Ophthalmologists should adopt a 'wait-and-see' approach before putting new technologies into practice.
This article was reviewed by Tetsuro Oshika, MD, PhD
Newer does not necessarily mean better. That can be applied to many things, and it may be especially true in medicine.
New advances in viewing systems, IOLs, and femtosecond laser-assisted cataract surgery (FLACS) should be evaluated before they are incorporated into clinical practice, according to Tetsuro Oshika, MD, PhD, who detailed his views on how these technologies positively and negatively affect practice.
Surgical viewing systems
The conventional microscopy system is in some cases being replaced by three-dimensional digitally assisted visualization system, the so-called “heads-up” surgical system, especially during vitreous surgery.
Three such systems are currently available: the Ngenuity 3-D system (TrueVision Systems, Alcon), Artevo800 (Carl Zeiss Meditec), and RV800 Viewing System (Leica Microsystems).
“These systems clearly have an advantage in vitreous surgery, in that they provide an enhanced depth of field,” said Dr. Oshika, professor and chairman, Department of Ophthalmology, faculty of medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. “In addition, the technology is a good educational tool because the systems allows everyone in the operating room to have the same surgical view as that of the surgeon.”
Other advantages in addition to the enhanced depth of field education offered by these systems include a 4,000-pixel monitor, decreased light phototoxicity, digital enhancements, digital filtering, and high dynamic range, Dr. Oshika pointed out.
“These clearly are beneficial for the patients,” he said.
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This raises the question about whether this technology also can benefit cataract surgeons.
There are some disadvantages that must be addressed, the first of which is latency—the lag in information delivery—that matters more in cataract surgery than in vitrectomy, Dr. Oshika pointed out, because cataract surgery is much faster than vitrectomy.
A second disadvantage involves ergonomics. The best distance to the monitor is about 1.2 meters.
“In many cases, the monitor should be placed next to the bed and not at the patient’s feet. The surgeon’s sightline is not always straight, which depends on the configuration of the operating room,” Dr. Oshika said.
Dr. Oshika cited a study (Graefes Arch Clin Exp Ophthalmol 2019;257:473-83) of surgeons’ responses to heads-up surgery that reported that the system was best used during retinal procedures, including peeling of internal limiting membranes and removal of epiretinal membranes, and the investigators considered that the procedure for which heads-up surgery was least beneficial was anterior segment surgery.