EyeWorld India June 2020 Issue

FEATURE 16 EWAP JUNE 2020 lot of fellows get nervous when operating with staff. For me, being able to sit back, not be in pain while awkwardly straining to look through assistant oculars, looking at the same image, sitting 3–4 feet behind them … it makes for a much better teaching experience,” Dr. Riemann said. In any teaching situation, there will be times when the faculty member needs to step in and show the trainee what to do (or perhaps help them if things go awry). With a typical operating microscope, this would require the student to pull back, for the instructor to move into position, and adjust the microscope to their personal pupillary diameter and instrument myopia settings. This, Dr. Riemann said, can take up 30–45 seconds. “In an eye where something isn’t going well, 45 seconds is a long time,” he said. “But [with a digital screen] I can jump in in about 10 seconds.” The screen itself is like a “digital surgical cockpit,” Dr. Riemann said. An overlay of machine parameters gives the surgeon vital information while allowing them to keep their eyes œ˜ ̅i ÃÕÀ}ˆV> wi`° “Instead of having to ask the tech, ‘What is my actual suction right now?’ I can look at the screen. It’s right there, without a head turn away from the surgical wi`]»…i Ã>ˆ`° Shannon Wong, MD, and Dr. Rubenstein also touted the information that could be available on the screen. Sri Ganesh, MD Chairman & MD, Nethradhama Super Speciality Eye Hospital 256/14, Kanakapura Main Road, 7th Block Jayanagar, Bangalore-560070 chairman@nethradhama.org ASIA-PACIFIC PERSPECTIVES D igital microscopy has evolved over time with a lot of new features which improve patient safety, surgeon ergonomics, and delight for residents. I have been using the ARTEVO 800 system for the past 10 months and have completely adapted to digital microscopy. The advantages of the heads-up 3D digital microscopes are the following: 1. ˜VÀi>Ãi `i«Ì…œv wi` ܈̅œÕÌ Ài`ÕVˆ˜} “>}˜ˆwV>̈œ˜° This improves the speed of surgery as the surgeon does not have to keep refocusing. 2. ,i`ÕVi` ˆÕ“ˆ˜>̈œ˜° The digital microscope requires only 10–15% light compared to conventional microscopes which require 30–40%. This improves patient comfort in topical anesthesia procedures and prevents phototoxicity in lengthy surgeries. 3. iÌÌiÀ Vœ˜ÌÀ>ÃÌ >˜` Ài܏Ṏœ˜° This results in better visualization and outcomes for the patients. 4. iÌÌiÀ œÛiÀ>Þà . Overlays of incisions, capsular rhexis, toric IOL axis, integrated OCT, and patient and IOL details simulate a surgical cockpit with all the information available to the surgeon in realtime. This improves «>̈i˜Ì Ã>viÌÞ >˜` ÃÕÀ}iœ˜ Vœ˜w`i˜Vi° 5. -ÕÀ}iœ˜ iÀ}œ˜œ“ˆVð Most high-volume surgeons suffer from back and neck problems due to leaning over and looking through oculars. Digital microscopy improves surgeon comfort and the surgeon can sit up straight and view the screen without any strain on the neck or back. The surgeon is disassociated from oculars and the system is very comfortable even for very tall or very short surgeons. It is possible to comfortably stand and operate. 6. /i>V…ˆ˜} /œœ° The digital microscope is an excellent teaching tool as observers have the same view as the surgeon. Also, multiple observers can have the same experience and observe surgeries unlike with a conventional microscope with observer tubes. 7. Ƃ }œœ` “ˆVÀœÃVœ«i vœÀ “Տ̈ ÃÕÀ}iœ˜ «À>V̈Við Surgeons using the same microscope need not make changes to oculars or IPD. 8. Î ÀiVœÀ`ˆ˜} . 2D and 3D high-resolution recordings are possible with digital microscopy, helping academic teaching programs. The drawbacks of the digital microscopes include lag and this can be disconcerting in anterior segment surgeries with fast movements; however, the newer digital microscopes have a reduced lag of less than 50 ms which makes the lag imperceptible. The earlier digital microscopes using HDR cameras had altered colors which appeared unnatural but the newer microscopes have more natural color perception similar to conventional microscopes. The newer digital microscopes also have hybrid systems where both oculars and ÃVÀii˜ V>˜ Li ÕÃi` >˜` ˆ˜ÌiÀV…>˜}i` œ˜ ̅i yÞ° In my opinion digital microscopy will evolve further and is here to stay. Editors’ note: Dr. Sri Ganesh is a consultant for Zeiss and Biotech Vision. Dr. Sri Ganesh using the ARTEVO 800 system. Source: Sri Ganesh, MD