Effectiveness of the Eyesi Surgical Simulator for ophthalmology trainees: systematic review and meta-analysis

The Eyesi Surgical Simulator (VRmagic, Mannheim, Germany) is the most commonly used ophthalmic virtual reality surgical simulator. While studies have demonstrated improved trainee skill acquisition with simulation-based training tools, a systematic review and meta-analysis evaluating Eyesi specifically has yet to be conducted. The aim of this study was to meta-analyze studies comparing Eyesi with other methods of technical skill teaching for trainees.MEDLINE, Embase, and CENTRAL databases were searched. Articles included compared Eyesi Surgical Simulator use with alternative methods of technical skill training for medical students or residents. A pairwise meta-analysis using inverse variance random effects was performed. Standardized mean differences (SMDs) were used as the primary outcome measure to account for differences in surgical skill evaluation tools.From 207 citations, 8 studies with 108 learners using Eyesi and 123 learners not using Eyesi were included. Improvements in technical skill scores were significantly greater with the use of Eyesi (3 studies; SMD = 2.02; 95% CI, 1.47-2.57; p < 0.001; I2 = 0%). There was a significant reduction in the number of learners experiencing post-training technical errors in the Eyesi group (5 studies: odds ratio = 0.43; 95% CI, 0.20-0.90; p = 0.03; I2 = 30%). There were no significant differences in post-training time to task completion between groups (3 studies; SMD = 1.96; 95% CI, -1.96-5.88; p = 0.33; I2 = 97%).The Eyesi Surgical Simulator may improve technical skill acquisition (grade: low certainty of evidence) and decrease technical errors (grade: very low certainty of evidence) during cataract surgery among trainees. Further prospective studies evaluating Eyesi modules with standardized scoring systems is warranted.