Eyeworld

WINTER 2026 | EYEWORLD | 47 C Contact Cherwek: dhunterc@yahoo.com Pettey: jeff.pettey@hsc.utah.edu Sun: grs2003@med.cornell.edu "There is also evidence of better capsulor- hexis performance and shorter operating times," he said. "The evidence is strongest for cataract surgery, though. It is less mature for glaucoma, MIGS, oculoplastics, and other areas." "One of the things I love about surgical sim- ulation is it produces quantifiable data that can be studied so that there are best practices, there are standards," Dr. Cherwek said. Dr. Sun also agreed that there is growing data to support the success of surgical simula- tion in improving outcomes, particularly in cata- ract surgery, noting several published studies. 1–4 Surgical simulation in the future Looking at how surgical simulation might continue to evolve in the future, Dr. Cherwek predicted that more of these pathways are going to be proctored by AI. "I think that in the next few years, we're going to have standard path- ways but also AI that can do customized courses and customized training. For example, if you are left-handed, it can very quickly get you custom- ized on a different pathway." Specifically from his experience with Orbis, getting simulation into the hands of nurses is also critical. "I think with immersive technology, there's going to be a lot more gamification, and I think there's going to be a lot more skills exchange and best practices across countries," Dr. Cher- wek said. "We're exchanging best practices, and we're finding that technology is important—that the team, the mentors, and the pathways upon which that component is placed is very import- ant; it is getting more and more standardized." Looking to the future, Dr. Pettey thinks that virtual reality will become the dominant teacher for the early stages of surgical training. Resi- dents may eventually take home a small headset or simulator and complete surgical "home- work" there. "AI should also make the feedback much better. Rather than just measuring time or instrument movement, systems should be able to identify bad habits, predict errors, and build an individualized curriculum around what each resident needs," he said. "Simulation will also allow residents to repeatedly practice rare complications before encountering them in a real patient." Dr. Pettey thinks the ultimate goal should not simply be completing a certain number of hours on a simulator but demonstrating profi- ciency before advancing. "Simulation will never replace an experienced surgeon teaching in the OR," he said. "But it can make that teaching safer and more efficient. The first time a trainee performs a step on a patient should not be the first time they have understood it, planned it, or practiced it." Dr. Sun sees surgical simulation evolving to be more accessible, with more programs adopt- ing a structured curriculum with assessment and faculty development. "With our anticipated workforce shortage by 2035, training skilled ophthalmic surgeons is critical to meeting the demand for surgery," she said. "Surgical edu- cation will be an even greater priority and may rely more on surgical simulation as well as AI tools. Competency-based medical education in ophthalmology will be emphasized. "In the future, these tools can utilize the gathered experience to better monitor and assess learners," Dr. Sun said, adding that while much of the discussion currently with surgical simulation focuses on cataract surgery, there are potential applications for AI integration and tools applicable to other ophthalmic surgical procedures in glaucoma, retina, and others. Residents training in the Weill Cornell Ophthalmology Simulation Lab Source: Grace Sun, MD

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