Teaching ophthalmic microsurgical skills: conventional microscopy versus heads-up visualization.

BACKGROUND: To compare training effects between conventional operating microscope and a3D heads-up system using the EyeSi® simulator (Haag-Streit, Köniz, Switzerland) in medical students and residents without prior microsurgical experience. METHODS: In a prospective single-center crossover study, 16 medical students with ophthalmological exposure and 16 residents completed standardized cataract and vitrectomy modules on the EyeSi® simulator using both a conventional ocular microscope and a 3D display. Objective performance parameters and subjective evaluations (questionnaire) regarding safety, handling, comfort, learning progress, as well as interaction were assessed. RESULTS: In the vitrectomy simulation, no significant difference in scores was found between visualization systems (p = 0.126), whereas in the cataract simulation, the conventional microscope achieved significantly higher scores (p = 0.023). The overall task scores did not differ significantly (p = 0.376). Subjectively, the 3D system was rated superior regarding control (p = 0.013), instrument handling (p = 0.033), movement precision (p < 0.001), comfort, and instructor interaction (p < 0.001). Students tended to prefer the 3D system, whereas residents more often preferred the conventional microscope, although this difference was not statistically significant (p = 0.183). All participants reported that skills acquired with the 3D system could be perceived transferability to the conventional microscope. CONCLUSION: The 3D display achieved comparable simulator performance in the vitrectomy module but lower performance in the cataract module compared with the conventional microscope, while offering perceived didactic and ergonomic advantages. The differing preferences between students and residents may suggest a possible habituation effect due to prior slit-lamp use and familiarity with conventional visualization techniques. As digital visualization systems are becoming increasingly integrated into contemporary ophthalmic surgery, early exposure to heads-up technology during simulator-based training may help familiarize trainees with modern visualization techniques. Future clinical studies are required to determine whether these simulator-based findings translate into improved operative performance.