Laser indirect ophthalmoscope (LIO) retinal therapy is a complex procedure that demands precision. We present LIO-VisionAR, an intelligence-enabled augmented reality (AR) guidance system designed to support safer and more effective training for LIO-based retinal laser therapy. A custom retina model with retinopathy areas was developed and integrated into a human phantom model. A virtual retina model and simulator were developed using the color fundus photo to compute the magnification and laser targeting guidance based on the user’s AR head-mounted device movement. Randomized user trials compared conventional and AR-guided retinal laser tasks, while multimodal behavioral telemetry were recorded for quantitative performance analysis and proof-of-concept skill inference. A total of 11 experts and 12 non-experts were included in the study. With AR guidance, laser targeting accuracy increased from 70.8% to 82.6% for experts and from 65.7% to 81.7% for non-experts. AR guidance increased laser instrumentation time, reflecting a deliberate speed–accuracy trade-off. Analysis of AR-captured behavioral telemetry showed that gaze exploration and temporal control features were associated with performance, and unsupervised clustering revealed distinct behavioral strategies linked to progressively higher accuracy. A composite performance-based skill score exhibited a moderate positive association with laser accuracy (Spearman ρ = 0.45, p = 0.032). Over 80% of experts agreed that our system is appropriate for teaching and could improve retinal laser therapy training and safety. LIO-VisionAR improves procedural accuracy under simulated conditions and demonstrates a concrete pathway toward adaptive, intelligence-based AR guidance for ophthalmic microsurgical training. • Augmented reality guidance system using virtual simulator for retinal laser therapy • Development of a virtual magnifier and a retina phantom with anatomical landmarks • Experts and non-expert users improved laser targeting accuracy with AR guidance • Increased eye gaze movement and reduced overall workload with AR guidance
Eom et al. (Wed,) studied this question.