Eyeworld

SUMMER 2026 | EYEWORLD | 31 C Relevant disclosures Braga-Mele: Alcon Devgan: CataractCoach.com Weinstock: Alcon, Bausch + Lomb, Beyeonics, Leica, Zeiss screen, but its microscope arm is designed with a C-shape to allow for better screen positioning. Dr. Weinstock has experience with several systems and said he performed the first cases in 2007 with the early prototype developed by TrueVision 3D Surgical. Since then, the technol- ogy has been refined, and the company has col- laborated with other ophthalmic companies who have gone on to incorporate TrueVision technol- ogy or to create their own systems. TrueVision was acquired by Alcon and is now embedded in the NGENUITY 3D Visualization System. In addition to the heads-up nature of these technologies, they often feature enhanced con- trast and light optimization, data overlays, and workflow integration. • Alcon NGENUITY 3D Visualization System: A 3D, heads-up system with the surgical field projected on a monitor • Bausch + Lomb SeeLuma: A 3D, heads-up system projecting onto 4K monitors or for use with digital binoculars • Beyeonics One: A wearable headset system for 3D surgical visualization • Haag-Streit METIS 3D Digital Heads-Up Module: A 3D, heads-up system that attach- es to the METIS 900 microscope for surgical visualization • Leica Microsystems Proveo 8x: A 3D, heads- up system with the surgical field projected on a monitor • Zeiss ARTEVO: A 3D, heads-up system with the surgical field projected on a monitor Dr. Braga-Mele said operating based on a heads-up display while wearing 3D glasses is much more ergonomic. "Your shoulders can be back, your neck can be more aligned because you're not trying to compensate for bed height, and you're not looking through binoculars," she said. "It's also nice because nurses in the OR and your assistant can be watching the screen in 3D while wearing the glasses as well. "I have a very tall resident who has to stoop down, and if I'm assisting a tall resident, I almost have to stand up for the procedure to see through a regular microscope," she said. "With heads-up technology, I can be sitting anywhere and watching at the same time." Improvements to operating microscopy through 3D, heads-up displays and headsets was sorely needed by surgeons. "In ophthalmology, musculoskeletal disorders are very prevalent … and it's because of the way we sit at the slit lamp and at the microscope," Dr. Braga-Mele said. "There are ergonomic chairs being devel- oped that will marry with these ergonomic mi- croscopes that we now have. To me, it's exciting because it will maybe increase the longevity of the ophthalmologist, but it will definitely increase our quality of life." From a surgical and patient safety stand- point, Dr. Weinstock said 3D technologies have helped with use of high magnification for parts of the procedure such as capsule polishing or finding the edge of a capsulorhexis tear. "When you zoom in with a normal optical microscope, you get a condition called asthe- nopia, and when you try to look at something under super high magnification, it hurts your eyes. It's very disorienting," Dr. Weinstock said. "But when you're sitting back looking at a screen that's 3 or 4 feet away, you can zoom in and comfortably see that without the eye strain. I use high magnification all the time on complex cataract surgery and even routine to see details that would be too uncomfortable for me to zoom in on with an optical microscope." Another feature that he's using with the Beyeonics system specifically is infrared light. This, he said, increases the transparency of ocu- lar tissues that you couldn't otherwise see with normal light. "If there's corneal haze that you're trying to look through, if there's a lot of cortical spoking of the cataract and it's reflecting light and not letting you get a red reflex, infrared helps with that," Dr. Weinstock said. "There's also a lot of gain settings and con- trast sensitivities that I can optimize on a digital microscope that we can't on an analog system. You can augment the image on a case-by-case basis," Dr. Weinstock continued, adding that he doesn't do this on every case. The surgeons have also experienced the benefit of these visualization systems for teaching purposes. "I take a fellow every year, and I'm training them how to do complex and premium cataract surgery. [With 3D, heads-up technology], they're able to stand or sit right next to me and see exactly what I'm seeing and vice versa," Dr. Weinstock said. "My ability to improve the learning curve and get another sur- geon trained is exponentially faster and better with a digital system or a headset than it would be with an optical system." continued from page 28 continued on page 32

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