AAO 2025: Innovations in surgical visualization and imaging

Katherine Talcott, MD, a retina specialist at the Cleveland Clinic’s Cole Eye Institute, explores the evolving landscape of retinal surgery, focusing on emerging imaging technologies. She begins by distinguishing 2 main categories of technological advancements: intraoperative optical coherence tomography (OCT) and heads-up display systems. Talcott highlighted how OCT has become indispensable in clinical settings for diagnosing and monitoring retinal disease. However, its incorporation into surgical procedures, while still limited, is proving increasingly valuable. Intraoperative OCT provides real-time insights into the retina during surgery, particularly for complex procedures such as membrane peeling in proliferative diabetic retinopathy. The technology enables surgeons to visualize retinal layers more precisely, identify safe planes for membrane dissection, and minimize unnecessary traction on delicate structures, thereby enhancing the safety and effectiveness of surgical techniques.

Talcott also discusses the recent rise of heads-up display technology, which moves beyond traditional operating microscopes. These immersive displays create a more comfortable and ergonomic environment for surgeons and significantly enhance the educational experience for trainees and medical students present in the operating room. By providing a detailed and comprehensive view of the surgical field, heads-up displays allow for better intraoperative decision-making, such as recognizing residual fluids, membrane presence, or retinal breaks, which can inform choices like gas selection and reduce the likelihood of additional surgical interventions.

The conversation also addresses future prospects. Talcott emphasizes the need for outcomes-based studies to quantify the benefits of these technologies. She asserts that evidence demonstrating improved safety and efficacy would encourage greater adoption in hospitals and ambulatory surgical centers (ASCs), ultimately resulting in safer surgeries and better patient outcomes. Action items identified include conducting such studies and advocating for wider dissemination of these advanced surgical tools.