Eyeworld

32 | EYEWORLD | SUMMER 2026 ATARACT C Efficiency-wise, in addition to not having to reposition the scope for different surgeons to step in and operate, Dr. Braga-Mele said digital operating visualization systems can help streamline positioning for other procedures. For example, to perform a MIGS procedure along with cataract surgery requires two different scope positions for a traditional operating mi- croscope, whereas a digital system can make the transition more streamlined. With several systems for heads-up cataract surgery on the market, how do you choose what system works best for you? Dr. Weinstock said there are distinct differences among them that can help surgeons narrow down the best choice for their practice. "It's going to come down to cost, relation- ships that the surgeon or the surgery center has with these companies, and how they can bundle it into purchase agreements with other products they use from that company," he said, adding that he thinks surgeons who demo different modalities of these systems will find that all of them provide an exceptional experience. Limitation of these systems, Dr. Devgan said, include the monetary investment required, adaptation time for the surgical team, and occa- sional lag or image artifacts that may interrupt the surgical flow. "Will traditional operating microscopes become obsolete? I don't think so, at least not yet," he said. "While digital systems are expand- ing rapidly, traditional optics continue to offer reliability, lower costs, and familiarity, especially in settings with limited resources. I expect they will remain in use, particularly for straight- forward cases or where new systems are not accessible." Intraoperative OCT Intraoperative OCT as digital technology in the OR was introduced in the early 2010s and since then has become more integrated clinically for certain anterior segment procedures. Dr. Braga-Mele said she finds intraoperative OCT helpful to see lens and corneal thickness. She said it can aid in making more accurate arcuate cuts for astigmatic correction with a femtosecond laser. Visualizing lens depth is useful as a teaching tool. She envisions intraop- erative OCT being married to AI technology to help visualize and put parameters around safe phaco depths. "I'm theorizing now, but I think intraoper- ative OCT will decrease our complication rates, specifically in learners," she said. Dr. Weinstock said that while OCT has proved itself useful for retina procedures, its utility for cataract surgery is still being in- vestigated. "It's probably on the horizon that OCT will be used intraoperatively for complex cataract surgeries, measuring IOL position, or maybe for MIGS," he said. Dr. Devgan had similar thoughts. "For cataract surgery, its role remains limited but may expand, especially in complex cases such as those involving weak zonules, posterior polar cataracts, or intraoperative complications. While not essential for routine cataract cases at present, its potential for specific indications is growing," he said. Next up … slit lamp? One area where the digital revolution hasn't hit yet in an impactful way is at the slit lamp. "An update is definitely needed," Dr. Weinstock said. "We don't have the bandwidth to see the patients we need to see. … But at some point, it would be nice to have the patient sit down in front of a machine that was basically an imag- ing device and a slit lamp all in one." Dr. Weinstock imagined a combination machine that would obtain topography, tomog- raphy, pupillometry, retinal OCT, and scan with a 3D camera to perform a slit lamp exam. "All of this, in theory, could be done without the physi- cian in the room examining the patient." Dr. Weinstock envisioned a future where the physician could then have a Zoom meeting with the patient, looking at the images and the data, to talk to them about a diagnosis. "This would streamline the whole clinical visit," he said. "You wouldn't have this process of the pa- tient being worked up by a technician, getting dilated, going to sit in the waiting room for 20 minutes, going back to the exam room, hav- ing the doctor go in and talk to the patient for 10–15 minutes, then having them go up to the front desk and checking out." Dr. Weinstock said AI, visualization advanc- es, automation, and robotics have already done a lot to streamline processes clinically, and he thinks that will only continue in the future. "There's a lot of room for visualization and automation on the clinical side," he said. continued from page 31 Contact Braga-Mele: rbragamele@rogers.com Devgan: devgan@gmail.com Weinstock: rjweinstock@yahoo.com

• Blank Page
• Blank Page (1)