Title: Multimodal training in ophthalmic surgery a systematic review of VR Wet lab and AI driven approaches
Abstract:
Purpose: Ophthalmic surgical training has evolved beyond the traditional apprenticeship model, incorporating simulation, wetlab practice, structured courses, online learning, and emerging AI-driven methods.
Setting: We provide the largest narrative synthesis on methods of learning the efficacy of these teaching modalities in improving surgical proficiency, safety, and learning efficiency among ophthalmology trainees.
Methods: We performed a systematic review of literature from 2015–2025 (PubMed, Embase, Cochrane). Inclusion criteria encompassed studies evaluating Virtual Reality (VR) simulation, wet laboratory training, structured surgical courses, online/webinar instruction, or AI-driven personalised training for ophthalmic surgery. We prioritised high-level evidence, excluded grey literature, and followed PRISMA guidelines. Two reviewers independently screened studies, extracted data, and assessed bias. Primary outcomes were objective surgical performance metrics, intra-operative complication rates, cost-effectiveness and trainee satisfaction. Where data permitted, we performed meta-analysis; otherwise, a narrative synthesis was conducted.
Results: Our systematic search yielded 1,982 records, with 234 full?text articles screened and 41 studies meeting inclusion criteria. A multi-centre trial showed novice surgeons improved OR skill scores by 32% (p=0.008) after VR training. An RCT of the phaco chop technique, the VR group achieved a mean simulator score of 83.9 versus 78.7 for wetlab (p=0.03). Three RCTs comparing VR to wetlab training found VR enhanced simulator efficiency, whereas wetlab practice offered more realistic tissue handling and slightly faster task completion (p=0.038). Structured courses that combined these modalities reduced errant surgical steps by 68%. Combined VR and wetlab training yielded higher performance scores (49.5 vs 39.0, p<0.001) than wetlab alone.
Conclusions: Modern ophthalmic surgical education benefits from a multimodal approach. VR simulation, wetlabs, and structured courses all improve surgical skills, each with unique strengths: VR offers unlimited, safe practice with objective feedback; wetlabs provide irreplaceable tactile experience; structured courses integrate theory and practice. Online learning enhances knowledge and supplements hands-on training, while AI-enabled platforms promise to personalise and potentially accelerate learning. The current evidence supports integrating VR and wetlab training to optimise proficiency and patient safety. Future research should focus on long-term outcomes, standardising metrics and evaluating emerging technologies in diverse training environments.
