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Objective performance parameters and subjective evaluations (questionnaire) regarding safety, handling, comfort, learning progress, as well as interaction were assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the vitrectomy simulation, no significant difference in scores was found between visualization systems (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.126), whereas in the cataract simulation, the conventional microscope achieved significantly higher scores (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023). The overall task scores did not differ significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.376). Subjectively, the 3D system was rated superior regarding control (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), instrument handling (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033), movement precision (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), comfort, and instructor interaction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Students tended to prefer the 3D system, whereas residents more often preferred the conventional microscope, although this difference was not statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.183). All participants reported that skills acquired with the 3D system could be perceived transferability to the conventional microscope.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 3D display achieved comparable simulator performance in the vitrectomy module but lower performance in the cataract module compared with the conventional microscope, while offering perceived didactic and ergonomic advantages. The differing preferences between students and residents may suggest a possible habituation effect due to prior slit-lamp use and familiarity with conventional visualization techniques. As digital visualization systems are becoming increasingly integrated into contemporary ophthalmic surgery, early exposure to heads-up technology during simulator-based training may help familiarize trainees with modern visualization techniques. Future clinical studies are required to determine whether these simulator-based findings translate into improved operative performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12909-026-10269-9","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:53:31Z","timestamp":1788137611000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Teaching ophthalmic microsurgical skills: conventional microscopy versus heads-up visualization"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5883-2529","authenticated-orcid":false,"given":"Franziska","family":"Eckardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian -Joachim","family":"Gerhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegfried","family":"Priglinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"10269_CR1","doi-asserted-by":"publisher","first-page":"982","DOI":"10.4103\/IJO.IJO_2729_20","volume":"69","author":"K Chhabra","year":"2021","unstructured":"Chhabra K, Khanna V, Vedachalam R, Sindal M. 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Informed consent was obtained from all individual participants included in the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent for publication of their clinical details and clinical images was obtained from the participant","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No author reports any financial interest relevant to this study.Franziska Eckardt received previous speaker fees from Novartis Pharma GmbH. Maximilian Gerhardt received previous speaker fees from Bayer, Novartis Pharma GmbH and Roche, advisory board fees from Rhythm Pharmaceuticals and has a consulting agreement with VeonGen and Opus Genetics with all fees paid to LMU Eye Hospital to support researchSiegfried Priglinger received previous speaker fees and\/or advisory boards fees and travel expenses from Novartis Pharma GmbH, Oertli AG, Bayer AG, Alcon Pharma GmbH and Allergan GmbH, BVI B&L and Roche.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1403"}}