Microsurgery training is a key component of ophthalmology residency education, taught progressively through a structured three-year curriculum. Given the complexity of surgery, logistical and ethical concerns regarding patient safety, and relatively limited case numbers, the introduction of robust simulation-based training has become essential.
Simulation education allows learners to practice microsurgical procedures, develop coordination, and learn the nuances of instruments and equipment. This has been shown to improve technical proficiency and reduce surgical complications.
The “Iowa Eye Wet Lab Curriculum” published in 2007 and the step-by-step guidelines for setting up a wet lab published by Henderson et al. in 2009 form the basis of many program curricula.
For major intraocular surgery simulations requiring multiple focal planes, such as phacoemulsification, glaucoma drainage device implantation, vitrectomy, and angle surgery, an operating microscope (e.g., Leica M620) is necessary.
A stereo microscope (e.g., Zeiss Stemi305) is suitable for single-plane tasks that require only magnification and limited depth of focus (e.g., corneal suturing, IOL loading, continuous curvilinear capsulorhexis, incision and dissection practice).
Wet Lab
Purpose: Simulation of intraocular surgeries requiring multiple focal planes (cataract, vitreous, glaucoma, etc.)
Microscope: Surgical microscope (e.g., Leica M620)
Main exercises: Phacoemulsification, IOL insertion, vitrectomy
Features: Uses biological tissue (animal eyes). Requires a phacoemulsification device.
Dry Lab
Purpose: Basic skill practice for single-plane tasks
Microscope: Stereo microscope (e.g., Zeiss Stemi305)
Main exercises: Corneal suturing, continuous curvilinear capsulorhexis, IOL loading, incision and dissection
Features: No biological tissue required. Cost-effective. Digital classroom built with iPad integration.
The integrated sink allows direct fluid processing from the surgical station. The combination of a modified shallow bar sink (Kegco Drip Tray) and a simple reusable tin paint tray provides cost-effective waste fluid management and simplified cleaning.
Corian material is chosen for the countertop, offering a good balance of cost, durability, maintainability, and customizability. The countertop height, knee space, and desk width are designed to accommodate adjustable stool heights for optimal foot pedal integration.
This station is designed to allow instructors to seamlessly conduct lectures, live demonstrations, and distance education.
Main equipment:
The Promethean ActivPanel has a built-in Android computer and features the ability to overlay text (drawing) on diagrams, illustrations, and surgical videos. With a closed circuit configuration, it can output from the Promethean to satellite TVs without using an HDMI splitter. This allows instructors to move freely around the room hands-free while amplifying their voice.
Professor Station Microscope: Leica S9i stereo Greenough microscope (attached to the table with an articulated arm). It features an integrated Bluetooth camera with wireless iPad connection capability, syncing with the iPad via the Leica imaging app. It does not require a reduction lens and achieves excellent depth of field and a wide range of magnifications with Fusion Optics technology. LED ring lighting (coaxial arrangement) provides uniform, shadow-free observation.
The iPad mirrors the microscope image to the Promethean and satellite monitors via a USB-C/HDMI adapter, allowing everyone in the room to view it from an unobstructed angle. It also functions as a document camera, enabling live demonstrations of non-microscope tasks such as IOL loading without additional hardware.
Microscope: Zeiss Stemi305 (mounted on a Stand-U articulated arm)
Island design: 4 stations × 4 islands. Each island has two sinks with integrated spray retractable faucets. Acrylic backsplash for instrument cleaning and microscope protection. Power management uses two 8-outlet surge-protected power strips (Tripp-Lite) including constant charging for iPads.
Since operating room stools are very expensive, a clinical revolving chair with a wide range of vertical adjustment and a backrest (Brewer New-Matic ST0OT1020BBLFG) is selected from a cost-effectiveness perspective. Proper adjustment to desk height achieves an ergonomic environment accommodating users of different heights, from small to large.
A conference room will be equipped with 10 computer stations (MiniDell terminals), a Promethean Active Panel (70-inch touch screen), conference hardware, ClickShare integration, a 3D printer, a podium, an Alienware desktop with Oculus Rift VR system, and a glass slide microscope with video integration.
This enables networked lectures and group learning activities among residents.
| Zone | Equipment | Primary Use |
|---|---|---|
| Wet lab | Operating microscope / phacoemulsification device | Intraocular surgery simulation |
| Dry lab | Dissecting microscope / iPad | Basic suturing / continuous curvilinear capsulorhexis / IOL loading |
| Conference room | Promethean, VR, 3D printer | Lectures and group learning |
The entire facility is open 24 hours a day, 365 days a year, designed to allow residents and students to engage in self-directed or group learning at any time.
Through thoughtful curriculum design, learners can understand technical details and standards in a relaxed environment, and educators can assess proficiency before operating together in the operating room. Despite years of ACGME requirements, there remains significant variability among programs, and validation and universalization of best practices are still in progress.
The following educational effects of simulation education have been reported.
Modern digital education systems enable the following:
Integration of VR simulations using head-mounted displays such as Oculus Rift into training facilities is progressing. Ongoing research is investigating whether VR simulators have educational effects equivalent to or greater than actual living tissue simulations.
The evolution of 4K/8K video technology and the integration of intraoperative OCT (Zeiss-RESCAN 700, Leica-EnFocus, etc.) and heads-up surgery (3D visual systems such as Alcon-NGENUITY) into training facilities are progressing. This is expected to enable visualization of fine structures that were not visible with conventional binocular microscopes, even in educational settings.
