To the Editor:

We appreciated the article titled “Overcoming barriers in access to ophthalmic education with virtual learning” by He et al. [1]. They highlighted the importance of virtual formats in ophthalmic education, the good acceptance of webinars among medical students, and the potential benefits beyond the current COVID-19-pandemic-related restrictions [1]. Multiple e-learning formats have been introduced for medical students and ophthalmology trainees to ensure the continuity of ophthalmic education [2, 3]. Moreover, virtual tools and simulation models can allow a controlled and plannable practice of surgical skills, respecting the social distancing [4]. In this light, we describe a virtual corneal suturing dry lab, adopted for medical students and junior registrars at the University of Liverpool, UK. Each student’s workstation (also placed at home) is equipped with a desk (surgical table), 5× high-resolution binocular loupes, two eye models (OKULO Anterior Segment BR8 and KERATO models, BIONIKO, Miami, USA), a corneal suturing kit (Hoskins forceps, tying forceps, Vannas scissors, Barraquer suture holder, 10-0 Nylon suture packs) and an IPEVO VZ-R Dual-Mode 8MP document camera connected to a laptop computer (Fig. 1). A 30-min pre-recorded lecture regarding eye anatomy, corneal suturing technique and including video tutorials on cardinal sutures for penetrating keratoplasty, is followed by a remote 30-min live session via Zoom in which the students can ask questions, make attempts at suturing with remote proctoring and the instructor can perform a demonstration of corneal suturing. The trainees can then access the pre-recorded lecture through a link and practice independently. After 1 week, the trainees hold a 15-min test in which they perform a maximum of eight sutures on the models, with additional feedback. This performance is recorded to assess “respect for tissue”, “time and motion”, “instrument handling”, and “suturing flow”, whereas a photograph of the final result is analyzed with Fiji Image J to calculate mean spacing, width, radiality, and symmetry of sutures.

Fig. 1: Corneal suturing dry lab.
figure 1

A Setup of the workstation for the dry lab. B View of the surgical field on the screen.

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We propose this virtual dry lab model as a feasible teaching format for microsurgical skills. As the repeated pandemic has led to the interruption of surgical training with potential consequences on their performance [5], a virtual simulation model might help trainees to retain surgical skills.