EyeWorld Asia-Pacific June 2020 Issue

EWAP JUNE 2020 15 FEATURE S ince January 2019, Jonathan Rubenstein, MD, has tried to use 3D, digital microscopy almost exclusively for his cataract and anterior segment cases. First and foremost, Dr. Rubenstein sees a value in 3D viewing systems for teaching. “Residents and anyone else in the room— whether it’s residents, medical students, OR staff, nurses, or technicians— can see what’s going on, have the same view I have and understand the surgery a little better,” he said. “For nurses and technicians, it makes them more interested in eye surgery and it also makes them better assistants for me and better help for the patient.” He also likes it because, as he put it, it’s fun. “New technology always makes surgery a little fresher and more exciting,” he said. “You are learning a new perspective about the eye and about surgery because you are using a different visualization system.” The transition from a traditional operating microscope to surgery off a screen isn’t as awkward as you might think, Dr. Rubenstein said. º ˜ “Þ wÀÃÌ V>Ãi ÕȘ} > Î system, adapting to it wasn’t much of a problem at all, and now I like it the more I use it. Right off the bat it was not a hard transition,” he said. The NGENUITY 3D Visualization System (Alcon), the system Dr. Rubenstein uses, consists of a 3D stereoscopic, …ˆ}…‡`iw˜ˆÌˆœ˜ `ˆ}ˆÌ> V>“iÀ> that’s mounted on the surgical microscope. The live imaging is broadcast on a large, …ˆ}…‡`iw˜ˆÌˆœ˜ ÃVÀii˜ ˆ˜ ̅i operating room. Everyone in the room wears 3D glasses and the surgeon operates while looking at the screen. Other 3D visualization systems include TrueVision 3D (Leica Microsystems) and ARTEVO 800 (Carl Zeiss Meditec). Christopher Riemann, MD, a retina specialist who published ̅i wÀÃÌ ÃiÀˆià œv ÃVÀii˜‡ based vitreoretinal surgery in 2011, also cited the teaching Li˜iwÌà œv `ˆ}ˆÌ> “ˆVÀœÃVœ«Þ° 1 One of these is lower risk for phototoxicity. Dr. Riemann, who has been doing screen-based vitreoretinal surgery almost exclusively since 2014, said he uses 35% illumination with the CONSTELLATION Vision System (Alcon) when operating with a traditional microscope, compared to 5–15% illumination when using digital microscopy. “Lower phototoxicity risk means residents and fellows, who might take longer, get to do more in surgery,” Dr. Riemann said. The teaching experience is also better for the attending and the trainee. “It is an up close and personal experience, and a 3D viewing systems: Is it time to upgrade your microscope? by Liz Hillman Editorial Co-Director AT A GLANCE • 3D digital microscopy has been making inroads in vitreoretinal and anterior segment surgery, LÕÌ ˆÌà ۈÃÕ>ˆâ>̈œ˜ Li˜iwÌà might depend on the procedure you’re doing. • Physicians agree on its value as a teaching tool, providing everyone in the OR with the same view as the surgeon. • Improved ergonomics of this “heads-up” surgery have been touted, but some think that Li˜iwÌ ˆÃ ºœÛiÀLœÜ˜°» This article originally appeared in the March 2020 issue of EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp. Dr. Rubenstein operates with the NGENUITY Visualization System.