This study was designed to determine the effect of a novel simulation-based training curriculum for scleral tunnel construction in manual small incision cataract surgery (MSICS) compared with traditional training. In this multicenter, investigator-masked, randomized clinical trial, resident surgeons within 3 months of matriculation with minimal or no prior experience with MSICS were assigned either to simulation-based training, the Experimental Group (EG), or to conventional training, the Control Group (CG). EG residents were trained to perform scleral tunnel construction using a simulation-based curriculum (HelpMeSee Eye Surgery Simulator), while residents in the CG followed institution-specific curriculum before progressing to live surgery. Surgical videos of the first 20 attempts at tunnel construction were reviewed by masked video raters. The primary outcome was the total number of any of 9 pre-specified errors. On average, the total number of errors was 9.25 (95% CI 0–18.95) in the EG and 17.56 (95% CI 6.63–28.49) in the CG (P = 0.05); the number of major errors was 4.86 (95% CI 0.13–9.59) in the EG and 10.09 (95% CI 4.76–15.41) in the CG (P = 0.02); and the number of minor errors was 4.39 (95% CI 0–9.75) in the EG and 7.47 (95% CI 1.43–13.51) in the CG (P = 0.16). These results support that novice surgeons trained using the novel simulation-based curriculum performed fewer errors in their first 20 attempts at tunnel construction compared to those trained with a conventional curriculum.

Purpose: To establish the face and content validity of the HelpMeSee Eye Surgery Simulator – a virtual reality-based cataract surgery simulator for manual small-incision cataract surgery (MSICS). Methods: The face and content validity were assessed on the sclero-corneal tunnel construction course. A questionnaire with 11 questions focused on the visual realism, with resemblance to real life surgery, and the training value of the simulator was developed. Thirty-five experienced MSICS surgeons participated in the study. Responses were recorded using a seven-point scoring system. Results: Overall, 74.3% (26/35) of the respondents agreed that the overall visual representation of the eye and the instruments in the simulator were realistic. The task of injecting a visco-elastic through the paracentesis was reported to be the most visually realistic task with a mean score of 5.78 (SD: 1.09; range: 2–7). With regard to content validity, 77.1% (27/35) of the subjects felt agreed that the errors and complications represented throughout the entire tunnel construction module were similar to those encountered in real life; the task of entering the anterior chamber with the keratome had a mean score of 5.54 (SD: 0.98; range 1–7), being rated the highest in that aspect. Overall, 94.3% (33/35) of the subjects agreed that the simulator would be useful in developing hand–eye co-ordination. A similar number of 94.3% (33/35) agreed that based on their experience, they would recommend cataract surgical training on this simulator. Conclusion: The results suggest that the HelpMeSee Eye Surgery Simulator appears to have sufficient face and content validity for cataract surgical training.

Purpose: The purpose of this study was to evaluate trainee performance across six modules of a virtual reality (VR) simulator. Methods: A retrospective observational study was conducted on 10 manual small-incision cataract surgery (MSICS) trainees who practiced cataract surgery on an MSICS VR simulator for one month. They were assessed in six major steps which included scleral groove, tunnel dissection, keratome entry, capsulorhexis, nucleus delivery, and intraocular lens (IOL) insertion under a trainer’s supervision. The information included in their score metrics was collected, and their overall performance was evaluated. Results: Thirty attempts were evaluated for scleral groove, tunnel dissection, and capsulorhexis and 15 attempts for keratome entry. Candidates had varied results in the dimensional aspects and their rates of complications with a mean satisfactory score of 3.1 ± 4.17, 6.8 ± 5.75, 5.8 ± 7.74, and 1.8 ± 2.57, respectively. Nucleus delivery ( n = 5) had more of iris pull and IOL insertion ( n = 5) had more of lost IOL as complications but both had a higher satisfactory outcome. Conclusion: A VR simulator is a useful tool for training surgeons before their entry into live surgery. It is an effective method for evaluating objectively the structural characteristics of each phase in MSICS and their associated complications, helping them anticipate it earlier during live surgery by giving them a near real world experience.