Training the Future of Cataract Surgery

By 2050, global blindness is expected to triple. Will there be enough skilled ophthalmologists to meet that challenge?

A recent paper published in Ophthalmology underlined a growing mismatch between the supply and demand of ophthalmologists in the US.¹ Moreover, ophthalmologists have an unequal distribution globally, with a higher density in developed countries compared to developing regions, as well as a difference between urban and rural regions. The World Health Organization’s latest report presented a global eye care target for 2030, aiming to achieve a 30% increase in effective cataract surgery capacity.

According to Ann Sofia Thomsen MD, PhD, meeting this goal will require focusing on three key areas for building capacity: people, skills, and systems.

“We would have to expand our workforce, train the new generation in an effective way using available technologies, and strengthen structures such as standardised international curricula and the integration of telemedicine, AI, and digital learning platforms,” she said.

Regarding skills, she underlined that what was once the realm of opinion has now entered an evidence-based era.

Knowledge of how to train cataract surgeons more effectively is already available, including different simulation models. Yet choosing between these models can be overwhelming, as the most expensive equipment does not always prove to be the most efficient or appropriate, she emphasised.

Dr Thomsen believes virtual reality simulation training can have a significant impact on patients’ safety and surgical outcomes, citing recent literature that shows a significant decrease in PCR rates after virtual reality training.² Furthermore, combining several simulation models such as virtual reality and wet labs can have a positive effect on surgical outcomes.³

The cost effectiveness of these measures strongly depends on the willingness to pay per outcome variable. For example, adding a synthetic eye model to a wet lab could improve cost effectiveness. Investing more in the combination of virtual reality and wet lab training could be worthwhile, depending on the number of trainees.

Self-directed training is not effective, showing varying training times irrespective of the initial skill level. Moreover, recent research showed pretrained trainees did not transfer basic skills to procedure-specific skills any better than those who received no pretraining.⁴ Dr Thomsen emphasised the training programmes should be specific to the procedure of interest.

Proficiency-based training has a major impact on efficiency, showing high variability amongst trainees at the beginning, becoming more consistent over time.

To ensure there will be enough skilled cataract surgeons, Dr Thomsen stressed that ophthalmic training programmes should use context-driven simulation models and said adding an early introduction to microsurgery, procedure-specific mandatory training, and competency-based training will lead to surgeons delivering better quality of care.

“I think we all should ask ourselves whether we would board a flight with a pilot who had trained a fixed amount of hours in a simulator without being tested, or, rather, with a pilot who had passed a competency-based test,” Dr Thomsen concluded.

Dr Thomsen spoke at the 2025 ESCRS Annual Congress in Copenhagen.

Ann Sofia Thomsen MD, PhD, FEBO is Research Associate Professor of the Department of Ophthalmology and Copenhagen Academy for Medical Education and Simulation, Denmark.

1. Berkowitz, Sean T, et al. Ophthalmology, 2024; 131(2): 133–139.

2. Yang L, et al. Eye, 2025; 39: 1700–1709.

3. Ng DS, et al. Medicine, 2023 Oct 6; 102(40): e35067.

4. Petersen SB, et al. Acta Ophthalmol, 2022 Aug; 100(5): e1074–e1079.