Isaamuddin Alvi
Deciding to embark on a career in ophthalmology has been a profoundly rewarding journey, marked by a commitment to mastering both theoretical knowledge and practical skills. Among the most valuable aspects of the application process has been the pursuit of ophthalmic surgical simulation experience. This reflection explores the structured steps one can take to develop surgical skills and the insights gained from these experiences.
Recognising the Value of Surgical Simulation
After completing my FY1 year, I decided to commit to applying for ophthalmology specialty training. It was evident early on that gaining surgical exposure was of high importance. Ophthalmology is one of the few specialties that uniquely bridges the surgical and medical world, requiring proficiency in both diagnostic acumen and technical skills. Gaining surgical experience is crucial not only for developing these essential skills but also for understanding the procedural demands of the specialty.
Surgical simulation offers a safe, controlled environment to practice technical skills and decision-making, bridging the gap between academic learning and real-world application. There is immense value in the ability to replicate real surgical scenarios without risking patient safety. By practicing in a controlled setting, one can refine technique, experiment with different approaches, and learn from mistakes. Additionally, practice promotes confidence, which is critical when transitioning to performing procedures in live environments.
Glaucoma Surgical Skills Course by Théa Academy (1)
My initial step was attending this event. Under the experienced guidance of Mr Biswas and Ms Chakarvarty, students could hone their manual dexterity and gain a deeper appreciation for the intricacies of glaucoma procedures. These included essential techniques such as suture placement, trabeculectomy, Baerveldt implant, canaloplasty, and trialling the new iStent device (2). The opportunity to make mistakes in a risk-free environment and learn from them was invaluable. For example, correct suture placement required repeated attempts to achieve consistency, and the structured feedback helped me identify areas for improvement. Through each session, the interactive process of learning reinforced my understanding of how simulation can accelerate skill acquisition without the risk of patient harm.
This course is geared towards ophthalmology trainees; however, the instructor faculty were very accommodating, considering this was my first exposure to microsurgery.
EyeSi Surgical Simulator Training
Following my initial exposure at the glaucoma surgical skills course, I completed four hours of focused training on the Eyesi surgical simulator. This advanced platform replicates the complexity of ophthalmic surgery, offering a realistic simulation of procedures such as phacoemulsification.
The Eyesi device is immersive and provides immediate feedback on key performance metrics, including precision, efficiency, and tissue handling. As part of the cataract course, there are four tiers: CAT-A, B, C and D. It is recommended to complete the first tier which will train basic microsurgical skills using abstract scenarios such as instrument navigation in the anterior chamber, tremor control, fine motor dexterity and proper microscope use (3).
The ability of the simulator to replicate potential complications provided valuable experience in managing challenging scenarios. This can bolster confidence and help prepare handling of unexpected scenarios in surgery. The training underscored the importance of persistence and deliberate practice in achieving surgical excellence.
The visual, auditory, and haptic realism of the simulator contributed to the depth of learning experience. It is important to note that simulators often have a waiting list due to Deaneries having a limited number of simulator machines so booking early is highly suggested.
Introduction to Ophthalmic Surgery by the Royal College of Ophthalmologists (4)
The Royal College offers a variety of skills courses with this comprehensive program providing an overview of fundamental surgical principles. Including ergonomics, instrument handling, and intraocular surgery techniques.
In preparation for the course, we completed e-learning modules on the elfh platform. These introduced critical topics such as identifying different surgical instruments, understanding various types of sutures and techniques for primary wound repair. This pre-course preparation ensures one has a solid foundational knowledge before engaging in hands-on practice.
The learning objectives included identifying commonly used microsurgical instruments, developing an understanding of different needles and suture materials, and learning how to knot-tie for essential ophthalmic procedures. Additionally, we aimed to develop the ability to construct corneal incisions, perform scleral suturing and repair lacerations under a microscope.
One of the standout features of this course was the emphasis on attention to detail. The teaching faculty led by Mr Innes highlighted the importance of correct positioning and handling of instruments to prevent fatigue during long procedures. Simulation exercises allowed me to refine my hand-eye coordination and develop a steady approach to surgical tasks.
The structured feedback sessions were particularly enlightening, as they provided actionable insights into improving precision and efficiency. Building muscle memory through repetitive practice underscored the value of perseverance. Minor adjustments in technique could lead to significant improvements in performance, such as achieving a more stable hand position or maintaining consistent tension during suturing.
This event deepened my appreciation for the meticulous nature of ophthalmic surgery. It also reinforced the importance of a systematic approach to learning- breaking down complex procedures into manageable steps that could be practiced and perfected over time. By the end of the course, I felt a renewed sense of purpose, knowing that these foundational skills would serve as building blocks for more advanced techniques.
Photos of my experience from the day:
Reflecting on the Journey
Looking back on these experiences, I am struck by the transformative role of surgical simulation in my development as an aspiring ophthalmologist. Each course and training session contributed uniquely to my skill set and understanding of ophthalmic surgery. Beyond technical proficiency, these experiences instilled in me a mindset of continuous improvement and resilience.
The journey also highlighted the importance of structured learning and feedback. For instance, the combination of hands-on practice and expert guidance during the courses provided a well-rounded approach to skill acquisition. Similarly, the EyeSi simulator’s data-driven feedback emphasized the value of objective metrics in tracking progress. These metrics served as benchmarks, helping me set realistic goals and measure growth effectively.
Looking Ahead
As I continue my journey in ophthalmology, I am eager to build on these foundational experiences. My next steps include seeking additional simulation-based training opportunities and gaining real-world surgical exposure through supervised practice. I am particularly interested in exploring advanced simulations that integrate augmented reality to further enhance procedural realism.
Ultimately, I am committed to the pursuit of excellence in ophthalmic surgery. I view this as both a privilege and a responsibility—to deliver the highest standard of care to patients and to contribute meaningfully to the field. The skills and insights gained through surgical simulation have provided a strong foundation, and I am determined to continue learning and growing as I progress in my career.
References
- Thea-Academy (2024). Glaucoma Surgical Skills – Théa Pharmaceuticals. [online] Théa Pharmaceuticals. Available at: https://www.thea-pharmaceuticals.co.uk/events/glaucoma-surgical-skills [Accessed 25 Jan. 2025].
- PINT Inc (2021). iStent inject® W | Glaukos. [online] Glaukos.com. Available at: https://www.glaukos.com/en-uk/glaucoma/products/istent-inject-w/ [Accessed 24 Jan. 2025].
- Haag-Striet (2024). Training simulators. [online] Haag-streit.com. Available at: https://uk.haag-streit.com/products/categories/simulators-training/training-simulators/eyesi-surgical. [Accessed 25 Jan. 2025].
- RCOpth (2025). Skills Courses. [online] The Royal College of Ophthalmologists. Available at: https://www.rcophth.ac.uk/training/simulation/skills-courses/. [Accessed 25 Jan. 2025].