By 2035, ophthalmology is projected to face the second most severe workforce shortage among all medical specialties.1 We can mitigate this deficit of physicians by reducing barriers to training and making learning more efficient through the use of augmented reality (AR) and virtual reality (VR) technologies in medical and surgical education. Such devices could assist ophthalmology students in learning complex surgical techniques more quickly than traditional methods. These technologies can also dramatically expand educational opportunities for ophthalmologists across the globe, facilitating a more streamlined, efficient and equitable field.
VR is designed to fully immerse the user in a virtual realm, while AR enhances real-life views with interactive digital overlays.2,3 Though they have some superficial similarities, each technology requires an independent hardware solution. Products vary widely in technical abilities and cost.
The Impact on Surgical Training
Vitreoretinal surgery is traditionally a difficult field to teach due to the technical challenges of sharing limited 2D images and videos. The addition of AR/VR enables users to view what the surgeon sees at the scope. It also provides interesting perspectives, such as viewing the retina from inside of the eye.4,5 In some cases, with advanced tracking, a user’s view can adjust as they move their head.
The Meta Quest 2 headset (Meta) is an excellent example of VR. Its capabilities offer a truly immersive experience. Users can “transport” themselves into a preconstructed environment (such as a classroom) and, with certain software applications, can interact virtually with anyone, anywhere, in real time. Known as the “metaverse,” this online setting has been shown to enable interactions that closely replicate the experience of being physically present in the same room (Figure 1). We’ve seen great examples of this using 3D content from MetaMed Media, which includes surgical videos, device demonstrations and panel discussions.6-8
On the AR side, several devices provide opportunities for ophthalmic training via remote experiential learning. These include the Apple Vision Pro AR Headset (Apple) and the Beyeonics One Ophthalmic Exoscope with AR Surgical Headset (Beyeonics).
The Apple Vision Pro AR headset offers enhanced resolution and, with some applications, eye-tracking and gesture-tracking capabilities. Through the goggles, surgeons can see their actual physical surroundings as well as interactive, computer-generated graphics. The Zeiss Surgery Optimizer AR software application (Zeiss) for Apple Vision Pro enables videos recorded via a Zeiss Artevo digital microscope to be viewed later in 3D stereoscopic vision.9
The Beyeonics One Ophthalmic Exoscope with AR Surgical Headset provides real-time remote viewing of the surgical field during ophthalmic surgeries, allowing students to see exactly what the surgeon sees: a high-definition, three-dimensional view of the surgical field that stays in front of them at all times without constraining movement (Figure 2). This content can be streamed online and downloaded afterward for review.10
With the Beyeonics One system, two headsets can be used simultaneously, enhancing training value. This includes the choice of identical three-dimensional views or a second two-dimensional view rotated 90 degrees from the primary surgeon’s perspective. Overlays and teaching pointers are available as well.2, 10
It should be noted that Alcon’s NGENUITY 3D Visualization System, while not AR, captures stereoscopic, high-definition digital video of ophthalmic micro-surgery that can also be streamed live or downloaded later for students to review.2, 5, 11 Conversely, Alcon’s Fidelis Virtual Reality Ophthalmic Surgical Simulator lets instructors observe remotely while their students practice surgical techniques virtually. Multiple users can connect to the same system.12, 13
These technologies could revolutionize surgical training by allowing residents to track their actions in real- time. Conceivably, they could shadow a physician from anywhere in the world by using their connected device to see everything the surgeon sees in the slit lamp and surgical scope.14
Conferences in the Metaverse
Conferences are an excellent way to share knowledge and network with colleagues. However, the cost and time of traveling to these events can discourage participation.
While video conferencing is a viable alternative to physical attendance, it often suffers from limited engagement and reduced meaningful interaction. VR offers a solution by enabling participants to move around, gesture, communicate emotions and build connections with others.15-17 Plus, with spatial audio, virtual guests can orient where sounds originate, making them feel like they’re in the room. Soon, artificial intelligence will translate any language in real time, facilitating seamless communication between individuals from different backgrounds.18
The Digital Ophthalmic Society already hosts VR “RetinaVerse” meetings weekly to discuss retina topics and surgeries, with plans to add a “Cornea Verse” as well.7, 19, 20
Looking Forward
As we look toward integrating more advanced technologies into ophthalmology, it is essential to consider ethical challenges — particularly around data privacy and equitable access. While AR/VR technologies are expanding opportunities, they may not be readily available in low-resource settings. Additionally, the adding of patient information into yet another computerized system with internet access raises questions about data security and patient consent. Addressing these concerns will be vital in ensuring that technological advancements benefit all patients equally.
Ophthalmology is poised to embrace new technologies that will enhance the experiences of physicians, trainees, patients and staff. The integration of AR/VR in medical education, conferences, surgery and beyond shows that the potential of these technologies is vast. They will shape how we approach patients, practice medicine and perform surgeries. By leveraging AR/VR, we are not just preparing the next generation of ophthalmologists, we are also ensuring that ophthalmology continues to evolve and thrive in a rapidly changing medical landscape. OM
References
1. Berkowitz ST, Finn AP, Parikh R, Kuriyan AE, Patel S. Ophthalmology workforce projections in the United States, 2020 to 2035. Ophthalmology. 2024;131(2):133-139.
2. Rosenberg ED. Digital visualization in the operative theater. Eyes On Eyecare. Jan. 19, 2024. https://eyesoneyecare.com/resources/digital-visualization-operative-theater/. Access Nov. 1, 2024.
3. Li T, Li C, Zhang X, et al. Augmented reality in ophthalmology: Applications and challenges. Front Med (Lausanne). 2021;8:733241. Published 2021 Dec 10.
4. Seddon IA, Rahimy E, Miller JB, Charles S, Kitchens J, Houston SK 3rd. Feasibility and potential for real-time 3D vitreoretinal surgery telementoring. Retina. 2023;43(12):2162-2165.
5. Iskander M, Ogunsola T, Ramachandran R, McGowan R, Al-Aswad LA. Virtual reality and augmented reality in ophthalmology: A contemporary prospective. Asia Pac J Ophthalmol (Phila). 2021;10(3):244-252.
6. Rosenberg ED. Unleashing the potential of digital technology. CRSToday. June 2023. https://crstoday.com/articles/june-2023/unleashing-the-potential-of-digital-technology. Accessed Nov. 1, 2024.
7. Parise M, Rosenberg E. Digital Ophthalmic Society. MillennialEYE. May/June 2022. https://millennialeye.com/articles/may-june-22/digital-ophthalmic-society/. Accessed Nov. 1, 2024
8. Greenbaum J. Ophthalmology enters the metaverse. Ophthalmology Management. 2023;27(1): 8. https://ophthalmologymanagement.com/issues/2023/january/quick-hits/. Accessed Nov. 1, 2024.
9. Samak Sriganesh, S. Upgrading cataract surgery skills: Unlocking the full potential of surgical video review using an AI-based application. https://www.zeiss.com/meditec/en/products/surgery-optimizer.html - Downloads. Accessed Nov. 11, 2024.
10. Beyeonics. Beyeonics One. https://beyeonics-vision.com/ophthalmology/for-physicians/. Accessed Oct. 18, 2024.
11. Alcon. NGENUITY 3D Visualization System. https://us.alconscience.com/article/ngenuityr-3d-visualization-system/. Accessed Nov. 11, 2024.
12. Alcon introduces state-of-the-art virtual reality surgical training technology. Press release. April 12, 2022. https://www.alcon.com/media-release/alcon-introduces-state-art-virtual-reality-surgical-training-technology/. Accessed Nov. 1, 2024.
13. Thomsen AS, Bach-Holm D, Kjærbo H, et al. Operating room performance improves after proficiency-based virtual reality cataract surgery training. Ophthalmology. 2017;124(4):524-531.
14. Pottle J. Virtual reality and the transformation of medical education. Future Healthc J. 2019;6(3):181-185.
15. Hillman L. Grand rounds have entered the metaverse. EyeWorld. October 7, 2022. https://www.eyeworld.org/2022/grand-rounds-have-entered-the-metaverse/. Accessed Nov. 1, 2024.
16. Young A. Ophthalmology takes the plunge into the metaverse. Healio.com. November 7, 2022. https://www.healio.com/news/ophthalmology/20221104/ophthalmology-takes-the-plunge-into-the-metaverse. Accessed Nov. 1, 2024.
17. Polascik BW, Thompson C, Weng P, Houston SK 3rd, et al. Meetings and conferences in the metaverse. Retinal Physician. May 1, 2024. https://retinalphysician.com/issues/2024/may/meetings-and-conferences-in-the-metaverse/. Accessed Nov. 1, 2024.
18. Moneus AM, Sahari Y. Artificial intelligence and human translation: A contrastive study based on legal texts. Heliyon. 2024;10(6):e28106. Published 2024 Mar 14.
19. Hillman L. DOS 1 year later. EyeWorld. May 9, 2023. https://www.eyeworld.org/2023/dos-1-year-later/. Accessed Nov. 10, 2024.
20. Ong J, Hariprasad SM, Chhablani J. Into the RetinaVerse: A new frontier of retina in the metaverse. Ophthalmic Surg Lasers Imaging Retina. 2022;53(11):595-600.
