Regarding the spatial conditions for train­ing under surgical-like situations, it is important to ensure that there is sufficient space for each aspiring surgeon as well as for the extensive equipment, while also ensuring that communica­tion with the tutor can be maintained over short distances (Fig. 7.7). Under extreme conditions (e.g., when distance rules must be observed dur­ing the coronavirus pandemic), this presents a particular challenge!

Cataract surgery requires a good sense of stere­opsis and spatial visualization, combined with excellent hand-eye coordination and the ability to use all four limbs simultaneously, as foot ped­als are used to control the operating microscope or the ultrasound energy of the phaco handpiece.

The most common intraoperative complica­tion of cataract surgery is posterior capsule rup­ture, which is widely regarded as a benchmark for assessing surgical quality. After a posterior capsule rupture, there is a significantly increased risk of retinal detachment and endophthalmi­tis, leading to vision loss. While certain ocular or systemic comorbidities may also be associ­ated with an increased risk of capsule rupture, the surgeon’s surgical skill and experience are among the most important risk factors for the occurrence of posterior capsule rupture.

The simulator’s cataract course offers a vari­ety of training modules to improve surgical skills and avoid such intraoperative complica­tions. Initially, trainees must complete abstract simulation tasks such as anterior segment navi­gation, forceps, and anti-tremor training, which allow them to practice microsurgical motor skills, hand-eye coordination, and microscope handling, and help them understand the spa­tial boundaries within the anterior chamber (Fig. 7.13). After completing each training, the software provides a detailed performance sum­mary that reflects the trainee’s accuracy and efficiency. Various parameters related to instru­ment and microscope handling, surgical effi­ciency, and tissue treatment are recorded by the

With the help of the simulator’s capsu­lorhexis module, trainees can practice creating a round capsulorhexis (Fig. 7.14a). The trainee can choose whether to use a cystotome or for­ceps and adjust the setting so that, for example, a guiding circle with a diameter of 5 mm is dis­played to visualize the optimal size.

insert the instruments, it is not possible to practice the paracentesis or the main incision. Additionally, despite the realistic simulations, there is no tactile feedback of “real tissue” as in the wet lab. The high cost of the simulator can also pose a financial burden for some training centers. However, Ferris and colleagues have argued that training trainees to cause fewer intraoperative complications, such as a posterior capsule rupture, through the invest­ment in and use of the simulator can be more cost-effective in the long run than bearing the costs associated with additional surgical instru­ments and outpatient visits that may be necessary in cases of retinal detachment or endophthalmitis following a capsule rupture [13].

The training of an eye surgeon requires a com­prehensive approach that should include knowl­edge of anatomy and surgical techniques, surgical judgment, and the development of manual skills. This last requirement can only be achieved by practicing movements and maneu­vers, with better results when performed in a controlled environment, with evaluation and cor­rection of errors between task repetitions.