Effectiveness of the Eyesi Surgical Simulator for ophthalmology trainees: systematic review and meta-analysis

Author: Carr L, McKechnie T, Hatamnejad A, Chan J, Beattie A.

Geographical coverage: Not reported

Sector: Eyesi surgical simulator

Sub–sector: Treatment

Equity focus: Not reported

Study population: Ophthalmology trainees

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background: Cataract surgery is a technically demanding procedure that requires years of deliberate practice. Historically, trainees have relied on lectures, wet labs and supervised operating sessions to acquire these skills. In recent years, virtual‑reality platforms such as the Eyesi Surgical Simulator have been introduced to enhance early skills training. The Eyesi provides a realistic operating microscope, virtual eye and foot controls that closely mimic live surgery. Several studies suggest that trainees who use Eyesi exhibit better technical performance and commit fewer surgical errors; however, findings remain mixed and the simulator has not yet become a routine component of training programmes. A systematic assessment of its true impact on skills acquisition is therefore warranted.

Objective: To evaluate the effect of the Eyesi Surgical Simulator on technical skills development in ophthalmology trainees.

Main findings: Eight studies (three randomised controlled trials and five retrospective cohort studies) published between 2009 and 2020 were eligible, comprising 108 learners who trained with Eyesi and 123 control learners. Trainees using Eyesi demonstrated significantly greater improvements in technical skill scores than controls (standardised mean difference = 2.02; 95 % CI 1.47–2.57; p < 0.001). They also made fewer post‑training technical errors (odds ratio = 0.43; 95 % CI 0.20–0.90; p = 0.03). No significant difference was detected in the time required to complete surgical tasks (SMD = 1.96; 95 % CI –1.96 to 5.88; p = 0.33).

Methodology:  Searches of MEDLINE, Embase and CENTRAL up to May 2022 sought randomised trials and cohort studies comparing objective technical skills in trainees who used the Eyesi simulator with those who did not, or used it to a lesser extent. Reference lists and grey literature were also screened. Two reviewers independently screened records, extracted data and assessed study quality using RoB 2 for RCTs and ROBINS‑I for observational studies; disagreements were resolved by discussion or third‑party adjudication. Inverse‑variance random‑effects meta‑analysis was applied; heterogeneity was examined with the Cochrane Q‑test and I² statistic. Sub‑group and risk‑of‑bias sensitivity analyses were undertaken, and the certainty of evidence was graded with GRADE.

Applicability/external validity: Certainty of evidence was low for technical skill improvement and very low for error reduction, owing mainly to heterogeneity in study design, training modules and comparator interventions. Further high‑quality, standardised studies are needed to confirm these results and guide integration of virtual‑reality simulation into ophthalmology curricula.

Geographic focus: No geographical limits were applied; however, the geographical distribution of included studies was not reported.

Summary of quality assessment: Overall confidence in the conclusions is medium. Searches were comprehensive; eligibility criteria were explicit; two reviewers independently screened, extracted data and assessed risk of bias; and meta‑analytic methods were appropriate with heterogeneity addressed. Nevertheless, the review did not list excluded studies and did not stratify findings by risk‑of‑bias status.