EyeWorld Asia-Pacific June 2020 Issue

EWAP JUNE 2020 17 FEATURE Everyone in the OR wearing 3D glasses sees the same view as the surgeon using 3D digital microscopy. Source: Jonathan Rubenstein, MD “The potential to have image overlays for astigmatism management (e.g., arcuate incision placement), capsulorhexis diameter, intraoperative aberrometry, OCT, or topography would be useful applications for this technology,” Dr. Wong said. “It gives you the potential opportunity to have all the applications you now visualize on separate screens alternatively project on one big screen. They haven’t totally coordinated that … but I think that this is what industry will end up creating,” Dr. Rubenstein said. The doctors are split on Ìi iÀ}V LiiwÌÃ v ÌÃ “heads-up” surgery. Dr. Riemann said 3D microscopy probably added 10 years to his surgical career by reducing his back pain. Dr. Rubenstein, in contrast, ÌÃ Ìi iÀ}V LiiwÌ v 3D microscopy is “overblown.” He said the visualization is projected somewhat off to the side, requiring the surgeon to turn their head or body slightly to visualize the big screen. He also has noticed he adapts a more relaxed posture when he uses the heads-up system. º w` Üi ½ ÜÀ} through the NGENUITY, I’m slouching because I’m sitting back like I’m in an easy chair. I’m not sure how good that is either. It’s more comfortable, but it’s not the correct posture to be in when you’re operating. It is still better for you to maintain a good erect posture to facilitate the correct use of your arms and hands when you’re operating,” Dr. Rubenstein said. Value of 3D depends on the procedure Dr. Rubenstein said he sees more value for this technology as you work deeper in the eye. The 3D visualization Üi «ii} wi iLÀ>iÃ off the retina or performing vitrectomies, for example, “gives you great depth of focus, more than with a conventional microscope,” he said. “When you are doing these deep procedures … you barely have to adjust your depth of focus,” he said. Dr. Rubenstein said that 3D in cataract surgery offers good depth of focus. “I’m not saying operating in 3D is superior to conventional microscopes for cataract surgery, but it’s probably as good as, and there are some things that are a bit better because of the increased depth of focus,” he said. Dr. Rubenstein also uses NGENUITY for DMEK and DSEK procedures, though he acknowledged it does “not produce as much of a ‘wow’ factor as you get with the cataract ÃÕÀ}iÀÞ°» À ÌÀÕi ÃÕ«iÀwV> corneal surgeries—corneal transplants, suturing on the ocular surface, pterygium, etc.—Dr. Rubenstein said he doesn’t think 3D microscopy is advantageous. “When I do a regular corneal transplant surgery, I do not use it because I think the suturing with it is weird. … It slows me down a bit,” he said. Final takeaways Overall, Dr. Rubenstein said he thinks this technology shows the most value in an academic setting and for those who “are motivated by new technology.” Ì Ã > LiiwÌ Ì }iÌ iÛiÀÞi the OR seeing what the surgeon is seeing, and there are other features that are nice for anterior segment surgeons to have, but they’re not necessary, he said. “It’s a great adjunct for education, is an amazing experience to operate with, and provides a fun factor for people who like new technology. It is also a great tool for the OR staff and people in the operating room to help them understand what’s happening in surgery, but I’m not sure that it will completely replace conventional microscopes. I think the ergonomics factor is a plus- minus,” Dr. Rubenstein said. Though Dr. Riemann sees utility of 3D digital microscopy in vitreoretinal surgery, he said the technology was originally intended for anterior segment surgeons. Surgeons can operate through media opacity better with a digital microscope vs. analog, Dr. Riemann said, because you can drop the light and reduce internal scatter. You can also negate refractive factors by increasing the depth of focus by closing the camera aperture, he added. “One of the best signs that this technology is here to stay is that other companies are now entering this space,” Dr. Riemann said. EWAP Reference 1. Riemann CD. Machine vision and vitrectomy: three dimensional high `iwÌ Î ® Û`i vÀ ÃÕÀ}V> visualization in vitreoretinal surgery. Proc SPIE 7863. Stereoscopic Displays and Applications XXII. 78630K (2011). Editors’ note: Dr. Riemann is Director of the Vitreoretinal Fellowship, Cincinnati Eye Institute and University of Cincinnati, Cincinnati, Ohio, and declared relevant interests with Alcon and Leica Microsystems. Dr. Rubenstein is Deutsch Family Professor of Ophthalmology, Rush University Medical Center, Chicago, Illinois, and declared relevant interests with Alcon. Dr. Wong practices at Austin Eye, Austin, Texas, and FGENCTGF PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU