The Role Of Extended Reality In Cataract Surgery Training: A Systematic Review And Meta-Analysis

Extended reality (XR) simulators, including virtual and augmented reality, hold significant promise for enhancing surgical training by providing a controlled practice environment. This is particularly vital in microsurgery, where the steep learning curve and the challenge of mastering surgical skills are significant. Despite advancements in XR technology, its role in ophthalmic surgical training remains uncertain. This study systematically reviews and analyzes the impact of XR on cataract surgery training.

A systematic review and meta-analysis of studies evaluating XR-based cataract surgery training across multiple institutions and training programs.

This systematic review was registered with PROSPERO and followed PRISMA guidelines. A comprehensive search of electronic databases and grey literature sources identified studies published between January 1, 2013, and April 6, 2023. Two independent reviewers screened studies and extracted data on study design, participant role, XR type, training duration, comparator, and surgical outcomes. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. A random-effects meta-analysis assessed the impact of XR training on posterior capsular rupture (PCR). Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted or calculated, and heterogeneity was evaluated using the I² statistic.

A meta-analysis of 17,623 eyes that underwent cataract surgery across seven studies revealed a significant decrease in PCR rates following Eyesi simulator training, with low heterogeneity across studies (OR = 0.71, 95% CI = 0.60–0.85, I² = 9%). Studies that predominantly utilized XR for cataract surgery training (84%) consistently demonstrated improved surgical outcomes, including reductions in complications such as PCR, retained lens material, and aphakia. Additionally, XR training significantly improved operating scores (p < 0.05), self-efficacy (p < 0.01), and non-dominant hand dexterity (p < 0.01). Of the 25 studies included, 22 (88%) reported overall benefits of XR training.

XR simulators enhance ophthalmic surgical training by reducing complications such as PCR and improving surgical performance, self-efficacy, and non-dominant hand dexterity. These findings support the integration of XR technology into ophthalmic surgical training programs to optimize learning and patient outcomes.