Our work highlights the absence of simulated retinal training in Latin America. In training centers where simulation resources are available, there are no systematic training models or consistency in resources being utilized.
The use of simulated training materials on the retina has already been evaluated with good results among ophthalmologists in traininig.7–9 Although most studies focus on cataract surgery training, there is a lack of research with respect to retinal training. Specifically, in Latin America, there are no studies that evaluate the effect of systematic training in ophthalmologists in retinal surgery.
It is important to take into consideration the expectations of the retina training fellows. There are no studies that evaluate the expectations of retina fellows regarding the number and type of surgeries to be performed. Scott et al, in a survey conducted in the USA, found that residents are expected to be able to perform retinal lasers and retinal injections, but not surgical procedures.10 The use of simulation also opens up a new opportunity to expose not only fellows but also residents in training to performing vitreoretinal procedures.
The most widely used material in Latin America to simulate vitreoretinal surgery is the pig's eye, due to its cost and accessibility.
When evaluating the reliability of the resources available in retinal simulation. It is important to emphasize that to date there is no universal method capable of classifying how reliable or not these resources are. It was not the objective of this work to compare the reliability of the different resources. However, it is important to emphasize that some resources allow you to better reproduce certain steps of the surgery. For example, the use of virtual reality does not allow practicing the insertion of trocars, but it does allow critical steps such as posterior vitrectomy and ILM peeling.12 The use of artificial eyes has been gaining popularity over time and likewise they have been perfected to give greater realism and versatility to practice not only the classic scenarios of retinal surgery but also complex scenarios such as intraocular foreign body removal. Studies are required to perform a comparative analysis between the different models available to date.
Evaluating the reasons why a retina surgical training center had or had not been implemented, we found that the main reason was economic. This correlates with what was found by la Cour et al, that the great barrier to performing a simulated retina training is the high costs associated with its implementation and maintenance.4
On one hand, the absence of evaluation methods does not allow for quantifying the surgical improvement of ophthalmologists-in-training. Additionally, the absence of evaluation methods does not allow us to provide tools to justify the implementation of new training models. This study highlights the main reasons for the lack of implementation of of retina training in Latin America: the lack of resources allocated for retinal surgical training is an important trend and the main reason for the absence of these resources, such as the absence of trained ophthalmologists to carry out such training following a systematic and standardized training methodology.
The main purpose of this study was to demonstrate in a quantitative way that we must take measures to improve the surgical training of our ophthalmologists in a safe environment before facing a real patient. Through this situational diagnosis of the availability and use of retinal simulation resources in Latin America we will be able to take measures to provide tools in the training of the next generation of retina surgeons. It is extremely important to collect more information on the real effect of a training with this type of resources to evaluate the real impact and its cost benefit. Which we will seek to evaluate in report No. 2 of the SIMRET project.