Hands-on at Haag-Streit Simulation – Testing a new ROP simulator in Mannheim, Germany.

In our first part of our VR and AR series, we generally outlined how this technology in ophthalmology can make the lives of doctors and patients easier. Now it gets more concrete: In the first hands-on part, we visit the company Haag-Streit Simulation in Mannheim, Germany, and test the new ROP simulator.

Haag-Streit Simulation Mannheim

Haag-Streit Simulation (formerly VRmagic) not only builds ophthalmic surgical simulators, but now also a variety of simulators for diagnostic training, such as direct and indirect ophthalmoscopy. We traveled to Mannheim, Germany, to visit the headquarters of Haag-Streit Simulation and test a new simulator for the examination of retinopathy of prematurity - so far it is not yet on the market, and we got exclusive access to the R&D department of the company. We were curious, what was going on there!

The company building of Haag-Streit Simulation is located in the old, meanwhile converted Kaiser-Wilhelm barracks - an imposing and dignified-looking building, constructed from blocks of natural stone and red clinker bricks. Such a building conveys tradition, value, but also conservatism. It is hard to believe that one of the most innovative companies in terms of ophthalmic training is located here.

Upon entering the interior of the old army barracks, however, exactly the opposite beams at you (Fig.1). Chic furniture, shiny parquet floor and a lot of glass. Seems to be a good combination of tradition and innovation. And somehow fitting – Haag-Streit has been building first-class optical devices such as the famous Haag-Streit slit lamp for a long time and was one of the first companies in the world to do so. Analogous to the style of the building, it also seems to have been a good move by Haag-Streit at the time to buy the innovative start-up VRmagic, which is the market leader with virtual reality simulators for training in ophthalmology.

Haag-Streit Simulation Foyer

Figure 1: Inside the building, classic architecture meets modern design - reflecting a bit of Haag-Streit Simulation's corporate philosophy.

Clemens Wagner, former founder and now head of research and development at Haag-Streit Simulation, gives me a tour of the company. Clemens has been with the company from the beginning and knows a lot about software, imaging and, of course, VR. And you can tell he's justifiably proud of what his company has accomplished and is on fire for innovative, new VR-powered solutions to advance education and both diagnostic and surgical training for ophthalmologists. What initially started as a simulator for cataract and retina surgery with the well-known Eyesi Surgical Simulator, now also includes simulators for direct and indirect ophthalmoscopy, as well as a virtual slit lamp. In addition, Haag-Streit Simulation has developed an otoscopy simulator for training of medical students.  Since 2016, the VRmNET web portal is available, a service for networked simulators that integrates tools for both instructors and trainees. The web portal enables individual learning and adds another aspect of gamification. Haag-Streit Simulation also offers companies to develop customized simulators. The Wall Street Journal, for example, reported on a trainer for the implantation of a depot system made especially for Genentech (San Francisco, CA, USA). Exciting certainly also for new implants of minimally invasive glaucoma surgery (MIGS) in the future.

This visit is all about a new simulator that allows to learn the examination of premature babies and diagnosis of retinopathy of prematurity (ROP) – The Eyesi Indirect ROP (Fig. 2).

Eyesi Indirect ROP is an advanced simulator that provides a highly realistic and immersive training environment for effective device handling. The simulator closely mirrors real examination scenarios, allowing trainees to interact with a virtual eye and authentic instruments. Moreover, the simulation incorporates the child's realistic responses to the examination, including crying, thus enhancing the training experience.

eyes-rop-simulator quad

Figure 2: The ROP simulator consists of a manikin that simulates the premature infant, a head ophthalmoscope, a screen for setting programs and simulation levels, and a hand-held lens and an indenting instrument.

Furthermore, Eyesi Indirect ROP offers a structured, standardized curriculum combined with computer-based performance evaluation, ensuring quality assurance in medical training.

Currently, there are no existing solutions for virtual training of newborn retinal examination or ROP diagnosis using VR manikins. While training tools with artificial eyes and interchangeable pathological photos for indirect ophthalmoscope exist, they do not cover ROP diagnosis training.

rop 9002 4000200 2023-07-24 15-51-420200

Figure 3: The virtual illustration of the ocular fundus is very realistic and a variety of stages of ROP with different pathologies can be simulated and trained.

During our hands-on test, the ROP Simulator looks and feels very high-quality. High-resolution VR screens are actually integrated into an ophthalmoscope. A dummy of a newborn, whose eyes can be rotated as well as indented by using a hand-held indentation instrument, appears as a real-looking premature baby when viewed through the head-mounted ophthalmoscope - including the often-frightening crying in real life. Different disease scenarios can be displayed and trained. In addition, you can track on the screen which areas of the retina you have seen and which not - perfect for self-monitoring. Again, as implemented on the other Haag-Streit simulators, the integrated gamification aspect enables learning through play. This is much more pleasant than gaining initial experience in the diagnosis of premature infants under often oppressive conditions (Video 1).

Video 1: The video shows the very good correlation between the examination dummy and the simulation image displayed using a VR headset. The haptics are also surprisingly realistic.

In the future it might be possible to train laser treatment of retinopathy of prematurity or intravitreal anti-VEGF injections on the simulator.

We would very much appreciate such a further advancement.

In summary, with the new simulator Haag-Streit Simulation once again shows what is possible in the field of VR, in the combination of software and hardware and in innovative training approaches.


Further Links

Haag-Streit Simulation

Haag-Streit Simulation in the Wall Street Journal

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Sebastian Siebelmann

Sebastian is Head and Founder of Digital-Ophthalmology.net and author of this article. He is a passionate eye surgeon and ophthalmologist, innovator and medical advisor. For this article he visted Haag-Streit Simulation in Mannheim, Germany.


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