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Introduction Current methods of training microsurgical interventions have various limitations, including limited transferability to the human model, economic demands, and ethical concerns. In this article, we show how surgery simulations can overcome these issues and how, combined with the application of an intelligent tutoring system (ITS), they can be used to train tasks in ophthalmic surgery more efficiently. Methods We investigated physician trainee efficiency of learning microsurgical skills using our purpose-built microsurgery simulator that tracks a micromanipulator and displays a three-dimensional representation of the interior of a human eye in an augmented reality (AR) headset. The expertise of ophthalmic surgeons helped define five subtasks corresponding to the steps of internal limiting membrane peeling. Using our AR surgery simulation, 50 participants underwent two training sessions, one using the ITS that dynamically adapts the task sequence to the participant's progress and one using a fixed task sequence. Results We found significant improvement in micromanipulation performance in the first training session with both the ITS and classic training. In the second session, however, only the participants training with the ITS had further improvements in performance. Conclusions Results of this study demonstrate the usability of AR simulation in training micromanipulation skills and support the claim that simulators can be used in ophthalmic surgery training. This study also extends the existing literature by demonstrating an application of ITS for surgical training. The potential of this method is further analyzed in ongoing studies and discussions with experts in ophthalmic surgery.

We present a new reorientation technique, “hyper-reoriented walking,” which greatly reduces the amount of physical space required in virtual reality (VR) applications asking participants to walk along a grid-like path (such as the most common layout in department stores). In hyper-reoriented walking, users walk along the gridlines with a virtual speed of twice the speed of real walking and perform turns at cross-points on the grid with half the speed of the rotation speed in the physical space. The impact of the technique on participants’ sense of orientation and increase in simulator sickness was investigated experimentally involving 19 participants walking in a labyrinth of infinite size that included straight corridors and 90° T-junctions at the end of the corridors. Walking accuracy was assessed by tracking the position of the head mounted display, and cyber-sickness was recorded with the simulator sickness questionnaire and with open questions. Walking straight forward was found to closely match the ideal path, which is the grid line, but slight errors occasionally occurred when participants turned at the T-junctions. A correction algorithm was therefore necessary to bring users back to the gridline. For VR experiments in a grid-like labyrinth with paths of 5 m in length, the technique reduces required size of the tracked physical walking area to 3 m × 2 m.

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