David Almeida, MD, MBA, PhD, advances ophthalmic training with near real surgical specimens at EyeCon 2025

David Almeida, MD, MBA, PhD, will lead a hands-on near real surgical systems workshop, offering ophthalmologists the chance to engage with anatomically accurate models that simulate real surgical scenarios. (Image credit: AdobeStock/Iurii)

A vitreoretinal surgeon and clinician-scientist with Erie Retina Research and The Centers for Advanced Surgical Exploration (CASEx), David Almeida, MD, MBA, PhD, is bringing his expertise to the Ophthalmology Times EyeCon® 2025 conference at the Margaritaville Hollywood Beach Resort in Hollywood, Florida, to be held September 26–27. As lead instructor for a special hands-on session, “Erie Retina for MDs: Near Real Surgical Systems (NRSS),” Almeida will guide ophthalmologists through innovative training models that replicate real-world surgical scenarios. The workshop takes place on Saturday morning, September 27, during the conference. Ahead of the event, The Eye Care Network spoke with Almeida to learn more about the development of NRSS and its impact on surgical education, clinical trials, and device innovation.

To learn more about or to register for EyeCon 2025, click here. Separate registration is required for the NRSS session; seating is limited.

Note: Transcript edited lightly for clarity and length.

Can you give us a brief overview of what are near real surgical specimens?

David Almeida, MD, MBA, PhD: Thank you so much for the interest. We’ve been developing the near real surgical specimens and Near Real Surgical Systems (NRSS) for a couple of years. Last year, we released them as a full-fledged product for the first time.

What the near real surgical specimens allow us to do essentially is to test, train, and educate a lot earlier without exposing patients to potential risks. We know that patient engagement is critical for any clinical trials but if we can de-risk some of that by taking it to some sort of other testing model, like NRSS, is where we really see utility for it. Up until now, we've had other options. We have virtual reality, augmented reality, cadaver eyes, animal eyes, and we have models, but all of them fail, especially the eye, which is a unique sphere environment that lack the ability to model and show what we need to show for those things. So what the NRSS, what we have done over last few years is validate different models.

We have strabismus, cornea, glaucoma, retina, sterile fixation, cataract, and then a lot of advanced modules like suprachoroidal subretinal gene therapy. For each of these therapeutic areas, with the NRSS, we can actually deconstruct it and then build up a whole module...you can actually do simulation of complications. This allows—whether it's a instructor, a student, a trainee, or a principal investigator of a clinical trial, you to educate in a much more comprehensive and engaging way that I think leads to better patient outcomes, because you're working on the NRSS.

What was the inspiration to develop this platform?

Almeida: Part pure frustration of not having a good enough model to train on and learn on, and coming from a patient first or a patient-centric model that we don’t want to expose patients if we can do stuff before it gets actual patients. I think that behooves us in the best possible way. We will see what these neurosurgical specimen we can now, kind of break down any parts of these procedures, and the intellectual property is based on multiple patents with the US Patent Trademark Office that allow us to create these specimens.

When we compare against other models, and when we think about the critical aspects, what do we need these NRSS to do? We need them to be anatomically accurate. That’s No. 1. And that’s where so many of the models and other methods failed, because they’re not accurate, they’re not true to what the eye actually does. And then reproducibility and validity once again, this is where there’s really no models that exist that are actually valid or reproducible. And so therefore, when we get to transferring skills and knowledge, translation and transfer is where we run the problems, old models. With the NRSS, we achieve all those in in a cost-effective solution, which is a welcome solution. We’ve now published multiple papers on the validity of the NRSS. This is probably, our one of our most important ones. This is a real-time visualization that published in Translational Vision Science and Technology, the ARVO journal, to show the device engaging with the suprachoroidal space for the first time ever, and showing that distribution patterns with the NRSS suffer from a lot less variation than the actual cadaver models that are previously used. This is like almost a three-fold difference. In a clinical trial and looking to approve a technology, you have 2 variables: 1 the acid that you’re testing, but also a procedure if it’s a new technique. By bringing this variability down, we are now have higher fidelity to the actual, true procedure in a human. We can do better at figuring out how this works time and time again in a real patient, by doing it in NRSS. So we’re excited how well that worked.

And we also have another paper called NRSS economics that shows that if you take the last 5 devices that were approved by the FDA—that’s the Kamra inlay, the Santen MicroShunt, the Alcon Lensx, the Alimera Iluvien corticosteroid implant, and the Roche Susvimo implant. We can see that even conservatively, by adding something like the NRSS, we have huge savings that we can do. All this really comes from a lot of time vectors that allow you to test in a much shorter time and develop that part of you for to actually go to a human. This is exciting to see that the evidence plays to it as well.

The NRSS is also a part of the CASEx global, the Centers for Advanced Surgical Exploration. This includes the headquarters where it started, in Erie, Pennsylvania, our training academy in Miami, but also in India, in Brazil, in Manila, and Tokyo. We’ve worked with many partners that are starting to see the benefits of the NRSS. You can follow the path of a drug or even a device as it goes to the different parts of the eye. And this is all in the NRSS. What we're going to show and train around this, and really as building this, the NRSS as a platform that we can readily engage with trainees and investigators to appreciate more insights, a better understanding of what we’re trying to do with these drugs and therapeutics.

In terms of surgical training, how does this change the landscape for residents?

Almeida: I think 2 major ways. One, you can engage someone with surgical parts of ophthalmology early in their career. This was never, especially for retina...this was always the last thing you did. Maybe if you're in a 2-year fellowship, the first year was medical, then you finally got the surgery. And that's okay because it's from a safety point of view. But if we can then use NRSS to have trainees exposed to it earlier, I think we can kind of see some sort of if not renaissance of surgery, at least an appreciation for its training.

And the second part is really the second and third world, right? We can now, with 1 NRSS, you can train a whole group of people that you just couldn't do before. And this is why we're set up where we are globally to try to bring these educational tools that are powerful to areas that are struggling more with the educational component.

Where do you see the NRSS integrating into practices or residency training?

Almeida: We see 3 pillars of it. We think of 1, training. You think about residents, fellows. Those are core trainees, year after year. I need exposure to this. That's a straightforward one.

The other, you think about when learners get old, they become investigators. So for investigators is really pillar No. 2. Now in clinical trials, the ability to train around and certified investigator to really de-risk an asset is important.

And then really the final one, which I think is probably the most exciting one, is things like turning the NRSS into an FDA human factor study and really using as a development tool for new devices and new technologies going forward. I think that development aspect is wide open.

What skills or confidence do you expect learners to walk away with?

Almeida: I expect them to have the ability to approach, essentially an eye and engage it in a procedural format that's going to be both consistent with the kind of best practices and allow them to actually gain skills that they didn't have before.

Anything else to add?

Almeida: Coming with an open mind to learn is really the best way.