Training to Target Global Cataract Blindness

Virtual reality (VR) simulation-based training programmes for manual small-incision cataract surgery (MSICS) can help to increase the number of skilled providers in low- and middle-income countries and thereby reduce the personal, economic, and social burdens associated with what remains the leading cause of blindness in the world.

Since introducing simulation training for MSICS in 2005, Orbis International launched a new tool in 2024 that will accelerate the utilisation and benefits of simulation training by allowing increased accessibility, according to Hunter Cherwek MD, Orbis Vice President of Clinical Services and Technologies.

“We believe our new VR training solution is a perfect tool for helping us fulfil our goals to democratise and globalise the best in ophthalmic education, training, and technology,” he told EuroTimes.

Created in cooperation with FundamentalVR, a for-profit company that develops VR surgical training platforms, the new tool integrates VR, haptic feedback, cloud assessment data, and off-the-shelf hardware in an affordable, durable, and portable platform—features that make it ideal for training surgeons in the countries where Orbis works.

It benefits users by being an autonomous learning system that provides automated performance monitoring, feedback, and guidance on next steps. Before being able to use the simulator, however, surgeons must first demonstrate commitment and competency through an online learning programme, Dr Cherwek said.

In addition to training on their own, surgeons can participate in connected learning via access to remote surgical mentorship provided by clinical faculty members. Users can also supplement their learning with Cybersight, Orbis’s telemedicine and e-learning platform.

“Simulation training is a valuable step in the journey towards surgical competency, and our new virtual reality system provides a great tool and environment for building knowledge, confidence, and communication that together make a surgeon better prepared to provide optimal patient care,” Dr Cherwek said.

“Moreover, it is being used to train other key members of the surgical team based on the idea that the knowledge gained by personnel supporting the surgeon will improve communication and efficiency in the operating room.”

Dr Cherwek noted the new VR simulator was developed through scientific research and input from a community of users. An initial prototype was distributed to centres across four continents in seven countries (Bangladesh, China, Ethiopia, India, Mongolia, the United Kingdom, and the United States) for rigorous study. The applied user feedback helped create a refined version that was launched at partner hospitals in Bangladesh, China, Ethiopia, India, and Mongolia.

“We did not want to design a high-tech, overly engineered tool and present it as a solution without getting direct input from users,” Dr Cherwek said.

Orbis is also working to incorporate the VR training solution as a component of surgery simulation training in residency programmes in various countries. It recently sponsored a major workshop in Bangladesh that brought representatives from all the country’s residency programmes together to support the development of a standardised national training curriculum.

VR training through HelpMeSee

Targeting eradication of blindness caused by cataract through the innovation of simulation-based training, HelpMeSee created its first VR simulator prototype in 2014 and introduced it for surgeon training the next year. By the end of 2023, about 2,500 surgeons trained on a HelpMeSee platform, with an expected 1,500 more to complete the course in 2024, said Bonnie Ann Henderson MD, President, Chief Executive Officer, and Head of Global Innovation and Technology at HelpMeSee.

“The amount and quality of ophthalmic training by doctors in low-resource regions is extremely variable, and a potential consequence of that variability is compromised patient outcomes. Simulation training levels the playing field,” she said. “By allowing surgeons to practice again and again, simulation technology can increase operator skills and confidence, which leads to better surgical outcomes. Better outcomes benefit patients who undergo the operation but are also important for eradicating cataract blindness because they increase willingness of people in the community to have cataract surgery.”

Dr Henderson noted that HelpMeSee is the only non-profit creating and providing high-fidelity virtual reality simulators with haptic feedback.

“Our mission is to train surgeons using technology to improve the quality and safety of surgical outcomes,” she told EuroTimes. “We deliver this training at no or minimal cost in low-income regions of the world.”

The HelpMeSee programme combines an interactive ebook, facilitated discussions with a certified instructor, and guided sessions on the HelpMeSee Eye Surgery Simulator. The current simulator system integrates high-quality computer graphics with a physics model of surgical activities in MSICS and provides tactile feedback.

Results of a randomised controlled pilot trial evaluating scleral tunnel construction performance among novice surgeons showed the group trained on the HelpMeSee MSICS system made fewer errors compared to the control group of surgeons who received traditional training. The company is further investigating the effectiveness of its simulation-based training by conducting a multicentre prospective masked trial at Aravind Eye Hospital (India), Moran Eye Center (Salt Lake City, US), and Copenhagen Academy for Medical Education and Simulation (Denmark).

For more information, please visit orbis.org and helpmesee.org.