Multimodal Training In Ophthalmic Surgery: A Systematic Review Of Vr, Wetlab, And Ai-Driven Approaches

Ophthalmic surgical training has evolved beyond the traditional apprenticeship model, incorporating simulation, wetlab practice, structured courses, online learning, and emerging AI-driven methods.

We provide the largest narrative synthesis on methods of learning the efficacy of these teaching modalities in improving surgical proficiency, safety, and learning efficiency among ophthalmology trainees.

We performed a systematic review of literature from 2015–2025 (PubMed, Embase, Cochrane). Inclusion criteria encompassed studies evaluating virtual reality (VR) simulation, wet laboratory training, structured surgical courses, online/webinar instruction, or AI-driven personalised training for ophthalmic surgery. We prioritised high-level evidence, excluded grey literature, and followed PRISMA guidelines. Two reviewers independently screened studies, extracted data, and assessed bias. Primary outcomes were objective surgical performance metrics, intra-operative complication rates, cost-effectiveness and trainee satisfaction. Where data permitted, we performed meta-analysis; otherwise, a narrative synthesis was conducted.

Our systematic search yielded 1,982 records, with 234 full‐text articles screened and 41 studies meeting inclusion criteria. A multi-centre trial showed novice surgeons improved OR skill scores by 32% (p=0.008) after VR training. An RCT of the phaco chop technique, the VR group achieved a mean simulator score of 83.9 versus 78.7 for wetlab (p=0.03). Three RCTs comparing VR to wetlab training found VR enhanced simulator efficiency, whereas wetlab practice offered more realistic tissue handling and slightly faster task completion (p=0.038).  Structured courses that combined these modalities reduced errant surgical steps by 68%. Combined VR and wetlab training yielded higher performance scores (49.5 vs 39.0, p<0.001) than wetlab alone.

Modern ophthalmic surgical education benefits from a multimodal approach. VR simulation, wetlabs, and structured courses all improve surgical skills, each with unique strengths: VR offers unlimited, safe practice with objective feedback; wetlabs provide irreplaceable tactile experience; structured courses integrate theory and practice. Online learning enhances knowledge and supplements hands-on training, while AI-enabled platforms promise to personalise and potentially accelerate learning. The current evidence supports integrating VR and wetlab training to optimise proficiency and patient safety. Future research should focus on long-term outcomes, standardising metrics and evaluating emerging technologies in diverse training environments.