Sir,

We read with interest the important study undertaken by Saleh et al.1

However, the only exclusion criterion for selection of candidates was novices with more than 2 h of simulation/intraocular surgical experience. The authors do not mention whether a baseline test of visual acuity and stereopsis was recorded for participants. The importance of stereopsis in achieving satisfactory skills in ophthalmic surgery remains debated.2 Recent studies have demonstrated that a decreased stereoacuity results in a statistically significant decrease in simulated surgical performance for most participants.3, 4 We suggest that all ophthalmic simulator-based studies should measure participant visual acuity and stereoacuity to ensure reliable results.

The authors also discuss the emergence of a ‘learning curve’ achieved in repeated tasks. In our simulator-based studies evaluating parameters affecting surgeon performance, we minimised the learning curve before data collection.5 Using one attempt level 1, one attempt level 2 and six attempts level 4 forceps module, stabilised scores for our participants. Applying the same methodology to other modules might produce similar results and could be used in training.