Democratizing Vitreoretinal Surgery Training With a Portable and Affordable Virtual Reality Simulator in the...

The purpose of this study was to develop and validate RetinaVR, an affordable, portable, and fully immersive virtual reality (VR) simulator for vitreoretinal surgery training.

We built RetinaVR as a standalone app on the Meta Quest 2 VR headset. It simulates core vitrectomy, peripheral shaving, membrane peeling, and endolaser application. In a validation study (n = 20 novices and experts), we measured: efficiency, safety, and module-specific performance. We first explored unadjusted performance differences through an effect size analysis. Then, a linear mixed-effects model was used to isolate the impact of age, sex, expertise, and experimental run on performance.

Experts were significantly safer in membrane peeling but not when controlling for other factors. Experts were significantly better in core vitrectomy, even when controlling for other factors (P = 0.014). Heatmap analysis of endolaser applications showed more consistent retinopexy among experts. Age had no impact on performance, but male subjects were faster in peripheral shaving (P = 0.036) and membrane peeling (P = 0.004). A learning curve was demonstrated with improving efficiency at each experimental run for all modules. Repetition also led to improved safety during membrane peeling (P = 0.003), and better task-specific performance during core vitrectomy (P = 0.038), peripheral shaving (P = 0.011), and endolaser application (P = 0.043). User experience was favorable to excellent in all spheres.

RetinaVR demonstrates potential as an affordable, portable training tool for vitreoretinal surgery. Its construct validity is established, showing varying performance in a way that correlates with experimental runs, age, sex, and level of expertise.

Fully immersive VR technology could revolutionize surgical training, making it more accessible, especially in developing nations.