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Impact of extended reality (XR) simulation on ophthalmology training outcomes: an updated systematic review and
Yuxi Jiang1, Shengfang Ge1, Bilian Ke1
1Department of Ophthalmology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
Extended reality (XR) simulation offers repeatable, risk-free practice for ophthalmic training. We conducted a systematic review and meta-analysis to quantify its effects on training outcomes.
Methods:
We searched MEDLINE (PubMed), Embase, Web of Science Core Collection, and Cochrane CENTRAL from inception to February 6, 2026. Risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (non-randomized studies), and certainty of evidence was evaluated with GRADE. Statistical analysis was performed using Stata 15.
Results:
Thirty-two studies (1,572 trainees) were included. XR training significantly reduced overall intraoperative complications (OR = 0.72; 95% CI, 0.63-0.82; P < 0.001), posterior capsule rupture (OR = 0.63; 95% CI, 0.49-0.81; P < 0.001), and CCC-related complications (OR = 0.44; 95% CI, 0.21-0.90; P = 0.024). Vitreous loss and retained lens material did not differ significantly. Technical performance improved, with higher global surgical scores (SMD = 1.93; 95% CI, 1.49-2.38; P < 0.001) and CCC scores (SMD = 0.73; P < 0.001). Total operative time was significantly shortened (WMD = -8.92 min; 95% CI, -16.38 to -1.46; P = 0.019). Trainee confidence generally improved, though perceived realism varied.
Conclusions:
Extended reality (XR) simulation training can enhance ophthalmic surgical technical performance and procedural efficiency, reduce the risk of intraoperative complications, and improve trainees' operative confidence. These findings provide an evidence-based foundation for the design and optimization of ophthalmology training curricula. Future studies should further investigate the value of XR technologies in non-cataract procedures and in the development of non-technical skills.
Systematic Trial Registration:
https://www.crd.york.ac.uk/prospero/, identifier: CRD420261288204.
