Welcoming the Era of AI Simulation Training

Simulation-based training represents a pedagogical shift in ophthalmic surgical education and is introducing a new era in which there can be improved patient safety and better surgical outcomes, said Anshu Arundhati MD.

“AI-based simulation and haptic virtual reality (VR) replace the model of ‘see one, do one, teach one’ with a model of ‘see in 3D, practice until perfect, and teach with objective precision’,” she said. “These approaches make competence a data point, not a guess, and mean learning does not come at the patient’s expense. With these tools, we are not just teaching surgery, we are upholding our most sacred oath: primum non nocere.”

Aiming to convince her colleagues of the necessity of simulation training, Dr Arundhati noted the existing crisis in training and growing disparity between demand and supply of ophthalmology services.

“By 2035, ophthalmology will face the second most severe workforce shortage in medicine,” she said. “Augmented reality/virtual reality (AR/VR) is a critical tool for scaling education efficiently, and with telesimulation leveraging low-cost hardware, it will allow for global access and democratisation of surgical training. Geography will no longer be a barrier to education in low- to middle-income countries because with simulation, trainees can ‘scrub in’ with a world-class expert and practise surgery safely anywhere in a shared virtual space.”

Proven benefits and possible risks

Dr Arundhati observed that simulation training allows quantifiable success and has been documented in several studies to strengthen basic surgical skills, enhance surgical efficiency, and improve safety.

“Simulation provides a safe setting where trainees can benefit from repeated practice that enables competence with surgical manoeuvres before entering the OR, including for uncommon complications they may not have encountered during a standard rotation,” she said.

Dr Arundhati acknowledged simulation training is not without potential limitations and safety considerations. Cost and accessibility are legitimate concerns, and there are challenges with realism.

“While VR/AR technology has advanced, sensory fidelity may not fully replicate real surgical experience. Still, simulation training improves spatial awareness and helps to build muscle memory.”

Another downside to consider is the likelihood for training to be disrupted by technical glitches or failures. However, as technology improves, these occurrences become less frequent.

Cybersickness, a form of motion sickness caused by sensory conflict between visual input and physical movement, is a real phenomenon that can occur while using VR simulators. However, the risk for cybersickness can be minimised if users are careful to limit session duration to 15 to 30 minutes.

A broader role

Dr Arundhati pointed out that AI-driven simulation is not just a tool for ophthalmology residents. At Singapore National Eye Centre, use of the EyeSi slit lamp simulator to educate optometrists and nurses is reducing the training-related fatigue among the surgeons responsible for teaching them. In addition, surgical simulators can be of benefit for even the most senior consultants who can use surgical simulators to practise specific complex surgical steps or to learn new procedures.

Oculomics is another area where artificial intelligence-driven simulation offers positive impact.

“We are no longer just eye doctors,” Dr Arundhati said. “Instead, ophthalmologists are the forefront to insights on systemic health. Now, AI-driven simulations train us to identify biomarkers of retinal images that predict systemic conditions, such as Alzheimer’s disease, cardiovascular disease, and chronic kidney disease, long before physical symptoms occur.”

Dr Arundhati spoke on this topic at the 2026 ASCRS annual meeting in Washington, DC.

Anshu Arundhati MD is Deputy Chief Executive Officer (Education) and a senior consultant in the cornea/external eye disease and refractive surgery services at Singapore National Eye Centre, Singapore. arundhati.anshu@singhealth.com.sg