Influence of surgery simulator training on ophthalmology resident phacoemulsification performance

Authors: David A. Belyea, MD, MBA, Sarah E. Brown, MD, Lamise Z. Rajjoub, MD.

Publication: J Cataract Refract Surg 2011; 37:1756–1761 2011 ASCRS and ESCRS.



To determine whether the use of an eye-surgery simulator during ophthalmology residency training improves cataract surgery performance.


Department of Ophthalmology, Medical Faculty Associates, George Washington University, Washington, DC, USA.


Comparative case series.


Residents were divided into a simulator group and a nonsimulator group based on the inclusion or absence of the eye-surgery simulator in residency training. Consecutive resident cataract surgeries with the same attending surgeon were retrospectively reviewed. The phaco time and percentage power and intraoperative complications in each case were recorded. The adjusted phaco time in each case was calculated.


The study reviewed 592 surgeries. The mean values for phaco time, percentage phaco power, adjusted phaco time, complication rates, and complication grade were 1.88 minutes (range 0.11 to 7.20 minutes), 25.32% (range 2.2% to 50.0%), 47.58 minutes (range 0.24 to 280.80 minutes), 0.04, and 2.33, respectively, in the simulator group (n = 17) and 2.41 minutes (range 0.04 to 8.33 minutes), 28.19% (range 8.0% to 70.0%), 71.85 minutes (range 0.32 to 583.10 minutes), 0.06, and 2.47, respectively, in the nonsimulator group (n = 25). The Student t tests showed a statistically significant between-group difference in mean phaco time (P<.002), adjusted phaco time (P<.0001), and percentage phaco power (P<.0001). Regression analysis showed a significantly steeper slope of improvement in mean phaco time and power in the nonsimulator group than in the simulator group (P<.0001).


Residents who trained using the simulator had shorter phaco times, lower percentage powers, fewer intraoperative complications, and a shorter learning curve.

Financial Disclosure

No author has a financial or proprietary interest in any material or method mentioned.