Democratizing Vitreoretinal Surgery Training With a Portable and Affordable Virtual Reality Simulator in the Metaverse

Purpose: The purpose of this study was to develop and validate RetinaVR, an affordable, portable, and fully immersive virtual reality (VR) simulator for vitreoretinal surgery training. Methods: We built RetinaVR as a standalone app on the Meta Quest 2 VR headset. It simulates core vitrectomy, peripheral shaving, membrane peeling, and endolaser application. In a validation study (n = 20 novices and experts), we measured: efficiency, safety, and module-specific performance. We first explored unadjusted performance differences through an effect size analysis. Then, a linear mixed-effects model was used to isolate the impact of age, sex, expertise, and experimental run on performance. Results: Experts were significantly safer in membrane peeling but not when controlling for other factors. Experts were significantly better in core vitrectomy, even when controlling for other factors (P = 0.014). Heatmap analysis of endolaser applications showed more consistent retinopexy among experts. Age had no impact on performance, but male subjects were faster in peripheral shaving (P = 0.036) and membrane peeling (P = 0.004). A learning curve was demonstrated with improving efficiency at each experimental run for all modules. Repetition also led to improved safety during membrane peeling (P = 0.003), and better task-specific performance during core vitrectomy (P = 0.038), peripheral shaving (P = 0.011), and endolaser application (P = 0.043). User experience was favorable to excellent in all spheres. Conclusions: RetinaVR demonstrates potential as an affordable, portable training tool for vitreoretinal surgery. Its construct validity is established, showing varying performance in a way that correlates with experimental runs, age, sex, and level of expertise. Translational Relevance: Fully immersive VR technology could revolutionize surgical training, making it more accessible, especially in developing nations.