Technological Influence on Retina Fellows' Learning Curves: A Prospective Study of Digital versus Analog Microscopes...

The BRAVE Study (Bridging Retina Fellows' Advancement with Visualization Enhancements) aims to compare the learning curves of retina fellows performing epiretinal membrane (ERM) surgery trained using digital heads-up display (HUD) systems versus analog surgical operating microscopes (SOMs) in a prospective manner. Fellows were assigned exclusively to either HUD or SOM for all ERM surgeries during the 2-year study. There was no crossover between modalities. Posterior vitreous detachment was consistently induced by active suction under the macula. Trypan blue was routinely applied to aid in visualization of the ILM/ERM. This standardized approach was used across both groups.

In this prospective 2-year study, four retina fellows were trained exclusively with either a digital (NGENUITY® 3D) or analog (ZEISS OPMI LUMERA 700) microscope. Each fellow performed 127 ERM surgeries (total: 508). Learning progression was rated using an 18-item Likert scale (1-5; higher scores = greater difficulty). Primary outcomes included visualization quality, surgical comfort, and instructor interaction. A linear regression model assessed learning trends.

Fellows using the digital system achieved proficiency within 3 months, compared to 7 months for the analog group. Initial difficulty scores were significantly lower in the digital group (1.64 vs. 5.14, p < 0.001). Monthly improvement rates were -0.30 (digital) vs. -0.86 (analog). Instructor interventions were higher in the analog group during the first 6 months (p < 0.05) but equalized later. Early ergonomic and comfort advantages with digital systems also leveled over time.

Digital HUD systems enhance early skill acquisition and reduce learning-related challenges in retina fellow training. Although long-term proficiency equalizes, these systems offer clear early-phase benefits, supporting their integration into surgical education.