Vision functionality and user comfort following the use of binocular indirect ophthalmoscope simulator

Clinical relevance: Headset-based simulator training is increasingly utilised in eye care education, offering opportunities to improve clinical skills in a controlled, reproducible environment. These tools support the development of innovative training approaches in eye care. Background: While the educational advantages of headset-based simulators are recognised, the potential challenges and limitations that users may encounter remain understudied. This study investigated changes in user comfort and vision functionality following a 40-minute headset-based simulator training of indirect ophthalmoscopy. Methods: Fifty-four participants aged 20 to 45 years (21 eye care professionals and 33 optometry students, analysed as a single group) underwent a 40-minute training session using the Eyesi binocular indirect ophthalmoscope simulator. User comfort with a custom-designed symptom questionnaire and visual functions using the RAF ruler, von Graefe technique, and prism bars were assessed before and immediately after the headset-based simulator training session. Results: Following the headset-based simulator training, there was a significant recession of both the near point of convergence (p <.001) and the near point of accommodation (p <.001). Baseline visual functions correlated with changes following headset-based simulator training, specifically near point of accommodation (r = 0.32, p =.02), horizontal near heterophoria (r = −0.37, p =.01), horizontal far heterophoria (r = 0.27, p =.04), blur point in positive fusional reserves (r = −0.61, p <.001), recovery point in negative fusional reserves (r = −0.36, p =.01), and AC/A ratio (r = −0.51, p <.001). Questionnaire results indicated a significant increase in discomfort following the headset-based simulator training (p <.001). Conclusion: Forty-minute headset-based simulator training can lead to altered vision functionality and pronounced discomfort in some individuals, highlighting the variability in individual responses to training indirect ophthalmoscopy skills in video see-through augmented reality.