Prioritising Cataract Surgery Training

Amid rising demand for cataract surgery services across Europe, worsening staffing shortages, and substantial intercountry differences in surgical exposure and trainees’ confidence, ESCRS is developing a pan-European formal training pathway in which simulation training will be a prerequisite for gaining OR autonomy and will be used to support competency maintenance throughout the surgeon’s career, said H Burkhard Dick MD, PhD.

“Training capacity must match the expanding surgical volume associated with population ageing while maintaining safety and quality,” Professor Dick said.

He noted that curricular structure and training vary widely across Europe, and in some countries there is no live cataract surgery training throughout the entire ophthalmology residency programme. A pan-European cataract simulation curriculum, developed under the guidance of Sarah Maling MD and Filomena Ribeiro MD, PhD, follows a stepwise progression, incorporates validated assessments, and is designed for continuous growth. It can define a formal training pathway, address the heterogeneous landscape, reduce variability, and ensure equitable access.

To implement, enforce, and scale the curriculum across Europe, the strategy will combine standards, access, and accountability. While aiming to harmonise competencies, it will also provide local flexibility.

Prof Dick said the Society will publish the ESCRS-endorsed simulation curriculum, including competency gates and minimum standards, and will then work with national societies and the European Board of Ophthalmology to secure its recognition and adoption. Training sites will be accredited using transparent criteria, and the use of ESCRS Moving Simulators, together with regional simulation centres, will enable equitable access.

Simulation training through virtual reality platforms will play a central role in the curriculum, enabling skill transfer to live cataract surgery. This training approach is supported by evidence demonstrating improved surgical performance.

“Studies show that virtual reality training enhances technical skills among novice cataract surgeons and reduces complications,” Prof Dick explained. “Evaluations of available virtual reality platforms are ongoing, recognising that different systems cover different surgical steps.”

The curriculum will also include wet lab practice with model eyes, as this approach offers distinct advantages over virtual reality simulation and addresses distinct learning objectives.

“Our recommendation is that virtual reality be used for early repetition and benchmarking and wet lab training be used to build proficiency in haptics, instruments, and ergonomics,” Prof Dick said. “Nevertheless, although simulation training compresses the early learning curve, it is not a replacement for supervised surgery.”

As a foundation for introducing a pan-European cataract surgery training pathway, ESCRS already has resources to support infrastructure and access. These include the ESCRS iLearn digital curriculum—an online modular learning programme comprising videos, cases, quizzes, and assessments—and two moving simulators (EyeSi Surgical) that are currently used as training tools for residents in low-access countries.

ESCRS also offers various cataract educational programmes, such as the Complex Cataract Masterclasses, which provide structured faculty-led learning and mentoring. Its Cataract Surgery Guidelines are a reference standard for quality and safety expectations and provide evidence-based guidance for a clinical cataract pathway, Prof Dick said.

Prof Dick spoke on this topic at the 2026 ASCRS annual meeting in Washington, DC.

H Burkhard Dick MD, PhD is professor, chairman, and director at Ruhr University Eye Hospital, Bochum, Germany. He is president of ESCRS and serves on the ESCRS Education Committee. burkhard.dick@kk-bochum.de