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Simulation models in direct ophthalmoscopy education: a systematic review.

Deepaysh Dcs Dutt^1,2,3, Harry Hohnen³, Subham Kulshrestha³

¹The University of Western Australia, Centre for Ophthalmology and Visual Science, Western Australia, Australia.

Canadian Medical Education Journal

|November 19, 2025

Summary

Direct ophthalmoscopy simulation models vary widely but their effectiveness is not well-established. This review evaluates simulation designs and identifies effective components for improved medical training.

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Area of Science:

Ophthalmology
Medical Simulation
Medical Education

Background:

Direct ophthalmoscopy simulation devices are increasingly prevalent.
The effectiveness of current simulation designs and components remains unevaluated.
This review addresses the need to assess direct ophthalmoscopy simulation models.

Purpose of the Study:

To systematically review and evaluate direct ophthalmoscopy simulation models.
To identify effective simulation components for ophthalmoscopy training.
To highlight challenges associated with using ophthalmoscopy simulation models.

Main Methods:

A systematic literature review adhering to PRISMA guidelines was performed.
Searches were conducted across Medline, Embase, Cochrane Library, and Web of Science.
Validity and effectiveness were assessed using established frameworks for simulation-based outcomes.

Main Results:

37 studies were analyzed, describing physical, digital, and virtual reality models.
Common models included plastic canisters, painted fundi spheres, and the EyeSi simulator.
Simulation enables repeated practice without patient discomfort, though realism is a limitation.

Conclusions:

Further evidence is needed to confirm the efficacy of direct ophthalmoscopy simulation designs.
Advancements in technology are expected to enhance realism and affordability.
Simulation-based teaching for direct ophthalmoscopy is poised for increased effectiveness.