As we emerge from the pandemic into a new world, we are able to look back and see how the usefulness and importance of VR in the acquisition and retention of surgical skills has been accelerated. With access to traditional training limited and healthcare workers stretched thin, utilizing VR for advanced surgical training is already proving to be one of the most worthwhile and exciting use cases in the ‘metaverse’. In particular, we are witnessing an increasing adoption of VR simulation in the ophthalmology sector. By combining VR with cutting-edge haptic technology, this training offers numerous physical and cognitive benefits to surgeons, wherein they can now train and gain competence and confidence with a range of ophthalmic surgeries, devices and therapies remotely. Moreover, the need for low-cost, high-fidelity training for ophthalmology is becoming more urgent for two key reasons: lack of access to training and the rate of innovation. The following article explores how VR can aid with these key issues, through existing case studies, spanning from low-cost cataract surgery (MSICS) to novel gene therapy.
An exponential rate of innovation
A large proportion of surgical training goes by the motto: see one, do one, teach one. In my view, this is an outdated approach to surgical training and is becoming increasingly problematic. In the last ten years, we have seen vast and rapid innovation in ophthalmology. Through the introduction of novel medical devices and therapies, from minimally invasive surgical devices for glaucoma surgery (MIGS) to the very first FDA-approved gene therapy for an inherited retinal disorder (IRD), the ophthalmic specialty has led the way in surgical modernization. It is clear that such rapid growth of new products and technology has great potential to improve eye care globally. However, as new techniques, therapies, and devices come to market, it has also never been more important to develop more effective and efficient ways to train HCPs on their use. Simply put, with the level of innovation in ophthalmic devices and therapies we are seeing right now, innovation in training and education must keep up.
Ocular gene therapy training enabled by Virtual Reality
With the advent of complex therapies which require intricate surgical procedures, such as ocular gene therapy, life science companies are faced with challenging requirements to develop corresponding training and education programs. For example, the first FDA-approved ocular gene therapy, delivered via injection into the subretinal space, requires extreme precision and skill. This is where VR with haptic capabilities comes in. Tools incorporating the latest HapticVR technology (developed by med-tech companies like FundamentalVR) specialize in creating a precise sense of touch that enables the necessary skills transfer and ongoing skills retention.
The COVID19 pandemic has only served to prove the viability and, more importantly, the necessity of this alternative to traditional training methods. Advances in kinesthetic haptics and 3D spatial technology with high-fidelity graphics alters the training landscape and has the potential to render risky surgical training obsolete. Immersive technology brings a sensory realism so acute that these solutions are now a credible alternative to traditional methods and can finally keep up with advances in treatments and therapies.
Access to adequate training
Surgical training has seen major disruptions during the pandemic, with lack of access to safe and adequate surgical training being significantly exacerbated. Across the world, we have seen elective surgeries canceled, wet labs axed and ophthalmology residents and attendings deployed to COVID wards and ERs. Although the entire world will feel the effects of the pandemic for a long time, those in low- to middle-income countries will and are being severely impacted, especially in areas in which surgical supplies and resources are low. The effect of the pandemic on low- to middle-income countries creates the possibility that a whole generation of ophthalmology residents could lose out on crucial training and experience. This is a devastating prospect, especially as we recognize that in many of these populations the prevalence of blindness is high, yet resources are low. Low-cost simulation presents itself as an invaluable and reliable solution to addressing this issue. By putting high-quality training programs into the hands of surgeons regardless of where they are, at a fraction of what it would normally cost, immersive technology has become a key way to circumvent the daunting headwinds, helping blunt the effects brought on by the pandemic.
Cataract surgery training with VR takes off with Orbis International
Orbis International is demonstrating how we can leverage VR to provide improved access to quality training. Orbis is tackling the prevalence of avoidable blindness in developing countries head-on with initiatives such as its Flying Eye Hospital, a fully operational teaching hospital on an MD-10 plane, its award-winning telemedicine platform, Cybersight, as well as long-term country programs. By tapping into VR, Orbis is able to scale its operations. As Dr. Hunter Cherwek, VP of Clinical Services and Technologies at Orbis, puts it: “This technology is taking our simulation portfolio to the next level in replicating the most delicate surgery and allowing it to be globalized to all of our partners at Orbis International”.
It is an incredibly exciting time to be working in ophthalmology and to experience first hand the transformational times in which we are increasingly able to envision a world where the prevalence of vision loss and blindness are greatly reduced. Moreover, today we are still only scratching the surface of what VR technologies can bring to ophthalmology training, education and promotion. The application of virtual reality for ophthalmology has the potential to shift the medical landscape worldwide.
Ashlie Leal is the lead for Ophthalmology at FundamentalVR. Over the past two years, she has been fortunate enough to experience working with medical device, pharmaceutical and nonprofit eye care organizations to provide high fidelity VR simulation training that has the power to change lives around the world.
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