As a young ophthalmologist, passionate about surgery, my journey with simulation training in cataract surgery has been nothing short of transformative. During the last 10 years, I have attended simulation surgery workshops and world-renowned courses, practiced on my own, and even organized immersive simulation weekends for others. The evolution of my skills and understanding has been immensely reshaped by these simulated experiences.
Simulation Training in Ophthalmic Surgery - 2013
During my time in medical school, I was part of an extracurricular class that included people who were interested in general surgery and microsurgery. I remember how me and my good friend Dr. Valentin Ivanov visited another university in Bulgaria (Medical University of Pleven) and got the chance to experience a virtual reality simulation surgical device for the first time.
Although the device was basic and we had limited time with it, I was blown away and discussed with one of my friends how this was a very promising technology and had enormous upside potential in the future.
Image from https://www.mavericsolution.com/lapvision
Simulation Training in Ophthalmic Surgery - 2016
Just after graduating from medical school, I had the chance to experience my first simulator in the field of ophthalmology. It was one of the first EyeSi Simulators, which was given on a rotational basis to different university clinics in Bulgaria to train young ophthalmologists.
Images from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179658/ This initial exposure was just a brief glimpse into the potential of simulation training. Looking back on it, the resolution was lower, the microscope controls were different. But the most fascinating was that it was really fun, I was very committed to doing my best, and it kind of felt like I was training to become an eye surgeon.
The experience was only for a few hours and I could not progress through many exercises. I was practicing mostly on my own, occasionally there was an ophthalmology resident who was observing and giving me some pointers. Anyway, this was one of the first places that I could test out my hand stability and improve it. Honestly, I was hooked. I wanted to practice more, as I saw how I was progressively getting better.
Simulation training in ophthalmic surgery - 2017
In 2017 I got to experience Simulation ocular surgery for the second time, again through a traveling simulator in the largest university hospital in Sofia, Bulgaria. While looking and feeling similar I noticed significant software improvement and the device was feeling more like a real surgeryreal-life-like. I was very grateful for the opportunity, but I did not receive any guidance and was left with the device on my own. Looking back on this I realise how limiting it could be.
Simulation training in ophthalmic surgery - 2020
During my ophthalmology residency, I visited a conference, where after signing up 6 months in advance, each resident was allowed a precious 60 minutes to spend practicing with the simulator. Although no specific curriculum, no mentor I was familiar with the system and managed to glide through a few excercises, making the most of my time.
Many of the young colleagues left after the session was over, but I decided to stay and found myself drawn to mentor others (who were struggling due to lack of previous experience with the system ), guiding them through their first encounters with the surgical simulator. It was a great decision because as I "mentored" others through difficulties, it was as if I was observing myself from a third-person perspective, gaining an understanding of not just the device, but also reflecting on my learning process.
I remember thinking: This step is so hard to explain in a simple way, that means I don't truly understand it and need to explore it in detail, when I have the time.
In the role of mentor, I discovered the value of collaborative learning, realizing that in guiding others, I was also deepening my comprehension and mastery.
Simulation training in ophthalmic surgery - 2022
Attending the Oftalmo University Simulation Course in Mexico
Only a few situations in your life feel like the "aha" moment and that you vividly remember as you reflect on your experiences. One of those was my talk with Dr. Ivo Ferreira - founder of Oftalmouniversity.
Read or watch a full Interview I did with him here: Interview with Dr. Ivo Fereira: Mastering your Ophthalmic Surgical Training (It's a really good one, I promise!) I will never forget the conversation we had with Dr. Ivo Ferreira when we first spoke about cataract surgery training, and if you know him you know how excited and energetic he gets when he speaks about the topic:
Dr. Ferreira: Have you trained on a surgical simulator? Me: Oh, yes! I've spent many hours on the simulator! Dr. Ferreira: Ok, great, and how much of this time of the training was with a mentor who not only knew what he was doing but was a good teacher? Me: ...
This statement blew my mind. It all made sense. In the same way, I was guiding others during the conference, getting guidance will mean that I will get my skills to the next level. This inspired me to go to Mexico City and visit the Oftalmo University Campus and spend 10 days there and learn from their amazing team.
Stay tuned for the full article regarding my experience in the Oftalmo University Campus. But meanwhile here are some bullet points of what made the most impression on me:
Dr. Ivo Fereira is a very inspiring colleague. He is full of energy, and motivation and has that champion, winner mentality. He can transform your way of thinking completely in the span of just a few days. His style of mentorship is individual and he focuses on breaking your firm beliefs and challenging concepts that you take for granted. I felt that I was in a cataract surgery training camp and he was my sport coach, pushing me beyond my comfort every time and expecting more of me each time. Fantastic!
The approach towards learning and teaching is very intensive. Oftalmo University is all about sharing and collaboration, they show you how important is to teach others and demonstrate to you how quickly progress, when you take the role of explaining and coaching others yourself.
They are treating Ophthalmology and Ophthalmology Surgery as a competitive sport. They aim to get the best out of you. They track your pulse and heart rate variability with ECG during your training. You get consulted and coached about nutrition, mindfulness, and dealing with stress. I was amazed to find a program that takes cataract surgery and tries to make not only your skills excellent but enhance you as a surgeon to reach the best version of yourself.
Taking part in Oftalmo University is probably single-handedly one of the most influential experiences in my surgical training in ophthalmology and I highly recommend it.
Simulation Training in Ophthalmic Surgery - 2023
ESCRS Haag-Streit dinner
For me attending the Haag-Streit Ambassador’s Event was game-changing. This event brought together surgeons and educators, who independently without talking to each other presented more or less the same concept when it comes to surgical training:
There is a problem with surgical training in residency in Europe
People who train in surgery on simulation have a better and deeper understanding of the surgery, have fewer surgical complications, and steeper learning curve
Simulation surgery could be a solution to the training problem in Europe.
I was invited as one of the presenters and My presentation too included the same points. It was a great experience, since for the first time I am visiting a meeting where we have complete consensus for a promising technology may be the revolutional keystone to advancing surgical education.
Haag-Streit’s simulators are great, because they showcase how technology can bridge the gap between theory and practice, creating a safe and immersive environment for skill development.
Last but not least - the event highlighted the key role of mentorship and collaboration in shaping future surgeons. It was an inspiring note that the future of ophthalmology lies in implementing these transformative tools in our training and everyday practice.
Read More: HAAG Streit Ambassadors Event 2023
Training on the latest software of EyeSi in Medical University Plovdiv
Most things in life can happen if you simply take the time to kindly ask someone.
One day I composed an email and reached out to MU Plovdiv's Simulation center to inquire whether training on their simulator was possible, and they promptly invited me to come.
This experience shows the value of being proactive - opportunities often exist, but you have to seek them out.
Over four days, training eight hours a day, I pushed myself beyond my previous experience with simulation, focusing on more challenging tasks that demanded more precision and better time efficiency. I practiced mastery of the temporal approach since I was starting to perform Microinvasive Glaucoma Surgery (MIGS) at my clinic and I needed to get more comfortable operating laterally.
Additionally, I spend much time refining my left-hand skills, an area often overlooked but crucial for surgical balance. I strongly advise everyone to practice with their non-dominant hand—it pays off in ways you don’t anticipate.
Simulation Training in Ophthalmic Surgery - 2024
There's a growing trend in ophthalmology with exciting new projects focused on simulation surgery. For example, "Help Me See" has recently opened a new simulation center in Europe, making it easier for surgeons to get hands-on training in phaco and extracapsular cataract extraction.
They use an approach where in addition to the didactic step-by-step course from the simulator itself you have a mentor who guides you and observes your movements from the side. The simulator provides haptic and resistance which is very helpful in understanding differences in fine movement in some steps of the surgery.
Fidelisâ„¢ Virtual Reality (VR) Ophthalmic Surgical Simulator uses the Meta Oculus Quest 2 with special instrument handles to introduce an immersive virtual reality experience and simulate surgery.
The ESCRS is also rolling out the ESCRS Moving Simulator Project, which takes an EyeSi Simulator from Haag-Streit, bringing training across many countries in the EU. These initiatives make it more accessible for young ophthalmologists to sharpen their skills and improve patient care.
Our team in Germany was lucky enough to host the ESCRS Moving simulator for 3 months and made the following inspiring video about it, feel free to check it out:
ESCRS Cataract Training Lab 2024 in Vienna
At the ESCRS Cataract Training Lab 2024Â in Barcelona, I had the privilege of being a mentor and teaching young ophthalmologists through an intensive cataract surgery training course using simulation and dry labs. The mentors were highly motivated and made the learning environment exceptional.
The key focus was on learning phacoemulsification. I worked closely with trainees to provide real-time feedback on key surgical steps, working on biomechanics, hand position, and fine movements - practical insights to boost their confidence in the OR.
The ESCRS Training Lab was an amazing success and highly appreciated form the next generation of cataract surgeons. I found it incredibly rewarding to contribute to their development at this prestigious event, but also learned a lot myself by mentoring others.
Building on the success of the 2024 edition, the ESCRS board has announced plans to expand the project during the 2025 conference in Copenhagen, aiming to offer even more advanced training opportunities and reach a broader group of aspiring surgeons.
Transition to Real-Life Phaco - 2024
It all came together when I started performing phacoemulsification in 2024. After many drylabs, wetlabs and hundreds of hours of simulation training (starting from basic hand stability drills in medical school to high-level immersive courses at institutions like Oftalmo University), transitioning to phaco on real patient felt very natural.
Unlike many peers who faced steep learning curves, I entered the operating room with a clear roadmap, precise hand movements, and an already-developed instinct for managing intraoperative challenges. My complication rate was noticeably lower, my efficiency significantly higher, I was more self-sufficient and I progressed through the surgical learning curve at an accelerated pace.
This solidified my already existing belief that simulation is not just a supplement to surgical training, it’s a game changer. I believe that Simulation Trainig is an essential tool that every young ophthalmologist should embrace.
Simulation training in ophthalmic surgery - 2025
Opening of the Oftalmo University Campus Europe: The biggest Simulation Survery Training Center in Europe
On February 10, 2025, Oftalmo University took a big step forward in ophthalmic education by launching its European campus in collaboration with IMO Grupo Miranza in Barcelona.
This new facility is packed with state-of-the-art training resources, including three EyeSi surgical simulators, a VR station for remote mentorship, and fully equipped dry and wet labs—giving ophthalmologists from all over Europe an incredible hands-on learning experience.
The opening event was led by Dr. Ivo Ferreira, who welcomed trainees from multiple countries and emphasized the importance of ergonomics, precision, and building surgical confidence. As a guest mentor, I had the opportunity to contribute to the hands-on training sessions, helping participants refine their skills.
With its innovative curriculum and expert mentorship, Oftalmo University Europe is set to transform cataract surgery training and play a key role in shaping the future of ophthalmology.
The future of simulation training in ophthalmic surgery - 2030
In the next few decades, I believe that simulation training in ophthalmic surgery will be highly advanced and fully immersive, transforming how we learn and our skills. Artificial Intelligence Coaching Models, together with Virtual reality and augmented reality technologies will likely dominate in all aspects of our training (starting from medical school), offering hyper-realistic surgical environments where trainees can practice complex procedures multiple times with precision.
AI-driven simulators will adapt to each learner’s skill level, providing personalized feedback and tailored challenges. With haptic feedback and emersion becoming more refined, these simulations will closely mimic the true sensations of real surgery, allowing for safe, repeated practice without risk to patients.
I believe, the global training standards will include simulation training as part of every eye surgeon's curriculum and will allow surgeons to share experiences and techniques, fostering a more connected and skilled ophthalmic community. Recently I've thought about how every hospital can have a surgical simulator and use it as a warm-up device for surgeons ( to be used in a similar way as you warm up for your gym workout) to improve outcomes. In the future, a spinoff project from surgical simulators in ophthalmology could evolve into a platform that enables a single surgeon to operate on multiple patients simultaneously, without needing to be physically present in the same operating room (Similar to the way Da Vinci Robotic Surgical Systems work).
Conclusion
Reflecting on my journey over the past decade, simulation training has been one of the most important instruments in shaping me into the surgeon I am today. This does not apply to cataract surgery, but to ophthalmic surgery in general - deconstructing every surgery into a series of steps and using the gamification mindset of making each step the best way possible.
With each simulated case, I gained new insights, refined my technique, and became more confident performing more complex surgical scenarios.
Whether you're a resident, young ophthalmology specialist, or experienced eye surgeon, I highly recommend incorporating simulation training into your continuous surgical skills development.