Objective To evaluate the self-developed virtual reality (VR) simulation training system for cataract operating room workflow management in terms of theoretical knowledge acquisition and user experience, and to explore its application value in cataract operating room workflow management training. Methods This prospective randomized controlled non-inferiority trial was conducted at the Clinical Skills Center of West China Hospital, Sichuan University, from September 2023 to September 2025. Trainees were randomly allocated to a trial group or a control group. Both groups received homogenized training content based on the standardized cataract operating room workflow management protocol established according to the surgical management regulations of this hospital. The trial group received one hour of immersive training in a three-dimensional operating room environment using the self-developed VR simulation training system for cataract operating room workflow management, while the control group watched a one-hour didactic teaching video recorded by ophthalmology experts from this hospital repeatedly. Both groups completed theoretical knowledge assessments on cataract phacoemulsification operating room workflow management before and after training, and completed the “User Acceptance and Perceived Advantages of Cataract Surgery Virtual Simulation Training System Questionnaire” after training. Differences in post-training theoretical knowledge assessment scores and user experience questionnaire scores were compared between the two groups. Results A total of 64 trainees were enrolled and randomly allocated to the trial group (n=34) or the control group (n=30). The trial group demonstrated non-inferiority to the control group in post-training theoretical knowledge assessment scores, with a between-group mean difference of ?0.57 [95% confidence interval (?4.65, 3.50)], meeting the pre-specified non-inferiority margin of ?5. User experience analysis revealed that the control group scored significantly higher than the trial group in “perceived usefulness” and “feedback quality and skill-mastery” (both P<0.05), while no significant difference was observed between the two groups in “technology acceptance and use willingness” or “overall satisfaction” (P>0.05). Both groups perceived VR training as having substantial advantages over traditional training across all 16 evaluation domains, with median scores ranging from 4 to 5. Conclusion The self-developed VR simulation training system for cataract operating room workflow management is non-inferior to traditional teaching in terms of theoretical knowledge acquisition, and demonstrates favorable user experience with significant perceived advantages, indicating promising application prospects in cataract operating room workflow management training.