Eyeworld

SPRING 2025 | EYEWORLD | 65 C continued. "These advancements could enable trainees and practicing physicians worldwide to participate remotely in training sessions, experi- encing them as if they were physically present. Imagine being able to virtually assist in any surgery from your home office. During a lunch break, for instance, one could virtually scrub in and observe a retina, cataract, or cornea special- ist through the assistant scope. Interactive fea- tures, such as live Q&A with the surgeon, could further enhance the learning experience. This technology has the potential to dramatically improve access to specialized surgical training, benefiting both ophthalmologists and patients worldwide." Training programs equipped to provide top-tier surgical education have a unique op- portunity to elevate the standard of care within their communities, Dr. Krad said. "By extending their educational resources virtually to practic- ing ophthalmologists, they can foster a culture of continuous learning and collaboration. The technology to livestream or post recordings of grand rounds and notable cases is readily available. Embracing this opportunity to share knowledge will ultimately translate to improved patient outcomes." Dr. Haugsdal finds that these newer simu- lation options complement the more traditional training approach. "The virtual simulators and traditional simulation models each have their benefits," she said. "The simulators may be bet- ter for more beginner level education of a tech- nique, whereas traditional approaches could be more helpful for advanced techniques." She added that some newer technology that is in development is the use of AI to analyze recorded surgical videos to assist with surgical education. "This could be used to determine in- efficiencies in surgery or track trends in surgical time of individual steps or whole surgeries, or even to compare trainee videos to expert videos to determine areas that deviate from expert lev- el," she said. "This technology could be used as an additional surgical teacher or mentor to help provide feedback to the trainee on their actual surgical videos." In terms of new and future technologies and applications, Dr. Chung noted the quest to try to get more objective data from surgery it- self. This will help to show the steps and where there's room for improvement, he said, adding that AI/machine learning could potentially help evaluate objective data in the future. At this point, Dr. Tipperman said to pause and assess the situation. Say to yourself, "Why is this occurring?" "If it's pharmacologic, a lot of people, myself included, think that putting some sort of agent in the anterior chamber like epineph- rine will stiffen the iris and prevent some of the billowing and the prolapse. Some people will use iris hooks also," he said. "If it's coming from positive pressure, are you putting too much pressure on the eye with the way the speculum is? Did you put in too much viscoelastic; do you need to burp some out? Or is it your incision— did you happen to enter a little too posteriorly, or is your incision a little too shallow and the iris is coming out?" farther away from the limbus so the iris is less likely to prolapse out. Intraoperatively, Dr. Tipperman said overfill- ing with viscoelastic, overly aggressive hydro- dissection, or even a speculum that's putting too much pressure on the globe can lead to iris prolapse. Prolapse management Dr. Tipperman said prolapse is most likely to occur early in the case when you have made the incision and you put in viscoelastic. In some cases, it occurs when you make the paracente- sis, which is a sign "you're going to be battling it all day," he said, though this is less common. "It's more common that the iris will come out of the main incision." continued on page 66 continued from page 63

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