Risantini Murugan

Learning to handle fine instruments under the microscope is one of the most challenging parts of ophthalmology training. Most residents realise early on that progress is slow and depends on regular, focused practice rather than a single breakthrough moment. Although many programs now offer simulation labs, the availability of time and equipment varies, so trainees often look for practical ways to continue building their skills between cases. A combination of simple at-home drills and short, well-planned simulation sessions can make a noticeable difference in confidence and consistency during early surgical experiences (1-4).

A range of low-tech drills can be done at home or in a small workspace, and many trainees are familiar with these exercises even if they do not rely on them regularly. One commonly used method is creating a controlled circular tear in the skin of a grape, which provides a reasonable sense of how a capsulorrhexis behaves. Peeling the thin membrane from a hard-boiled egg encourages light, steady traction, while suturing along the inner surface of an orange peel allows residents to practise needle depth control and spacing. None of these tasks requires much time, yet repeated practice helps build the type of muscle memory that supports more advanced steps later (5,6).

Simulation forms the second major component of early skill development. Virtual reality systems such as EyeSi have been shown to help with tremor control, shorten learning curves and reduce complication rates in early cataract surgery (1-3,7). Short, frequent VR sessions tend to be more useful than occasional long ones. Wet-lab work remains valuable, especially for wound construction and suturing, and several groups now recommend integrating both VR and wet-lab sessions into structured teaching programmes (4,8). These environments give residents a reliable way to rehearse surgical steps that they may not encounter often in the operating room.

Daily habits also contribute to microsurgical readiness. Paying attention to posture can reduce unnecessary strain during longer cases, which in turn steadies the hands. A moment of controlled breathing before a delicate manoeuvre helps maintain focus. Incorporating small tasks with the non-dominant hand, such as opening containers or handling small objects, gradually improves bimanual coordination. These minor adjustments mirror the elements that are evaluated in formal microsurgical assessments (9).

Microsurgical skill develops through steady, consistent effort. Regular access to VR and wet-lab practice is ideal, but when these are limited, short at-home drills offer meaningful reinforcement. Combining both approaches gives residents a stronger foundation and greater confidence as they move through the early stages of surgical training.

References

1. Thomsen AS, Bach-Holm D, Kjaerbo H, et al. Operating room performance improves after proficiency-based virtual reality cataract surgery training. Ophthalmology. 2017;124(4):524–531.
2. Pokroy R, Du E, Alzaga A, et al. Impact of simulator training on resident cataract surgery. Graefes Arch Clin Exp Ophthalmol. 2013;251(3):777–781.
3. Ferris JD, Donachie PHJ, Johnston RL, et al. The influence of EyeSi virtual reality training on complications in cataract surgery performed by first-year trainees. Br J Ophthalmol. 2020;104(3):324–329.
4. Saleh GM, Lamparter J, Sullivan PM, et al. The International Forum for Ophthalmic Simulation: recommendations for simulation-based training in ophthalmology. Br J Ophthalmol. 2013;97(6):655–658.
5. Sivaraman KR, Patel V, Ashraf DC. Low-cost task trainers for microsurgical skill reinforcement in ophthalmology. Ophthalmic Surg Lasers Imaging Retina. 2020;51(2):110–115.
6. Staropoli PC, Gregori NZ, Junk AK, et al. Surgical simulation training reduces intraoperative cataract surgery complications among residents. Simul Healthc. 2018;13(1):11–15.
7. Lam CK, Sundar G. Simulation-based cataract surgical training: a systematic review. Asia Pac J Ophthalmol. 2022;11(1):16–26.
8. Saleh GM, Lamparter J, Sullivan PM, et al. The International Forum for Ophthalmic Simulation: recommendations for simulation-based training in ophthalmology. Br J Ophthalmol. 2013;97(6):655–658.
9. Mahr MA, Hodge DO. Construct validity of anterior segment anti-tremor tasks of the MicroSurgical Skills Assessment. J Cataract Refract Surg. 2008;34(9):1539–1544.