Eyeworld

3D SURGERY (PRESENTED IN 3D)—IS NOW THE TIME? continued from previous page attending anxiety (identical view and faster switch), and better teaching ergonomics. Dr. Riemann discussed how active aperture manage- ment with these systems gives you better visualization through media opacity. He also presented research that showed no differences in outcomes or case duration be- tween a digital or analog microscope, advantages in ergo- nomics, and how things like latency in the digital systems do not impact the case. From a personal ergonomic standpoint, Dr. Riemann speculated that if he had not made the switch to 3D surgery, he would have required a two-level cervical disc fusion as opposed to a two-level disc replacement to manage his own work-related injury, and he likely would be medically retired now. In addition to showing several vitreoretinal cases in 3D, Dr. Riemann concluded that screen-based vitreoretinal surgery has already proven itself superior to ocular-based surgery. "There's no reason not to embrace this tech now," he said. Dr Riemann teased that digital visualization will become mainstream in the exam room as well, noting the digital Elara 900 slit lamp (Haag-Streit). Dr. Riemann also showed a 3D HD slit lamp video generated by the VitaPixel prototype camera. With the Constellation Vision System (Alcon), Dr. Rie- mann said light pipe settings can be set at 5–20% compared to 30–40% with traditional oculars. With the EVA NEXUS (DORC/Zeiss), light pipe settings are 20%, compared to 50–70% with the oculars. In cataract surgery, he noted via a published report, there is 60% less light using screen-based surgery vs. oculars. Why is this important? Because less light equals safer surgery. As Dr. Riemann presented, diseased ret- inas may be more susceptible to phototoxicity. Dr. Riemann also discussed the benefits of digital signal processing with color channels and digital overlays. One ex- ample he showed was a "sea of red" during a scleral buckle. If you turn off the red pixels, you're able to see detail that was unseen without digital red-free. "There is a bunch of color channel tweaking that you can do so you see what you want to see when you want to see it," he said. There are also digital overlays, such as a capsulorhexis template, LRI template, and toric IOL alignment. "Another advantage is the auxiliary video feed," Dr. Riemann said, showing the ability to include a view from the endoscope on the same screen as the top-down surgical view. "It's very powerful to be able to have two images on the same screen." The advantage of screen-based surgery for residents and fellows includes less trainee anxiety (it gives them the illusion of independence; the screen feels more natural than oculars; and there's no issues with accommodation), less THANK YOU TO THE SPONSORS OF THIS SYMPOSIUM diamond level platinum level gold level Dhaliwal: dhaliwaldk@upmc.edu Hovanesian: Dr.Hovanesian@harvardeye.com Lobanoff: mlobanoff@gmail.com Riemann: Criemann@cvphealth.com Rosenberg: rosenberg@alumni.upenn.edu Schiefer: christopherpschiefer@gmail.com Singh: ipsingh@amazingeye.com contact Dhaliwal: None Hovanesian: Alcon, Bausch + Lomb, Horizon Surgical Systems, Zeiss Lobanoff: Alcon, C2, Lochan, Tracey Technologies Riemann: Acusurgical, AI:ON Health, ANI Pharmaceuticals, Bausch + Lomb, Digital Surgery Systems, DORC, Haag-Streit, VEO, VitaPixel, Zeiss Rosenberg: Alcon Schiefer: None Singh: AbbVie, Nova Eye Medical relevant disclosures about the physicians Deepinder Dhaliwal, MD Professor of Ophthalmology University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania John Hovanesian, MD Harvard Eye Associates Laguna Hills, California Mark Lobanoff, MD OVO LASIK + Lens St. Louis Park, Minnesota Christopher Riemann, MD Professor of Ophthalmology University of Cincinnati Clinical Governance Board and Retina Fellowship Director Cincinnati Eye Institute Cincinnati, Ohio Eric Rosenberg, DO SightMD New York West Babylon, New York Christopher Schiefer, MD Eye Institute of West Florida Largo, Florida Inder Paul Singh, MD The Eye Centers of Racine and Kenosha Racine and Kenosha, Wisconsin

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