CataTrain Setup Guide

Follow these simple steps to assemble your simulator and get ready for surgical training.

What's Included

  • Base – Main support structure.
  • Capsulorhexis film – For practicing capsulorhexis techniques.
  • Nucleus material – Malleable material for creating your own cataract nuclei.
  • Iris insert – Optional component for iris-related training.
  • Threaded top cap – Secures the components in place.
  • Grooving and cracking insert – Preformed thick nuclei for practicing nucleus sculpting and cracking techniques.
  • Nucleus Centering Ring – A positioning ring designed to keep the nucleus centered and stable during surgical training.
  • Bimanual Dexterity Training Plate – A dedicated training plate featuring precision exercises designed to improve bimanual coordination, control, and dexterity.
  • Microsurgical Training Beads – A set of small training pieces designed for precision placement and hand-to-hand transfer exercises to improve fine motor control and bimanual dexterity.

Assembly Instructions:

  Step 1. Prepare the base: Place the CataTrain base on a stable surface.

  Step 2. Insert the posterior capsulorhexis film: Place the capsulorhexis film over the base.

  Step 3. Prepare the nucleus and centering ring: Add the nucleus material to the center and shape it into a lentil-like form, resembling a natural cataract nucleus. Place the centering ring around to ensure perfect centering.

  Step 4. Insert the anterior capsulorhexis film: Carefully position the capsulorhexis film over the nucleus and centering ring.

  Step 5. Add the iris insert (optional): If you wish to practice with the iris, place the iris insert on top of the capsulorhexis film.

Important: Make sure the iris insert remains centered while screwing the top cap into place.

  Step 6. Secure the top cap: Gently screw the threaded top cap onto the base to secure all components.

Tip: To prevent the films from shifting during assembly, hold them in position with your fingers on either side while tightening the cap.

Step 7. Start training!

Your CataTrain simulator is now ready to use.

Watch the Assembly Video: 

Follow our step-by-step video tutorial to see how to assemble your CataTrain simulator correctly.

General Training Recommendations

Make every practice count.

CataTrain is designed to encourage repetition, creativity, and progressive surgical skill development. Whether you are developing basic bimanual dexterity or refining advanced cataract surgery techniques, consistent and structured practice is essential.

We recommend incorporating these exercises into your regular training routine:

  • Practice regularly: Aim for 10–15 minutes per session, at least 2–3 times per week. Daily practice is encouraged.
  • Train both hands: Perform each exercise with your dominant and non-dominant hands to develop balanced dexterity and bimanual coordination.
  • Prioritize precision over speed: Focus on accurate movements, smooth instrument handling, and proper surgical technique before increasing your speed.
  • Track your progress: Time each exercise and record your results to monitor improvements over time.
  • Increase difficulty progressively: Start with basic movements and gradually challenge yourself as your accuracy, confidence, and coordination improve.

Your Training, Your Progress

Explore the 15 guided exercises below, progressing from basic bimanual dexterity to more advanced cataract surgery techniques, or create your own surgical challenges.

Remember, the goal is not simply to complete each exercise faster, but to achieve increasingly precise, controlled, and reproducible movements.

Safety Note

CataTrain is intended for educational and simulation purposes only and must never be used on patients. Handle microsurgical instruments carefully, inspect all components before use, and replace any damaged parts. Training should be performed in a safe, controlled environment.

*Important: The simulator is not suitable for phacoemulsification, and its use does not replace supervised surgical training.

*Latex Allergy Warning: The iris insert included in this kit contains natural rubber latex, which may cause allergic reactions. Individuals with a known latex allergy should avoid handling or using this component.

Learn. Practice. Improve.

The only limit is your imagination.

Exercises 1–5: Bimanual Dexterity Training

Develop precision, coordination, and instrument control through five practical exercises designed to improve the fundamental microsurgical skills required for cataract surgery.

Fine motor control & accuracy

Exercise 1 — Precision Placement

Objective: Improve precision, instrument handling, and fine motor control with both hands.

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Using your microsurgical forceps, pick up the small training pieces included in the kit and place them accurately in their designated positions along the letters on the training base.

Place each piece as precisely as possible, keeping movements controlled and deliberate.

Perform the exercise first with your dominant hand, then repeat it with your non-dominant hand.

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Training challenge: Time yourself and aim to reduce your completion time while maintaining the same level of accuracy.

Bimanual coordination & symmetry

Exercise 2 — Synchronized Bimanual Movements

Objective: Develop simultaneous, symmetrical, and coordinated movements of both hands.    

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Place three training pieces at equal distances along each side of the two parallel lines on the training base, as shown in the reference image.

Using one forceps in each hand, simultaneously grasp and move the pieces from one position to another, either along the lines or across them.

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Try to perform each movement with both hands at the same time, maintaining symmetry, equal distances, and precise placement.

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Training challenge: Focus on keeping both hands synchronized throughout the exercise. Gradually increase your speed without compromising accuracy or symmetry.

Instrument agility & spatial coordination

Exercise 3 — Instrument Navigation & Hand-to-Hand Transfer

Objective: Improve instrument navigation, spatial awareness, and coordinated movements in multiple directions.

Using the geometric pattern on the right side of the training base, practice guiding your forceps through different movements.

Follow the central circle, cross the instruments upward and downward, trace the circular path, and navigate along the straight lines and corners of the surrounding square.

You can also perform this exercise while holding a training piece, transferring it from one forceps to the other as you repeat the different movements.

Alternate the direction and starting hand to develop equal control with both hands.

Training challenge: Complete the different movement patterns smoothly, minimizing unnecessary instrument movements and maintaining precise control during hand-to-hand transfers.

Bimanual dexterity & instrument transfer

Exercise 4 — Zigzag Transfer Challenge

Objective: Develop fluid bimanual coordination through repeated instrument-to-instrument transfers.

Using the zigzag path on the lower section of the training base, pick up a training piece with your forceps and guide it along the marked line.

At every change of direction, transfer the piece from one hand to the other before continuing along the next segment.

Repeat this process until you reach the end of the zigzag path.

Training challenge: Complete the entire path without dropping the piece, keeping every transfer smooth, controlled, and precisely aligned with the zigzag pattern. Time your performance and attempt to improve with practice.

Speed, precision & bimanual coordination

Exercise 5 — Color Sorting Challenge

Objective: Improve fine motor speed, spatial organization, and dexterity in both hands.

Place all the colored training pieces together in the center of the training box.

Assign a different color to each corner of the box. Using your forceps, pick up each piece individually and transfer it to its corresponding corner.

Perform the exercise using both your dominant and non-dominant hands, alternating between them or coordinating their movements.

Training challenge: Time how long it takes to correctly sort all the pieces. Repeat the exercise and aim to improve your completion time while maintaining precise placement and avoiding dropped pieces.

Exercises 6–15: Surgical Skills & Techniques

Take your microsurgical training to the next level with ten practical exercises designed to develop essential cataract surgery skills, from corneal incisions and capsulorhexis to nucleus manipulation, iris management, and intraocular lens implantation.

Practice each technique progressively, focusing on precision, instrument control, spatial awareness, and reproducible surgical movements.

Blade control & incision architecture

Exercise 6 — Corneal Incision Practice

Objective: Improve incision architecture, blade positioning, and control of surgical entry.

Position the simulator's top cap correctly and practice creating corneal incisions using a 15° side-port blade and a 2.2 mm keratome.

Focus on maintaining the correct blade orientation and creating a controlled, self-sealing valvular incision.

Use the designated thinner areas of the upper ring to facilitate blade passage.

The simulator also includes preformed incisions to facilitate subsequent capsulorhexis and instrument manipulation exercises. However, creating your own incisions is an excellent opportunity to develop proper incision technique.

Practice the incisions sequentially, maintaining a controlled entry angle and directing the blade toward the center of the simulated anterior chamber.

Training Challenge: Repeat the incisions from different positions, focusing on consistent wound architecture, precise blade alignment, and smooth entry movements.

Depth perception & spatial awareness

Exercise 7 — Anterior Chamber Navigation & Bubble Aspiration

Objective: Develop spatial awareness, depth perception, and precise instrument control within the anterior chamber.

Fill the simulated anterior chamber with an ophthalmic viscosurgical device (OVD) and introduce small air bubbles at different depths.

Using an appropriate aspiration cannula, carefully navigate through the chamber and aspirate the bubbles individually until the chamber is completely clear.

Focus on identifying the relative depth of each bubble and maintaining controlled movements without touching the surrounding structures.

Repeat the exercise with both your dominant and non-dominant hands.

Training Challenge: Try to remove every bubble while minimizing unnecessary instrument movements. Gradually increase the number of bubbles and vary their positions to improve three-dimensional awareness and depth control.

Precision & capsular tear control

Exercise 8 — Continuous Curvilinear Capsulorhexis

Objective: Develop precision, flap control, and consistency in capsulorhexis creation.

Using the simulated anterior capsule film, practice performing a continuous curvilinear capsulorhexis with a target diameter of approximately 5.5 mm.

Begin by creating the initial capsular opening with a cystotome, then continue using either the cystotome or capsulorhexis forceps.

Practice different approaches:

  • Clockwise capsulorhexis.
  • Counterclockwise capsulorhexis.
  • Cystotome-assisted capsulorhexis.
  • Forceps-assisted capsulorhexis.
  • Dominant and non-dominant hand techniques.

Focus on maintaining a circular shape, controlling the direction of the tear, and achieving a consistent diameter.

Training Challenge: Perform consecutive capsulorhexes with the same diameter and centration. Alternate hands and directions while maintaining a smooth, controlled tearing movement.

Flap manipulation & directional control

Exercise 9 — Spiral Capsulorhexis Challenge

Objective: Improve capsular flap manipulation, tearing direction control, and confidence in capsulorhexis enlargement.

Start by creating a very small central capsulorhexis.

Instead of completing the opening immediately, progressively enlarge it in a spiral pattern, gradually increasing its diameter with each rotation.

Maintain continuous control of the capsular flap as you move outward from the center.

Practice the spiral technique clockwise and counterclockwise, using both your dominant and non-dominant hands.

This exercise is particularly useful for developing familiarity with capsular tearing mechanics and improving control of the capsulorhexis forceps.

Training Challenge: Create a smooth, continuous spiral without losing control of the flap. Try to maintain consistent spacing between successive turns while progressively enlarging the opening.

Capsulorhexis rescue & tear redirection

Exercise 10 - Capsulorhexis Rescue: Little's Technique

Objective: Improve fine motor speed, spatial organization, and dexterity in both hands.

Place all the colored training pieces together in the center of the training box.

Assign a different color to each corner of the box. Using your forceps, pick up each piece individually and transfer it to its corresponding corner.

Perform the exercise using both your dominant and non-dominant hands, alternating between them or coordinating their movements.

Training challenge: Time how long it takes to correctly sort all the pieces. Repeat the exercise and aim to improve your completion time while maintaining precise placement and avoiding dropped pieces.

Fluid control & nucleus rotation

Exercise 11 — Hydrodissection & Nucleus Rotation

Objective: Develop controlled hydrodissection techniques and improve nucleus manipulation and rotation.

Prepare the simulated nucleus and position it inside the capsular system.

During assembly, apply a small drop of OVD over the posterior capsule film, as illustrated, to facilitate subsequent nucleus rotation.

After completing the capsulorhexis, introduce a hydrodissection cannula beneath the anterior capsular edge.

Using balanced salt solution (BSS) or saline for simulation, practice controlled fluid injection beneath the anterior capsule to reproduce the hydrodissection maneuver.

Next, use a suitable blunt instrument to gently engage the simulated nucleus and initiate rotation.

Practice rotating the nucleus clockwise and counterclockwise until a complete 360° rotation is achieved.

Focus on maintaining the correct instrument position, applying controlled rotational forces, and avoiding unnecessary stress on the surrounding capsular structures.

Training Challenge: Achieve smooth, complete nucleus rotation in both directions with minimal instrument repositioning.

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Training Note: For smooth nuclear rotation, we recommend applying a drop of OVD both underneath and on top of the nucleus to ensure adequate lubrication. The use of the Nucleus Centering Ring is important during this exercise to maintain proper nuclear centration and facilitate rotation.

Instrument positioning & nuclear division

Exercise 12 — Nuclear Grooving & Cracking

Objective: Develop nucleus division skills, instrument positioning, and controlled separation movements.

Prepare a simulated nucleus using the nucleus material included in the kit. You can vary its size, shape, and consistency to simulate different levels of difficulty.

The kit includes a groove-creating insert, allowing you to practice mechanical nuclear division.

Begin by using a central groove in the simulated nucleus.

Position your non-activated phaco handpiece or appropriate simulation instrument and nucleus-cracking instrument within the groove, ensuring that both instruments are correctly positioned and sufficiently deep to produce an effective separation.

Apply controlled opposing forces to split the nucleus into two halves.

Focus on instrument depth, correct positioning, and controlled separation of the nuclear fragments.

Training Challenge: Divide the simulated nucleus into four equal quadrants, maintaining consistent instrument positioning and minimizing unnecessary movements.

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Training note: This is a mechanical simulation exercise. The nucleus material is non-emulsifiable and must not be used for powered phacoemulsification.

Bimanual coordination & nucleus fragmentation

Exercise 13 — Horizontal & Vertical chop

Objective: Develop chopping techniques, bimanual coordination, and controlled nucleus fragmentation.

Using the simulated nucleus, practice two fundamental mechanical chopping techniques.

Part A — Horizontal Chop

Begin with an intact or partially divided simulated nucleus.

Position the phaco tip or equivalent simulation instrument to stabilize the nucleus.

Introduce the chopper beneath the anterior capsular opening and advance it toward the nuclear equator, reproducing the positioning used in horizontal chopping.

Bring the chopper toward the central instrument in a controlled movement to simulate nuclear cleavage.

Rotate the nucleus and repeat the maneuver to obtain additional fragments.

Part B — Vertical Chop

Position the stabilizing instrument centrally within the simulated nucleus.

Instead of advancing the chopper toward the equator, position it closer to the central region of the nucleus.

Practice a controlled downward chopping movement, followed by separation of the instruments to reproduce the vertical cracking maneuver.

Repeat the technique at different positions and compare instrument positioning and hand coordination with horizontal chopping.

Training Challenge: Alternate between horizontal and vertical chop techniques. Focus on precise instrument positioning, coordinated bimanual movements, and controlled fragmentation without excessive displacement of the nucleus.

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Training note: Both techniques are performed mechanically, without ultrasound activation.

Iris handling & pupil expansion

Exercise 14 — Iris Manipulation & Pupil Expansion

Objective: Develop atraumatic iris manipulation skills and become familiar with different pupil expansion techniques.

Position the flexible iris insert within the simulator, ensuring that it is correctly centered before securing the threaded top cap.

Depending on the instruments available, practice different iris manipulation techniques.

Part A — Iris Stretching

Using two suitable blunt iris manipulators or hooks, practice gentle, controlled stretching movements in different directions.

Repeat the maneuver in all four quadrants, focusing on symmetrical movements and controlled instrument handling.

Part B — Iris Hook Placement

Using a 15° blade, create small access incisions at suitable positions around the upper ring of the simulator.

Practice introducing iris retractors through the incisions and engaging the pupillary margin.

Position the hooks symmetrically to achieve an enlarged, centered pupil.

Part C — Pupil Expansion Device

If available, practice inserting and positioning a pupil expansion ring or other expansion device within the simulated anterior chamber.

Focus on controlled insertion, correct positioning, and careful manipulation of the iris insert.

Training Challenge: Practice achieving a centered, symmetrical pupil using different expansion techniques while minimizing unnecessary iris manipulation.

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Training note: The available techniques depend on your  instruments. Avoid excessive stretching or force that could damage the material.

Lens positioning & rotational alignment

Exercise 15 — Intraocular Lens Implantation & Alignment

Objective: Develop intraocular lens insertion, manipulation, rotation, and final positioning skills.

Prepare the capsular system without the simulated nucleus and fill the capsular bag with OVD to create sufficient space for lens implantation.

Using an appropriate intraocular lens injector, practice introducing an artificial intraocular lens (IOL) into the simulated capsular bag.

Focus on controlled lens delivery, correct orientation, and positioning of both haptics inside the bag.

Once the lens is implanted, practice rotating and centering it using a suitable blunt manipulator or bimanual techniques.

If you have access to a toric IOL, select a target axis and practice rotating the lens until the alignment marks reach the desired position.

Repeat the exercise with different lens orientations and insertion approaches.

Training Challenge: Implant and center the IOL with minimal manipulation. For toric lens training, practice achieving precise alignment with a predetermined axis while avoiding unnecessary additional rotation.

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Training note: Lens insertion and manipulation depend on the IOL, injector, and simulator dimensions. Use compatible training components and avoid forcing instruments or lenses into the model.

Final Thoughts — Practice Makes Progress

The only limit is your imagination.

These 15 exercises are just the beginning. We encourage you to experiment, challenge yourself, and develop your own training exercises and surgical techniques.

If you come up with a new exercise, creative idea, or alternative training technique, we would love to hear from you! Share your ideas with us at hello@catatrain.com and help us build a community of surgeons committed to continuous improvement.

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Consistency is key. We recommend repeating these exercises regularly, focusing on precision, coordination, and proper technique rather than speed alone. Even 10–15 minutes of consistent practice can help you develop greater confidence and familiarity with microsurgical movements.

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We know that no simulator can perfectly reproduce the complexity of real cataract surgery. And that is not our goal. Our aim is to make essential surgical maneuvers as accessible and realistic as possible, allowing you to practice the movements, instrument handling, and bimanual coordination you will eventually need in the operating room (OR).

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The operating room is where you truly learn to become a surgeon. But your preparation can begin long before you enter it.

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By building a strong foundation through simulation, our goal is to help you approach your first surgeries with greater confidence, better technical preparation, and the skills needed to contribute to safer surgery and potentially reduce avoidable complications.

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Practice today. Improve tomorrow.

Learn. Practice. Improve.

The CataTrain Team