Eyeworld

72 | EYEWORLD | MARCH 2020 I ILLUMINATING INTRAOPERATIVE TECHNOLOGIES N FOCUS Contact Riemann: Criemann@cincinnatieye.com Rubenstein: Jonathan_Rubenstein@rush.edu Wong: shannon@austineye.com 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 ad- junct 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 oper- ate through media opacity better with a digital microscope vs. analog, Dr. Riemann said, be- cause 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. "When you are doing these deep procedures … you barely have to adjust your depth of focus," he said. Dr. Rubenstein said that 3D in cat- aract surgery offers good depth of focus. "I'm not saying operating in 3D is su- perior to conventional microscopes for cat- aract 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 surgery." For true superficial corneal surger- ies—corneal transplants, suturing on the ocular surface, pterygium, etc.—Dr. Rubenstein said he doesn't think 3D microscopy is advanta- geous. "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 academ- ic setting and for those who "are motivated by new technology." It is a benefit to get everyone in the OR seeing what the surgeon is seeing, Reference 1. Riemann CD. Machine vision and vitrectomy: three dimen- sional high definition (3DHD) video for surgical visualization in vitreoretinal surgery. Proc SPIE 7863. Stereoscopic Displays and Applications XXII. 78630K (2011). Relevant disclosures Riemann: Alcon, Leica Microsystems Rubenstein: Alcon Wong: None continued from page 71 "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." —Jonathan Rubenstein, MD Compass.OnPeak.com

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