EyeWorld India December 2021 Issue

EWAP DECEMBER 2021 19 patient’s distance and inter- mediate vision, implanting the ReSTOR ® IOL in his right eye. After this implantation, the patient was happy with the distance and computer vision, though he was not impressed with his reading ability, wishing for better near vision in his left eye. Dr. Vasavada thus planned to implant the PanOptix ® IOL in the left eye, warning the patient not to compare eyes and that he may need to wear glasses for selective activities. Two months after surgery, the patient report- ed achieving a practical and successful outcome. He was able to ride his motorcycle with no glare in his vision while hardly having to use glasses. In a third case, Dr. Vasava- da presented a 60-year-old male patient who is an active ophthalmologist with bilat- eral cataracts using progres- sive glasses. The patient himself reported moderate use of multifocal IOLs in his own practice and was keen Copyright 2021 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. © Alcon 2021 ASIA-ACP-2100004 Exp Date 30 June 2022 on being implanted with multifocal IOLs himself as he had positive experiences with his own patients. The patient reported one month after surgery that he was very happy. He was able to operate on and examine pa- tients, drive, and read with- out any difficulty. Though he observed halos at night, he reported that it was not bothersome. Dr. Vasavada stressed that having a forthright discus- sion with patients preoper- atively is very important in managing patient expecta- tions and outcomes. Patients also must be motivated to accept some compromises such as occasional spectacle usage or seeing occasional halos. Though picking the right patients is also im- portant in his practice, Dr. Vasavada says he is happy customizing the needs of his patients and emphasiz- es dedicating enough chair time preoperatively to man- age patient outcomes. T echnological innovations in refractive cataract surgery are constantly evolving, making surgical procedures more efficient for both surgeon and patient. With Alcon’s NGENUITY ® 3D Visualization System, the operating space is transformed allowing surgeons to go beyond the limits of visualization. The NGENUI- TY ® system provides a high-definition video camera and workstation for 3D visualization of the eye with greater depth and detail during surgery than traditional microscopes. The versatile high dynamic range surgical camera and optimized high-speed image processor allows the surgical team to expand collaboration through a shared heads-up surgical view. Fea- tures of NGENUITY ® also include per- sonalized color profiles to customize the approach for each patient, light temperature profiles, custom image profiles, and the ability to operate under low lighting conditions. Using NGENUITY ® , Naren Shetty, MD, India found that not only is he more comfortable during surgical proce- dures, but “patients are so much more comfortable.” The reasons for greater comfort are outlined in his publication “Comparison of ease of visualization and comfort during phacoemulsification using NGENUI- TY ® 3D Visualization System versus Standard Operating Microscope.” 1 Dr. Shetty and his team aimed to com- pare the ease of visualization and comfort as perceived by the surgeon while performing phacoemulsifica- tion in cataract patients using the NGENUITY ® system compared to the standard operating microscope (SOM). In the prospective, random- ized study carried out at a single tertiary eye care center, an interim analysis of five experienced sur- geons operating on 123 eyes of 123 patients showed many advantages to using NGENUITY ® . From their newly developed questionnaire, “Surgeon’s Comfort Score” or SCS, the results showed that surgeons experienced a lesser illuminated surgical field with NGENUITY ® than with the SOM and this difference was statistically significant. A brighter surgical field, experienced with the SOM, is not desired and may be detrimental to the patient’s retina due to phototox- icity. Additionally, all five surgeons reported more comfort with the brightness of the surgical field of NGENUITY ® than with the SOM, and this difference was also statistical- ly significant. Finally, three out of five surgeons reported statistically significantly better neck comfort after the surgery while operating on NGENUITY ® as compared to the SOM. With a shallow learning curve, NGENUITY ® provides Dr. Shetty with a wonderful experience. “Initially, it looked like using NGENUITY ® was going to be difficult, but soon after I began the surgery, I forgot I was looking at the screen. You start and you forget.” Additionally, Dr. Shetty remarked that there was no differ- ence in time for cases; he was able to complete eight to nine cases per hour with NGENUITY ® . Dr. Shetty also found that patients, because it is important for them to look at the light during surgery, were much more co- operative with the lesser illumination of the surgical field, which allowed for improvements in surgical tech- nique as well as clinical outcomes. Not only does NGENUITY ® benefit surgeons and patients, but it also becomes a superior teaching tool for fellows and residents. When the surgeon is operating, students can clearly see the high-definition screen. “When our students are operating, we don’t need to lean to the side [to see]; we can just stand and look at the screen to instruct,” says Dr. Shetty. Especially in the current state of the COVID-19 pandemic, the ease of visualization provides a significant advantage with greater distance between surgeon, patient, and staff. Finally, the ergonomic set-up is important to consider for the surgeon. Every time there is a difference in patient height, the surgeon has to change the placement of the micro- scope set-up with the SOM. “With NGENUITY, you don’t need to change. You can place the patient’s head where you’re most comfortable. If the patient’s height isn’t in the average range when using the SOM, the surgeon has to compromise [with the set-up],” says Dr. Shetty. The transformative NGENUITY ® 3D Visualization System and its power- ful depth perception, in Dr. Shetty’s words, is “simply amazing.” As technology continues to evolve in the refractive and cataract realm, NGE- NUITY ® is a stepping stone for the future of surgical visualization. FOOTNOTE: 1. Shetty N et al. "Comparison of ease of visualization and comfort during phacoemul- sification using NGENUITY®3D Visualization System versus Standard Operating Micro- scope." In: Proceedings from the Asia-Pa- cific Association of Cataract and Refractive Surgeons; July 30-July 31, 2021; Virtual. Abstract PP1-48. NGENUITY ® 3D Visualization System Transforms the Surgical Experience Going beyond the limits of visualization