Eyeworld

WINTER 2026 | EYEWORLD | 45 C bring both the technology and the talent to train on that technology. "Orbis has been globalizing simulation for more than 20 years," he said, adding that he's learned from experience that it takes a village to give someone their sight back. Specifically referring to his work with Orbis International, Dr. Cherwek noted the use of simulator technology around the world. "We've placed the simulator we designed, in partner- ship with Fundamental XR, into hospitals in Bangladesh, Ethiopia, Ghana, India, Mongolia, Nepal, Peru, Rwanda, and Zambia." The role of surgical simulation in training Dr. Cherwek thinks simulation has played a massive role already and is only getting better. "I think simulation is obviously important for teaching procedures, but it's also now teaching judgment and anticipation," he said. "What we have found is that it's fantastic for teach- ing communication. … Before you go into the OR, you and your mentor can work out how to communicate." Simulation isn't just about how to do a procedure; it's about putting that procedure in a broader context and how to communicate as a surgical leader, he said. Over the last decade, simulation has be- come more mainstream. "Using simulator tech- nology in ophthalmic training today requires a blended learning longitudinal pathway," Dr. Cherwek said. "You have to demonstrate basic science knowledge; you should already know the rules of the game, the anatomy, the physi- ology, and the steps of the procedure. Then you do the simulation, go into a wet lab using real instruments, and finally into the OR with a men- tor/observer. I find with each step of that path- way, [training participants'] anxiety goes down, and their enjoyment of not just the procedure but working with their mentor is great." Surgical simulation helps emphasize under- standing of the microdexterity, the instruments involved, the steps of the procedure, and the anatomy. "One of the things I love about our simulator is that it gives quantitative feedback," he said. Noting that this was a challenge that he often struggled with in training, Dr. Cherwek said the simulators are often self-monitored and self-proctored and give quantitative advice, so you can find your deficits. The surgeon who is mentoring can look at the scorecard and say, for example, "I see you're doing great with wound construction and continuous curvilinear capsu- lorhexis. What we need to work on is trenching or sculpting." He noted the value of simulation in training for capsulorhexis creation because you can replicate learning the skill, whereas in the OR, you might only do a handful of cases per day. "I do think there is huge value in mus- cle memory and repetition." Dr. Pettey noted that simulation is often used in a "just-in-time fashion." Before doing a step in the OR, residents review it, watch the surgical video, discuss it with faculty, then practice it in the simulator or wet lab, he said, adding that Thomas Oetting, MD, was an early leader in this approach. "The sequence is essen- tially understand it, watch it, practice it, then perform it on a patient with supervision," Dr. Pettey said. Dr. Pettey said that the repetition and im- mediate feedback of simulation are some of the ways its most helpful. "A resident can practice the same movement over and over without using OR time or putting a patient at risk." Like Dr. Cherwek, he also noted that capsulorhexis continued on page 46 Trainees practiced on the HelpMeSee Eye Surgery Simulator at the John A. Moran Eye Center at the University of Utah. Source: John A. Moran Eye Center

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