To the Editor:
We congratulate Lee et al.  on their recent article that provided a comprehensive overview of technical and non-technical simulation skills in ophthalmology. Eyesi® (VR Magic, Germany) simulator had the best evidence base for its role in cataract surgery training and has been shown to reduce posterior capsular rupture (PCR) rates amongst first and second year surgeons .
Recent events have resulted in a prolonged and widespread hiatus of elective surgery and redeployment of staff. This in turn has emphasised simulation as a potential tool that can help surgeons retain and retrain their cataract skills. It is hypothesised that de-skilling due to a surgical hiatus may lead to an increase in complications such as PCR. Although PCR is an infrequent complication, it holds the potential, if poorly managed to result in significant visual morbidity . The impact of simulation on PCR rates is not well known and national access to standardized PCR simulation facilities remains unclear.
Our objective was to update the national locations of Eyesi® simulators and identify whether anterior vitrectomy modules were available. Regional simulation leads were contacted directly via the RCOphth simulation lead and asked to provide updated details about their facilities. Where information was absent, direct contact was made with local simulation users.
Table 1 provides a useful reference that may encourage cataract surgeons to make best use of locally available resources. Simulation offers an important tool in helping surgeons limit the risk of de-skilling and ensuring the safest level of care is offered to our patients. Although the impact of simulation on PCR rates is yet to be established in the literature, there is mounting evidence for the efficacy of simulation in both cataract and glaucoma surgery [2, 4]. The RCOphth recommends trainees in particular to access “extensive simulation” . At present there is some inter-deanery variation in access to both cataract and anterior vitrectomy modules. We would like to highlight this geographical disparity to the college and hope that this leads to a more even distribution of simulation facilities in the future. Improved local access will lead to the greatest benefit for ophthalmologists and their patients.
Lee R, Raison N, Lau WY, Aydin A, Dasgupta P, Ahmed K. A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology. Eye. 2020. https://doi.org/10.1038/s41433-020-0832-1.
Ferris JD, Donachie PH, Johnston RL, Barnes B, Martina O, Sparrow M. Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 6. The impact of EyeSi virtual reality training on complications rates of cataract surgery performed by first and second year trainees. Br J Ophthalmol. 2019;104:324–9.
Ti SE, Yang YN, Lang SS, Chee SP. A 5-year audit of cataract surgery outcomes after posterior capsule rupture and risk factors affecting visual acuity. Am J Ophthalmol. 2014;157:180–5.
Dean WH, Buchan J, Admassu F, Kim MJ, Golnik KC, McNaught A, et al. Ophthalmic surgical competency assessment rubric (Sim-OSSCAR) for trabeculetomy. BMJ Open Ophthalmol. 2019;4:e000313.
Royal College of Ophthalmologists. Simulation in training. Royal College of Ophthalmologists. 2019. www.rcophth.ac.uk/training/ost-information/simulation/.
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Maubon, L., Nderitu, P. & Swampillai, A.J. National access to Eyesi® and anterior vitrectomy simulation. Eye 35, 2051–2052 (2021). https://doi.org/10.1038/s41433-020-1107-6
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