Wet-lab to virtual reality: A narrative review of cataract surgery simulation training in ophthalmic education

Cataract surgery, the most common ophthalmic surgical procedure, presents a steep learning curve for trainees, with traditionally increased rates of intraoperative complications in hands of beginners. The objective of this study is to synthesise existing evidence regarding the impact of simulation-based training (SBT) on real-world cataract extraction outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, this review analysed 20 studies, including systematic reviews and randomised controlled trials. Methodological quality was appraised using the risk of bias and risk of bias in non-randomised studies of interventions-I tools. Simulation training, particularly with structured curricula, significantly reduces intraoperative complications, notably posterior capsule rupture in initial learning curve. Virtual reality (VR) simulators, such as the Eyesi platform, demonstrate strong construct validity. Evidence favours a multimodal approach, combining VR with wet-lab and supervised practice, especially for novices. In conclusion, SBT is a valuable pedagogical tool that improves patient safety and operative efficiency. Future efforts must focus on standardising proficiency-based curricula and exploring the long-term retention of surgical skills across diverse training settings using multiple training tools.