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Ophthalmology Times | Virtual reality brings care to at-need areas

April 2023 Hunter Cherwek, MD, VP of Clinical Services and Technologies at Orbis International, and Ashlie Leal, Director of Ophthalmology at FundamentalVR, share with Ophthalmology Times how the Orbis FVR Simulator came to be and its life-changing impact on global patient care.
Published April 6, 2023

Ophthalmology Times | Volume 48 | Issue 3

Eye care nonprofit Orbis International is collaborating with FundamentalVR (FVR) to develop a training technology in the field of ophthalmology: the Orbis FVR Simulator is the world’s first-ever simulation training platform for ophthalmology that uses virtual reality (VR), haptic feedback, cloud assessment data, and low-cost, off-the-shelf hardware.

The technology is easily portable and mimics the sense of touch, allowing ophthalmology students to practice procedures on their own, without a professor present, on what feels like actual human tissue and get immediate, standardized feedback on their performance.

The tool offers the potential for accessibility and scalability to countries that bear the greatest burden of avoidable vision loss, which is why Orbis hopes to use it to train more eye surgeons in skills development at a fraction of the cost of existing simulators.

Orbis currently has 17 simulators, in beta version, deployed in select residency training programs and prospective digital training hubs around the world – in several low- and middle-income countries, as well as in the United States. The simulator’s impact on residents’ surgical skills is being evaluated, and user feedback is being obtained from both residents and experienced ophthalmologists to inform further developments to the technology.

Globally, 1.1 billion people live with vision loss,1 and a staggering 90% of it is avoidable. Nine out of 10 people with vision loss live in low- and middle-income countries,2 where eye care is often difficult to access. The number of people in need of eye care is outpacing the number of trained ophthalmologists. An increase in the number of skilled eye care professionals as well as high-quality training and mentoring opportunities are urgently needed if we are to meet rising demands and ensure that no one loses their sight from preventable or treatable causes.

For more than 40 years, Orbis has been training eye care teams in areas with the greatest need to ensure everyone has access to quality eye care, no matter where they live. To accelerate those efforts, Orbis has long been at the forefront of new innovations in medical training technology and democratizing access to them. Cutting-edge technologies have the potential to revolutionize eye health, but their price points have too often kept them out of reach for the eye care professionals who need them the most.

Many of the other ophthalmic simulators on the market costs at least 6 figures to purchase. The hardware for the Orbis FVR Simulator is expected to cost around $15,000 per installation, plus licensing. As a result, the technology is expected to particularly benefit doctors in places where previous simulators were too ex- pensive to be deployed, enhancing the quality of ophthalmology practice globally.

Another challenge is that most existing simulators for cataract surgery focus on phacoemulsification and not on manual small-incision. While phacoemulsification is the most common cataract surgery procedure in high-income countries, this is not the case in low- to middle-income countries. The Orbis FVR Simulator focuses on the manual small-incision technique in order to train eye care professionals in underserved communities on the procedure they are most likely to use.

Developing the Orbis FVR Simulator

In 2017, Orbis recognized that FundamentalVR’s technology had the capabilities to solve key training problems that Orbis was facing, and the 2 parties began working on a solution utilizing FundamentalVR and its HapticVR platform, Fundamental Surgery. While other ophthalmology simulators can be large, and not easily portable, the Fundamental Surgery platform and its compact and easily sourced components, matched with world-leading hap- tic fidelity, proved a perfect solution for Orbis’s global training needs.

The simulator was developed with funding from the Silicon Valley Orbis Innovation Fund established by John A. and Susan Sobrato, from Dr. David F. and Victoria A. Chang, the ASCRS Foundation, and Connie and Bob Lurie.

The Life-Changing Impact of Training

A device like the Orbis FVR Simulator is the low-cost and portable platform that the ophthalmic community has needed to accelerate bringing quality training to eye care professionals everywhere.

When eye care teams receive quality training that was previously inaccessible to them, they can successfully restore sight for their patients. This means people can return to work or school or participate more fully in family and community life. Eliminating avoidable vision loss is one way to combat poverty, and affordable VR technology is one way to achieve that goal by helping treat patients and avoid vision loss.

Hunter Cherwek, MD
P: 800-672-4787
Cherwek is vice president of Clinical Services and Technologies at Orbis International, a nonprofit dedicated to eliminating avoidable vision loss by ensuring everyone has access to quality eye care, no matter where they live.

Ashlie Leal
P: 617-500-4327
Leal is the director of Ophthalmology at Fundamen- talVR, a healthcare technology company with a mission to accelerate human capability via precision simulation and as a result, advance pre-human competence in surgery and additional clinical environments to improve patient outcomes.


  1. Number of people affected by vision loss, 2020. IAPB Vision Atlas. Accessed March 7, 2023. vision-atlas/
  2. Vision loss is unequally distributed. IAPB Vision Atlas. Ac- cessed March 7, 2023. las/inequity-in-vision-loss/

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