USC Roski Eye Institute Acquires Advanced Cataract Surgery Simulator

The USC Roski Eye Institute has become one of the first medical education institutions in the country to acquire a HelpMeSee Surgical Simulator to train ophthalmology residents in cataract surgery techniques. The institute acquired the machine in the fall of 2024, replacing an older EyeSi Simulator previously used for training.

Residents currently use the simulator during their Glaucoma rotation under the supervision of Brian Song, MD, MPH, director of the USC Department of Ophthalmology Residency Program. This scheduling often allows second-year residents to practice their cataract surgical skills in a supervised simulated environment before performing their actual cataract surgery later in the week.

“Having an attending observe has been amazing, as you get real-time feedback on how to improve,” said Victoria Wang, MD, a second-year ophthalmology resident. “They can help you identify weaknesses that you can work on immediately.”

The simulator allows residents to encounter surgery complications in a low-stress environment before encountering them with real patients. With features designed to mimic surgical conditions, the simulator provides tactile feedback during procedures, which residents find particularly valuable.

“The feedback feels very advanced compared to the simulator we had previously,” said Kimberley Yu, MD, a second-year ophthalmology resident.

“The machine provides feedback and resistance based on if you’re making a simulated incision into the cornea correctly,” added Dr. Song. “The software has hard stops built into every module, so if a complication occurs or a maneuver is done in an unsafe manner, it will end the simulation and provide a data assessment that can be reviewed.”

Designed to replicate the surgical experience comprehensively, the device includes instruments for each hand, as well as a foot pedal to control the phacoemulsification (the machine used to remove the cataract).

“Cataract surgery is like driving a stick shift car,” said Dr. Song. “You use all four limbs.”

While residents acknowledge the machine doesn’t perfectly replicate operating on an actual eye, they find it more realistic than other available devices, helping bridge the gap between didactic learning and operating room experience.

“I found it helpful to practice steps such as the capsulorrhexis,” said Dr. Yu, referring to creating a circular opening in the anterior capsule of the eye’s lens. “I felt much less nervous doing the procedure for real once I’d practiced the step a few times on the simulator.”

Looking toward the future, Dr. Song plans to expand access to resident teaching sessions on the simulator and to study learning outcomes comparing residents who use the simulator versus those who historically did not. The simulator acquisition comes at a strategic time as the Accreditation Council for Graduate Medical Education (ACGME) is expected to require surgical simulator experience assessment starting in 2026.

Residents report increased confidence in performing their first cataract surgeries after simulator training. Dr. Wang believes the simulator will be especially beneficial for first and second-year residents beginning to learn cataract surgery.

“It’s a great resource that helps build confidence and familiarity,” she said.