Eyeworld

40 | EYEWORLD | OCTOBER 2020 by Ellen Stodola Editorial Co-Director Exploring heads-up technology R DEVICE FOCUS EFRACTIVE H eads-up technology offers surgeons a new approach in the OR instead of the traditional operating mi- croscope. Two surgeons discussed their experience with the technolo- gy and how it compares to the tried and true method. "In some regards, there's very few things that can replicate or simulate true glass optics when you're trying to do microscopic surgery," said Robert Weinstock, MD. "For 100-plus years, optics have been refined by companies like Zeiss, Nikon, and Leica." They have pro- vided surgeons with an outstanding view of the surgical field, he said. Different light sources now inside microscopes can provide amazing optics to capture the surgical field in high reso- lution. The problem, Dr. Weinstock said, is the surgeon has to conform to the device, looking through the oculars, putting their body in a po- sition where they're over the patient, potentially hunched or bending over awkwardly. In addition, Dr. Weinstock said, optics, be- cause of the working distance, make it such that when you operate under high magnification, it increases strain on the eyes, the convergence, accommodation, etc., which can cause pain and discomfort. Current microscopes also only allow one person at a time to be able to see what's going on, he said. Enter the heads-up approach. Dr. Wein- stock said he has extensive experience with this because he was one of the first surgeons global- ly to operate with the technology in 2008. He noted that he helped TrueVision develop this technology. At first, it was rudimentary, had low-speed image capturing, and low resolution. But over the last decade, it has been refined to be a state- of-the-art device that provides a perfect image of the eye for surgeons to use, he said. Dr. Weinstock now uses the NGENUITY system (Alcon). Sri Ganesh, MD, also has experience work- ing with this technology. He first experimented with the TrueVision system and has also used the Alcon and Carl Zeiss Meditec technology. For about a year, he's mainly been using the ARTEVO 800 (Carl Zeiss Meditec). Dr. Ganesh noted that there's familiarity among surgeons with a traditional microscope. "We have been training on it for years, and it's just a matter of comfort using something for many years." Like any new system, he said, heads-up technology requires adaptation. However, he noted that this technology addresses one of the main disadvantages of the traditional micro- scope: ergonomics. With the traditional microscope, you have to bend your neck when looking at the oculars, which can cause neck and shoulder pain. He noted that the distance between your eyes and hands are always fixed, so this could be chal- lenging for both short and tall surgeons. Features and how it compares to a traditional microscope In terms of depth perception, Dr. Weinstock said this depends on the positioning of the 3D screen and also a bit on the surgeon's brain. Other factors may include the diaphragm and the aperture system in the microscope. There are multiple ways to augment the depth of field, he said. "In general, I've noticed a greater depth of field and a more immersive type of experi- ence by operating heads-up." Dr. Weinstock said that while earlier heads-up technology was a lower resolution system where you might notice a subtle lag and granularity, the latest technology has improved significantly. An example is the sensors in the 3D camera that capture the image coming from the microscope, he said. The optics of About the doctors Robert Weinstock, MD The Eye Institute of West Florida Largo, Florida Sri Ganesh, MD Nethradhama Super Specialty Eye Hospital Bangalore, India

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