The Metaverse in Ophthalmology?

A review of current and upcoming virtual reality simulators for microsurgical training.

Geoffrey Nguyen, MD, and Paul Kang, MD

Cataract and Refractive Surgery Today

The use of virtual reality (VR) for ophthalmologic surgical training is a captivating topic. Recent technological advances have propelled an unprecedented level of research in this area—especially timely during the COVID-19 pandemic. This public health emergency prompted ophthalmology residency programs to explore surgical training resources that allow residents to practice microsurgical skills without direct patient contact. The proliferation of VR headsets, haptic technology, and virtual education has enabled educational innovators to offer a reliable, high-fidelity alternative to traditional surgical training methods. These innovative simulators allow ophthalmology trainees to receive real-time feedback and visual guidance for cataract and vitreoretinal surgery from educators worldwide. Some devices have become foundational to the surgical curricula of many ophthalmology institutions, whereas others are just becoming commercially available. This brief overview highlights some remarkable surgical simulators and future plans for integrating VR into ophthalmology. EyeSi Surgical Simulator The EyeSi Surgical Simulator (Haag-Streit USA), the most established device of its kind, has been integrated into more than 650 ophthalmology residency programs worldwide. The unit comprises a virtual operating microscope for simulating stereoscopic images, handheld probes for simulating instruments when inserted into an artificial eye, and a programmable virtual environment for phaco cataract or vitreoretinal surgery. Tasks can be performed while an instructor monitors them on a viewing panel (Figure 1).

Effective Preoperative Assessment and Management of the Ocular Surface

Tips for optimizing the ocular surface and therefore surgical success.

Priya M. Mathews, MD, MPH

Cataract and Refractive Surgery Today

The precorneal tear film is the most critical refractive surface in the human optical system. When striving to deliver a glasses-free experience, especially with multifocal IOLs, the preoperative management of dry eye disease (DED) is critical (see The Link Between Dry Eye Severity and Patient Satisfaction). An unoptimized ocular surface during cataract surgery assessments compromises the accuracy of measurements critical to surgical planning. The Link Between Dry Eye Severity and Patient Satisfaction A thorough analysis conducted at Center for Sight in 2019 (unpublished data) involving four surgeons and 113 eyes found a direct correlation between dry eye disease severity and patient dissatisfaction following premium IOL surgery. In the analysis, a preoperative complaint of vision fluctuation was closely linked to dry eye disease severity, highlighting the necessity of addressing ocular surface health preoperatively. Untreated DED can also complicate patients’ postoperative recovery. I therefore advise my patients to prioritize DED treatment before undergoing surgery. This approach not only facilitates a smoother, quicker recovery but also optimizes their chances of achieving the desired surgical outcome. Comprehensive Preoperative Ocular Surface Assessment Before I enter the exam room, I review the patient’s testing outside their room. My biometrist will indicate the quality of the measurements on the Notes section of the IOLMaster 700 (Carl Zeiss Meditec) by grading the distortion from 0 to 4+.

New Retina Radio Journal Club with VBS: Comparison of Antiseptics Use for IVT

Sruthi Arepalli, MD; Vaidehi Dedania, MD; and Rebecca Soares, MD, MPH

Eyetube

How do endophthalmitis rates after intravitreal injection differ after using povidone-iodine compared with chlorhexidine? Moderator Sruthi Arepalli, MD, hears from panelists Vaidehi Dedania, MD, and Rebecca Soares, MD, MPH, about a recent peer-reviewed retrospective cohort study on this topic. After the break, the trio discuss how to manage patients who do not tolerate antiseptics, the benefits of visualizing antiseptics on the conjunctiva, and the specific practice patterns that work best in their clinics.