Eyeworld

44 | EYEWORLD | WINTER 2026 ATARACT C by Ellen Stodola Editorial Co-Director About the physicians Hunter Cherwek, MD Chief Medical Officer Orbis International Jeff Pettey, MD Clinical Vice Chair John A. Moran Eye Center University of Utah Salt Lake City, Utah Grace Sun, MD Associate Professor of Ophthalmology Weill Cornell Medicine Director of Ophthalmology Clinical Practice New York-Presbyterian Lower Manhattan Hospital New York, New York where the trainees develop surgical skills in a safe, controlled, and reproducible environment. "Becoming a skilled and competent surgeon can be associated with a steep and lengthy learning curve," she said. "Surgical simulation is an important educational modality for its poten- tial to enhance knowledge and skill without risk to live patients." She noted that it is emphasized in the updated Accreditation Council for Gradu- ate Medical Education (ACGME) ophthalmology program requirements, effective July 1, 2026, which require residents to have surgical skills instruction in a simulated setting (e.g., wet lab, model eyes, simulator), including a structured curriculum that includes assessment. She said there has been a simulation requirement in place for several years, with most training programs using a combination of synthetic or animal eyes in a traditional wet lab setting as well as virtual simulators. In the last few years, more literature has come out demonstrating the benefits of surgical simulation in training, and more virtual simu- lators have become available. Some examples, she said, include the virtual simulators such as HelpMeSee for MSICS as well as phacoemulsi- fication with haptic technology, which can be helpful in that the resident can "feel" resistance and get feedback from the tissue. The more portable Alcon Fidelity VR sim- ulator also incorporates haptic feedback. "The simulator puts you in a virtual operating room to give a more complete experience even out- side the microscope," she said. Similarly, Dr. Sun said the Orbis Interna- tional and Fundamental XR system utilizes a VR headset and is a lower cost, yet delivers a high fidelity MSICS experience. More advanced and higher fidelity synthetic eyes, some of which can be multiple use, have come onto the market, such as the Bioniko and SimulEYE in addition to Phillips Studio and Kitaro eyes. Dr. Sun noted that AI tools in surgi- cal education also continue to grow. Hunter Cherwek, MD, works with Orbis In- ternational and noted that they were one of the first to get the Eyesi simulator around 2005. When using simulator technology, Dr. Cher- wek discussed the importance of being agnostic to who makes the technology. It's important to TO THE MOON AND BACK Surgical simulation: exploring a universe of possibilities in ophthalmic training S urgical simulation is a useful aid in training for various ophthalmic pro- cedures. Current applications mostly focus on its use in cataract surgery, though there are growing options in other ophthalmic specialties as well. Several physicians discussed the value of simulation, available technologies and training options, their personal experience, and where they see this going in the future. Simulation has become a major part of sur- gical education, especially in cataract surgery, but also in retina, glaucoma and MIGS, and oculoplastics, said Jeff Pettey, MD. "My basic belief is simple: Before a trainee performs a sur- gical step on a patient, they should have already learned it and practiced it multiple times. Sim- ulation moves the earliest part of the learning curve away from the patient," he said. Dr. Pettey said the Eyesi Surgical simulator (Haag-Streit) began appearing in training pro- grams 15–20 years ago and has become the gold standard for virtual cataract surgery training. "Over the past decade, virtual reality has be- come much more widely accepted," he said. "In the past few years, we've seen newer platforms, including the Orbis Simulator, the HelpMeSee phaco simulator, and the Alcon Fidelis VR sys- tem. The trend is toward smaller, more portable, and hopefully less expensive systems." In terms of available options in surgical simulation, Dr. Pettey noted Eyesi for cataract and vitreoretinal surgery, traditional wet labs using animal eyes, synthetic eyes such as Kitaro and SimulEYE, the HelpMeSee Eye Surgery Simulator (which started with manual small in- cision cataract surgery and now includes phaco training), and the Alcon Fidelis Virtual Reality (VR) Ophthalmic Surgical Simulator. "At Moran Eye Center, we have Eyesi, artificial eyes, and animal eyes," Dr. Pettey said. "We have also had the HelpMeSee simulator in the past." He noted that each option has a role. "Eyesi allows almost unlimited repetition with immediate feedback," he said. "The wet lab lets residents sit at an actual microscope and use real instruments, the phaco machine, and both the phaco and microscope pedals." Grace Sun, MD, agreed that surgical simu- lation is an essential part of residency training

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