OphthalmicASC Aug

AUG 2017

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T H E O P H T H A L M I C A S C | A U G U S T 2 0 1 7 16 W hen you talk to Steve Charles, MD, FACS, FICS, of Charles Retina Institute in Germantown, TN, about heads-up eye surgery, he is quick to tell you two things: 1) "heads-up" is a misnomer, and 2) he loves the technology. "Ophthalmic surgery is all 'heads-up' — with modern oculars, we haven't been operating bent over a microscope for 25 years," he points out, rejecting a moniker that he says implies the advantages of this technology are ergonomic. "The real reason for using a 3D camera system is that its image quality exceeds a purely optical operating scope. When I tried one of the latest systems in October 2016, I bought it out of my own pocket. Since then, I have used it exclu- sively for about 18 retina procedures a week." Pravin U. Dugel, MD, managing partner at Retinal Consultants of Arizona, and clinical pro- fessor at USC Roski Eye Institute, Keck School of Medicine, Los Angeles, agrees that although the technology is excellent, the "heads-up" tag has to go. "I don't like the terms 'heads-up' or '3D sur- gery' at all because they just belittle the entire technology," says Dugel, who has used a 3D camera system exclusively for 3 years. "This has nothing to do with my back or looking 'heads- up' at a 3D screen. To me, that's all superflu- ous. This has everything to do with giving you better depth of field and visualization than the microscope today, and most importantly, digi- tizing images as a groundwork for informatics overlays tomorrow. This is an age of informat- ics, and I think these systems will revolutionize retinal surgery." These surgeons' enthusiasm is typical of those who embrace 3D camera systems in the OR. Currently, two options are available: the Ngenuity 3D Visualization System (Alcon), and Sony 3D (Sony Medical). Here, users share the reasons behind their enthusiasm. • Depth of focus. 3D camera systems for surgical microscopes provide greater depth of field than microscopes alone, which means that all depths, from foreground to background, are simultaneously in focus. Dr. Charles explains: "This gives us a better 3D experience, and as patients breathe deeply or move, the image remains in focus, so there is no pausing to re- focus the microscope." • Big-screen view. Instead of viewing the eye through the oculars of the surgical micro- scope, surgeons using 3D camera systems wear 3D glasses and watch a big-screen monitor mounted a few feet in front of them. The high- definition magnification is enormous, enabling surgeons to use their foveal vision to look around on the highly magnified image. • Color adjustment. Because 3D camera systems provide digital imagery, surgeons have the power to adjust color to their advantage. Dr. Dugel opts to "remove the blood" before sur- gery to better see the structures he is targeting. Dr. Charles changes color gains during macular surgery, enhancing his ability to see faint bril- liant blue stain as the rest of the image tints to a contrasting orange. "I can also turn up the red to see indocyanine green stain, which allows me to use a much weaker and less toxic amount," he says. "Turning down the background noise of red reflex is helpful as well, making the vitreous become a more visible, bluish hue." Surgeons share their enthusiasm for the "heads-up" approach Discovering Surgical 3D Camera Systems O A S C | T E C H N O L O G Y By Erin Murphy, Contributing Editor

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