Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
The Effect of Phaco-Simulators on Surgical Proficiency and Skills in Ophthalmology Surgery Education in Türkiye: Cross-Sectional Study
Türkiye'de Oftalmoloji Cerrahi Eğitiminde FAKO Simülatörlerinin Cerrahi Yeterlilik ve Özgüven Üzerine Etkisi: Kesitsel Çalışma
Murat ERDAĞa , Selma ASLAN MEHMETALİOĞULLARIa , Mehmet CANLEBLEBİCİb , Ali DALc , Hakan YILDIRIMa , Mehmet BALBABAa
aFırat University Faculty of Medicine, Department of Ophthalmology, Elazığ, Türkiye
bKayseri State Hospital, Clinic of Ophthalmology, Kayseri, Türkiye
cHatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Department of Ophthalmology, Hatay, Türkiye
Turkiye Klinikleri J Ophthalmol. 2025;34(4):183-92
doi: 10.5336/ophthal.2025-110405
Article Language: EN
Full Text
ABSTRACT
 Objective: This study aims to evaluate the impact of phacoemulsification (phaco) virtual reality simulator training on the surgical competence and skills of ophthalmology residents in Türkiye. Material and Methods: An online survey consisting of 21 questions was conducted among ophthalmology residents at university and training hospitals with prior experience using the EyeSI phaco-virtual reality simulator. Participants were classified into 2 groups based on their ophthalmology experience: Group 1 (≤2 years) and Group 2 (>2 years). The survey assessed surgical experience, technical adequacy of the simulator, its contribution to training, and its impact on surgical confidence. A total of 34 valid responses were analyzed. Results: Nineteen participants (55.9%) were in Group 1, while 15 (44.1%) were in Group 2. Before training, 50% of Group 1 participants reported low surgical selfconfidence, which improved to 73.5% at a moderate level post-training. No significant difference was observed between groups regarding selfconfidence gain (p=0.255, p=0.637). The simulator improved hand-eye coordination (76.5%) and phaco technique proficiency (73.5%) but was less effective in complication management (20.6%). The simulation's similarity to real surgery was rated as low by 35.3% and very high by 5.9%. Limited access, financial constraints, and technical issues were the main barriers to widespread use. Conclusion: Virtual reality simulators play a valuable role in ophthalmic surgical training by improving skills and self-confidence. Integrating simulator training into ophthalmology curricula may enhance training efficiency and reduce complications.

Keywords: Cataract; surgery; phacoemulsification; education; simulator
ÖZET
 Amaç: Bu çalışma, sanal gerçeklik tabanlı fakoemülsifikasyon (FAKO) simülatör eğitiminin Türkiye'deki göz hastalıkları asistanlarının cerrahi yeterlilik ve becerilerine olan etkisini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: EyeSI fako-sanal gerçeklik simülatörünü daha önce kullanmış olan üniversite ve eğitim araştırma hastanelerinde görev yapan göz hastalıkları asistanlarına 21 sorudan oluşan çevrim içi bir anket uygulanmıştır. Katılımcılar oftalmoloji deneyim sürelerine göre 2 gruba ayrılmıştır: Grup 1 (≤2 yıl), Grup 2 (>2 yıl). Ankette cerrahi deneyim, simülatörün teknik yeterliliği, eğitime katkısı ve cerrahi özgüvene etkisi değerlendirilmiştir. Toplam 34 geçerli yanıt analiz edilmiştir. Bulgular: Katılımcıların 19'u (%55,9) Grup 1'de, 15'i (%44,1) Grup 2'de yer almıştır. Eğitim öncesinde Grup 1 katılımcılarının %50'si düşük cerrahi özgüven bildirmiş, bu oran eğitim sonrası %73,5 ile orta düzeye yükselmiştir. Gruplar arasında özgüven artışı açısından anlamlı fark gözlenmemiştir (p=0,255, p=0,637). Simülatör, el-göz koordinasyonu (%76,5) ve FAKO tekniği yeterliliği (%73,5) üzerinde olumlu etkili olmuş; ancak komplikasyon yönetiminde daha az etkili bulunmuştur (%20,6). Simülasyonun gerçek cerrahiye benzerliği %35,3 oranında düşük, %5,9 oranında ise çok yüksek olarak değerlendirilmiştir. Yaygın kullanımın önündeki başlıca engeller sınırlı erişim, finansal kısıtlamalar ve teknik sorunlardır. Sonuç: Sanal gerçeklik simülatörleri, cerrahi beceri ve özgüven gelişimini destekleyerek göz hastalıkları asistan eğitiminde değerli bir rol oynamaktadır. Simülatör eğitiminin oftalmoloji eğitim programlarına entegrasyonu, eğitim etkinliğini artırabilir ve komplikasyon oranlarını azaltabilir.

Anahtar Kelimeler: Katarakt; cerrahi; fakoemulsifikasyon; eğitim; simülatör
REFERENCES:
  1. World Health Organization [Internet]. World report on vision © 2025 WHO [Cited: February 15, 2025]. Available from: [Link] 
  2. Gower EW, Lindsley K, Tulenko SE, Nanji AA, Leyngold I, McDonnell PJ. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database Syst Rev. 2017;2(2):CD006364. [PubMed]  [PMC] 
  3. Muttuvelu DV, Andersen CU. Cataract surgery education in member countries of the European Board of Ophthalmology. Can J Ophthalmol. 2016;51(3):207-11. [PubMed] 
  4. Kotsis SV, Chung KC. Application of the "see one, do one, teach one" concept in surgical training. Plast Reconstr Surg. 2013;131(5):1194-201. [PubMed]  [PMC] 
  5. Khalifa YM, Bogorad D, Gibson V, Peifer J, Nussbaum J. Virtual reality in ophthalmology training. Surv Ophthalmol. 2006;51(3):259-73. [PubMed] 
  6. Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, Srivastava SK. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol. 2007;125(9):1215-9. [PubMed] 
  7. Wallace BS, Sabates NR. Simulation in ophthalmology. Mo Med. 2013;110(2):152-3. [PubMed]  [PMC] 
  8. Gillan SN, Saleh GM. Ophthalmic surgical simulation: a new era. JAMA Ophthalmol. 2013;131(12):1623-4. [PubMed] 
  9. Grodin MH, Johnson TM, Acree JL, Glaser BM. Ophthalmic surgical training: a curriculum to enhance surgical simulation. Retina. 2008;28(10):1509-14. [PubMed] 
  10. Haag-Streit Simulation [Internet]. EyeSI Surgical Simulator: Training Simulator for Intraocular Surgery. © 2025 haag-streit.com [Cited: April 26, 2025]. Available from: [Link] 
  11. Munro MG. Surgical simulation: where have we come from? Where are we now? Where are we going? J Minim Invasive Gynecol. 2012;19(3):272-83. [PubMed] 
  12. Glaser BM. Surgical simulation: why now? Retina. 2009;29(3):289-91. [PubMed] 
  13. Almaliotis D, Athanasopoulos GP, Almpanidou S, Papadopoulou EP, Karampatakis V. The contribution of wet labs in the education of ophthalmologists. Ann Med Surg (Lond). 2021;72:103034. [PubMed]  [PMC] 
  14. Lopez-Beauchamp C, Singh GA, Shin SY, Magone MT. Surgical simulator training reduces operative times in resident surgeons learning phacoemulsification cataract surgery. Am J Ophthalmol Case Rep. 2019;17:100576. [PubMed]  [PMC] 
  15. Sikder S, Tuwairqi K, Al-Kahtani E, Myers WG, Banerjee P. Surgical simulators in cataract surgery training. Br J Ophthalmol. 2014;98(2):154-8. [PubMed] 
  16. Cissé C, Angioi K, Luc A, Berrod JP, Conart JB. EYESI surgical simulator: validity evidence of the vitreoretinal modules. Acta Ophthalmol. 2019;97(2):e277-e282. [Crossref]  [PubMed] 
  17. Belyea DA, Brown SE, Rajjoub LZ. Influence of surgery simulator training on ophthalmology resident phacoemulsification performance. J Cataract Refract Surg. 2011;37(10):1756-61. [Crossref]  [PubMed] 
  18. Baxter JM, Lee R, Sharp JA, Foss AJ; Intensive Cataract Training Study Group. Intensive cataract training: a novel approach. Eye (Lond). 2013;27(6):742-6. [PubMed]  [PMC] 
  19. McCannel CA, Reed DC, Goldman DR. Ophthalmic surgery simulator training improves resident performance of capsulorhexis in the operating room. Ophthalmology. 2013;120(12):2456-61. [Crossref]  [PubMed] 
  20. Jaud C, Salleron J, Cisse C, Angioi-Duprez K, Berrod JP, Conart JB. EyeSi Surgical Simulator: validation of a proficiency-based test for assessment of vitreoretinal surgical skills. Acta Ophthalmol. 2021;99(4):390-6. [PubMed] 
  21. Vergmann AS, Vestergaard AH, Grauslund J. Virtual vitreoretinal surgery: validation of a training programme. Acta Ophthalmol. 2017;95(1):60-5. [PubMed] 
  22. Lockington D, Saleh GM, Spencer AF, Ferris J. Cost and time resourcing for ophthalmic simulation in the UK: a Royal College of Ophthalmologists' National Survey of regional Simulation Leads in 2021. Eye (Lond). 2022;36(10):1973-6. [PubMed]  [PMC] 
  23. Mondal S, Kelkar AS, Singh R, Jayadev C, Saravanan VR, Kelkar JA. What do retina fellows-in-training think about the vitreoretinal surgical simulator: a multicenter survey. Indian J Ophthalmol. 2023;71(8):3064-8. [PubMed]  [PMC] 
  24. Campbell S, Hind J, Lockington D. Engagement with ophthalmic simulation training has increased following COVID-19 disruption-the educational culture change required? Eye (Lond). 2021;35(10):2660-1. [PubMed]  [PMC] 
  25. Lee R, Raison N, Lau WY, Aydin A, Dasgupta P, Ahmed K, Haldar S. A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology. Eye (Lond). 2020;34(10):1737-59. [Crossref]  [PubMed]  [PMC] 
  26. Thomsen ASS, Smith P, Subhi Y, Cour M, Tang L, Konge L, et al. High correlation between performance on a virtual-reality simulator and real-life cataract surgery. Acta Ophthalmol. 2017;95(3):307-11. [Crossref] 
  27. la Cour M, Thomsen ASS, Alberti M, Konge L. Simulators in the training of surgeons: is it worth the investment in money and time? 2018 Jules Gonin lecture of the Retina Research Foundation. Graefes Arch Clin Exp Ophthalmol. 2019;257(5):877-81. [Crossref]  [PubMed] 
  28. Francone A, Huang JM, Ma J, Tsao TC, Rosen J, Hubschman JP. The effect of haptic feedback on efficiency and safety during preretinal membrane peeling simulation. Transl Vis Sci Technol. 2019;8(4):2. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 154 - 153
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 197
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 197
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com