Journal of Surgical Simulation 2021; 8: 72 - 76

Published: 11 February 2022


Original article

The effect of video game play on ophthalmic microsurgical simulator performance: a randomized controlled trial

Stephen C. Dryden, Ryan D. Gabbard, Fabliha Anbar, Shane D. Marsili, James C. Fleming and Brian T. Fowler
Corresponding author: Stephen C. Dryden, Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA. Email:


Objective: To examine the impact of real-time video game play on anterior segment ophthalmic microsurgical performance using a cataract surgical simulator (Eyesi).

Methods: Medical students and ophthalmology residents at the University of Tennessee Health Science Center in Memphis, Tennessee, completed a questionnaire and baseline microsurgical evaluation using the capsulorhexis module on the surgical simulator. Participants were excluded if they had any previous intraocular surgical experience or extensive surgical simulator practice. Participants were randomized to group A (intervention) or group B (control). Group A completed as many levels of Tiltmasters as possible over a 30-min period, and group B was only allowed to watch the capsulorhexis demonstration video without any additional practice. After the 30-min time period elapsed, all participants performed the capsulorhexis module.

Results: Of the 41 participants, regular video game players had greater baseline scores than non-players (P=0.003) on the capsulorhexis module. There was no significant difference in the final surgical performance between the control and intervention groups. However, the intervention group showed significantly more improvement in surgical performance than the control group (P=0.04). All participants demonstrated improvement in the final surgical performance regardless of whether they were in the control group or the intervention group.

Conclusions: Regular video game play enhanced baseline microsurgical simulator performance. Both the control and intervention groups demonstrated improvement in final surgical simulator performance, indicating a warm-up effect. Participants in the intervention arm demonstrated significantly higher improvement than the control group, indicating skills transfer of the video game to surgical simulator performance after 30 min of intervention.


video game; ophthalmic microsurgical simulator; anterior segment surgery; resident education; capsulorhexis; warm-up effect