New 3-D Technology for Eye Surgery Offers Multiple Advantages

Three-dimensional technology could soon revolutionize the way ophthalmologic surgery is performed.

Cleveland Clinic has pioneered the use of Alcon’s NGENUITY® 3-D visualization system, a workstation incorporating a 3-D, stereoscopic, high-definition, digital video camera that sits atop a microscope and projects magnified stereoscopic images of the surgical field onto a large high-definition screen in real time.

“It’s an interesting technology because it marries some of the existing technologies we already use,” says Rishi P. Singh, MD, a staff surgeon in Cleveland Clinic’s Cole Eye Institute.

Singh was one of the first American retinal surgeons to pilot test an earlier version of the 3-D camera device on about a half dozen patients. Cole Eye Institute will use the final marketed device in both retina and cataract surgery.

Advantages for surgeon and surgical team

The system’s design allows the vitreoretinal surgeon to operate while sitting straight up and looking at the screen, instead of hunched over the eye piece of the microscope for anywhere from 30 minutes to three hours.

“You wear goggles as if you’re watching a 3-D movie, but you’re really operating in front of you with your hands on the patient, and it’s projecting your work on the screen as you’re doing it…It has the ability to reduce fatigue and improves visualization of the surgical field by projecting a wider field of view,” says Dr. Singh.

In addition to the ergonomic advantage for surgeons, the big-screen projection also engages the entire surgical team. Typically in the operating room, the various staff — nurse anesthetist, anesthesiologist, scrub nurse and circulator nurse — are all in the OR during the procedure, but they’re concentrated on other things and not necessarily paying attention to the surgery, Dr. Singh explains.

With the 3-D screen, “a lot of them will watch and comment and help determine the next steps. They can see when we’re opening and closing and anticipate needs for the room and know what to do next. It helps the flow.”

It’s also an educational tool, a great advantage for a teaching institution like Cleveland Clinic. “We thought it would be quite a nice addition to what we currently do…This really helps to explain what we’re doing and how we’re doing it. It engages people in a group,” says Singh.

Enhanced viewing

Other advantages include better depth perception and color contrast than are available on current standard television monitors used in operating theaters, the capability for the surgeon to increase magnification while maintaining a wide field of view, and the use of digital filters to customize the view to highlight particular ocular structures and tissue layers.

And perhaps a smaller but significant advantage is that there’s no need to drape and prep the scope for every procedure. “We currently use a sterile drape to cover the microscope…The new version is much smaller with the 3-D camera so we don’t need to use this drape. This takes a minute or more per case but as you can imagine if you have multiple cases the time adds up,” Dr. Singh says.

As for patient outcomes, the system also allows for minimizing light exposure to the patient’s eye, which may reduce the risk of damage. Whether there are any further benefits for patients remain to be seen, Dr. Singh says.

“I would anticipate outcomes will be better, but that’s a very high bar to hit. I think generally speaking this will improve ergonomics for the surgeon operating for long periods of time and turnover time…And certainly from a teaching perspective I think it would be a great advance for all of us.”