The future of ophthalmology training is here—and it’s digital

In recent years, advancements in technology have revolutionized ophthalmology education, transforming the traditional learning environment into a highly dynamic digital experience. Surgical simulators, such as Eyesi (Haag-Streit) and Eye Surgery Simulator (HelpMeSee), offer valuable hands-on practice that enhances surgical proficiency and safety. This shift has been particularly accelerated in the wake of the COVID-19 pandemic, which necessitated a rapid pivot toward online and digital learning platforms.^1,2 Today, virtual reality (VR), augmented reality (AR), artificial intelligence (AI), and various digital education platforms provide immersive, real-world simulations, allowing trainees to practice surgical techniques and diagnostic skills remotely.^2,3

This technologic landscape is evolving rapidly. AI-driven diagnostic algorithms are a promising addition, enabling real-time feedback that supports decision-making and enhances clinical judgment.^4-6 Furthermore, personalized e-learning modules and automated assessments offer a self-paced, customized learning experience.^1-3

Although promising, these technologic tools are not without challenges. These include high developmental costs, limited access due to the cost of VR devices, technical constraints such as integration with existing systems and data processing demands, and ethical considerations around AI implementation.^1-6 Despite these obstacles, technology has become a core component of ophthalmology education, enhancing traditional training models and paving the way for a more interactive, accessible future in medical education.

Benefits and challenges

VR presents unique benefits in ophthalmology education by enhancing skill practice, thereby improving anatomic and technical understanding through self-paced learning. For instance, Bascom Palmer Eye Institute (BPEI) at the University of Miami Miller School of Medicine in Miami, Florida, has developed detailed VR models to supplement traditional in-person learning. VR models of both the eye and the slit lamp teach students intricate eye anatomy as well as clinical examination skills in a low-stress setting before the in-person clinical experience. One advantage of VR over traditional digital models is that VR allows for stereoscopic views, which enables trainees to better understand 3-dimensional anatomic relationships in the eye. This supports a deeper understanding of spatial intricacies before entering the clinical environment. Additionally, students practice at their own speed with self-paced VR learning, providing a flexible alternative to in-person classes. These immersive experiences provide a controlled, risk-free setting where trainees can build confidence before real-world applications.

Integrating VR into medical education brings challenges as well. Financial and other resource-driven limitations can restrict access to VR equipment, such as headsets and wireless networking connectivity. Technical issues can disrupt learning and require consistent device maintenance. Costly hardware and software upgrades demand ongoing funding and technical expertise. Effective solutions to these obstacles require collaboration between medical educators and VR developers, emphasizing the need to make VR more accessible while refining the realism and accuracy necessary for impactful medical training.

Another challenge is physical discomfort during prolonged VR sessions, as users may experience symptoms of motion sickness, headaches, and nausea. Finally, ethical considerations present a significant obstacle to integrating disruptive technologies into medical education, such as data security and accountability for mistakes or incorrect information. Addressing these issues is essential to harnessing VR’s full potential in training future ophthalmologists.

Current BPEI initiatives

At BPEI, VR is used to introduce medical students to eye anatomy, pathology, and clinical skills before their in-person rotations. Their training culminates in presenting a clinical case within the VR platform. In addition, students participate in workshops to gain hands-on experience with the latest VR technology in ophthalmic testing, including visual acuity, perimetry, extraocular motility, pupillometry, and Ishihara color testing. An introductory lecture familiarizes students with the workshop, and subsequent practice sessions allow them to develop proficiency in a controlled environment.

Student feedback has been positive, highlighting the workshop’s role in strengthening clinical knowledge and practical skills. Moving forward, BPEI aims to expand these efforts to include AR and AI for teaching step-by-step technical skills clinically and intraoperatively, creating an even more robust educational framework.

The future of technology in ophthalmology education

The integration of emerging technologies in medical education holds promise. However, further progress is needed to overcome current limitations, including high costs, accessibility to VR devices, and physical symptoms. Nevertheless, the potential applications of VR and AI extend beyond traditional learning, with possibilities for advanced didactic and surgical simulations. By fostering a dynamic, interactive learning experience, these technologies empower students and residents to deepen their clinical understanding, hone their skills, and approach patient care with greater empathy and precision. Medical education is evolving rapidly, and technology is paving the path for a transformative future in ophthalmology.

References

1. Al-Khaled T, Acaba-Berrocal L, Cole E, Ting DSW, Chiang MF, Chan RVP. Digital education in ophthalmology. Asia Pac J Ophthalmol (Phila). 2022;11(3):267-272. doi:10.1097/APO.0000000000000484

2. Hu KS, Pettey J, SooHoo JR. The role of technology in ophthalmic surgical education during COVID-19. Curr Surg Rep. 2022;10(12):239-245. doi:10.1007/s40137-022-00334-9

3. Iskander M, Ogunsola T, Ramachandran R, McGowan R, Al-Aswad LA. Virtual reality and augmented reality in ophthalmology: a contemporary prospective. Asia Pac J Ophthalmol (Phila). 2021;10(3):244-252. doi:10.1097/APO.0000000000000409

4. Heinke A, Radgoudarzi N, Huang BB, Baxter SL. A review of ophthalmology education in the era of generative artificial intelligence. Asia Pac J Ophthalmol (Phila). 2024;13(4):100089. doi:10.1016/j.apjo.2024.100089

5. Valikodath NG, Cole E, Ting DSW, et al. Impact of artificial intelligence on medical education in ophthalmology. Transl Vis Sci Technol. 2021;10(7):14. doi:10.1167/tvst.10.7.14

6. Hallak JA, Scanzera AC, Azar DT, Chan RVP. Artificial intelligence in ophthalmology during COVID-19 and in the post COVID-19 era. Curr Opin Ophthalmol. 2020;31(5):447-453. doi:10.1097/ICU.0000000000000685