London – Februrary 15th, 2022 – As we emerge from the pandemic into a new world, a world in which Meta (previously Facebook) recently announced its vision for the future – a VR ‘Metaverse’, virtual reality technology has never been more relevant or had more practical, proven applications. One such application is surgical training, which is already proving to be one of the most worthwhile and exciting use cases for VR.

Today, VR is being used in ophthalmology to enhance training and education around the world and offers multiple physical and cognitive benefits to its users. By combining VR with cutting edge haptic technology, which provides surgeons with the ability to both see and feel a virtual patient, surgeons can train and gain ‘pre human’ competence within a range of ophthalmic surgeries, devices and therapies. Moreover, the need for low-cost, high-fidelity training for ophthalmology is becoming more urgent for two key reasons: lack of access to training and the rate of innovation.

Rate of innovation

See one, do one, teach one is an outdated approach to surgical training and is becoming increasingly problematic. The last 10 years have seen a staggering rate of innovation in Ophthalmology. With the invention of novel medical devices and therapies from minimally invasive surgical devices for glaucoma surgery (MIGS), to the very first FDA approved gene therapy for an inherited retinal disorder (IRD), the ophthalmic specialty is leading the way. This rapid growth of technology and new products has the potential to positively impact eye care globally and increasingly we are able to envisage a world in which vision loss and blindness are a thing of the past. However, with the exponential growth of complex new medical devices and novel therapies, the medical world is looking for an alternative to traditional training methods.

As difficult to master techniques, therapies and devices become more common, it is crucial to provide surgeons with adequate, safe and effective training. Providing access to fluid, changeable and high-quality training programs which can encompass new products, techniques and therapies is a goal for ophthalmologists across the world. Innovative alternatives to existing training methods will be crucial as we navigate our way through the transformational time we are experiencing in medicine. Put simply, in order to ensure safe surgery and improved patient care, we need to ensure we are matching the rate of innovation in the ophthalmic devices and therapies, with innovation in training and education.

Ocular Gene therapy deployment via Virtual Reality

Increasingly, leading companies are faced with challenging requirements to develop training and education programs for complex and intricate new therapies such as ocular gene therapy. An example of this was a requirement to train leading surgeons on the safe delivery of an ocular gene therapy which is delivered into the subretinal space during a surgical procedure which requires extreme precision and skill. The solution to this was configured by FundamentalVR in conjunction with key opinion leaders and the resulting dual-user VR system employs the latest HapticVRTM technology, to create the precise sense of touch, allowing experienced Ophthalmic surgeons to acquire the necessary skills transfer. Furthermore, with the COVID19 outbreak, this alternative to traditional training has rapidly become a must have. FVR used the tool to provide over 50 training sessions and trained over 100 surgeons using the VR technology, all during a pandemic year. Having the capability to provide a virtual replacement for wet labs shows the future is now.

Access to adequate training

The issue of lack of access to safe and adequate surgical training has been significantly exacerbated during the pandemic. Across the world, elective surgeries have been canceled, wet labs axed and ophthalmology residents and attendings deployed to COVID wards and ERs globally. Although the entire world will feel the effects of the pandemic for a long time, those in low- to middle-income countries will and are being severely impacted, especially in areas in which surgical supplies and resources are low. The effect of the pandemic on low- to middle-income countries creates the possibility that a whole generation of ophthalmology residents could lose out on crucial training and experience. This is a devastating prospect, especially as we recognize that in many of these populations the prevalence of blindness is high, yet resources are low. Simulation is an invaluable solution to addressing this issue, by putting high-quality training programs into the hands of residents, regardless of where they are in the world.

Orbis International VR cataract surgery training takes off across the world

An example of how VR can bridge the gap is the work Orbis International is doing across the globe. Orbis International is tackling the prevalence of avoidable blindness head-on by combining training with innovation to reach areas with the greatest need through its Flying Eye Hospital, a fully operational teaching hospital on an MD-10 plane, its award-winning telemedicine platform, Cybersight, long-term country programs, and more. Orbis is dedicated to ensuring it achieves lasting impact through training and education in low- to middle-income countries. Orbis’s commitment to providing training to local medical teams has enabled it to start to use Haptic VR to provide a cost effective, high-fidelity way of providing surgical training and education, starting with cataract surgery. The implementation of VR will allow Orbis to globalize simulation to all its partners. With a long history of providing simulation for training, Dr Hunter Cherwek, VP of Clinical Services and Technologies at Orbis International, says, “This technology is taking our simulation portfolio to the next level in replicating the most delicate surgery and allowing it to be globalized to all of our partners at Orbis international”. The MSICS simulation is a key example of how portable, affordable and high-fidelity simulation has the potential to make a real and positive impact, everywhere.

VR environments have the potential to provide surgeons, nurses and anesthesiologists with the tools they need to provide the best possible care to their patients and ultimately to improve patient outcomes, globally. The application of virtual reality for ophthalmology is shifting the medical landscape and has the ability to increase the potential to live in a world where the prevalence of blindness and vision loss is greatly reduced. From low-cost cataract surgery (MSICS) to novel gene therapy, these case studies and use cases illustrate the capability of technology to positively transform surgical training and education across the board in ophthalmology.

It is an incredibly exciting time to be working in ophthalmology and today we are still only scratching the surface of what is possible for VR technologies in ophthalmology training, education and promotion. As we move further into the ‘metaverse’ we must ensure that VR technology is available across the globe to enable the surgeons of future to be the surgeons of today.

About the author:

Ashlie Leal, Director of Ophthalmology, is the lead for Ophthalmology at FundamentalVR. Over the past two years, she has been fortunate enough to experience working with medical device, pharmaceutical and nonprofit eye care organizations to provide high fidelity VR simulation training that has the power to change lives around the world.