities is essential for supporting the growth of future surgeons.” Dr. Chung said that digital tools like this are more of a self-directed learning option. “Because it’s self-directed, it can be like a video game,” he said. “You learn on your own and learn how to play the system, but whether or not that system is creating good habits for surgery is another thing.” He said that using these simulators also requires proper guidance when you’re first learning to ensure you’re using the right techniques. Speaking about the pros and cons of virtual simulators vs. traditional simulation, Dr. Haugsdal again mentioned that virtual simulators are easy to set up and clean and allow for repetition. They are also good at teaching hand positioning, moving in the eye, and maintaining centration. But they may come with cost or space limitations and could be missing a more realistic feel. A more traditional simulation approach (like with pig/cow eyes or with artificial eye models) could be more realistic and could use actual surgical equipment and instrumentation. But resources could be limited, making repetition difficult, and the use of biological material requires proper handling and cleaning. Many surgical simulators focus on cataracts, but Dr. Chung added that some have vitreoretinal modules on them, too. While these are unique ways to learn, Dr. Chung also believes in the combination of both virtual and traditional learning methods working together. “You need to be in front of patients and learning from the patients while doing your due diligence and practicing outside the OR,” he said. “I think all of these simulation techniques out there are supplemental to the traditional method of operating with the attending.” Anecdotally, Dr. Chung said he will often tell residents that the motion they use when performing the procedure is not terribly different from what he uses, but the difference he notices is in the pacing between each movement. Dr. Chung added that the wet lab is a passion of his, and he hopes there comes a time when wet lab curriculum is more standardized among programs. This will help define
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