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Varman A, Varman NVA, Balakumar D. Assessing the surgical competency of novice surgeons by using a three-dimensional heads-up display microscope. Indian J Ophthalmol 2024; 72:1329-1335. [PMID: 38990609 DOI: 10.4103/ijo.ijo_2677_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/27/2024] [Indexed: 07/12/2024] Open
Abstract
PURPOSE To evaluate the surgical performance of novice surgeons operating on a three-dimensional (3D) heads-up display system compared to those using a traditional microscope (TM). METHODS Prospective study design in a private practice setting. Twenty novice surgeons with similar experiences in cataract surgery were selected. Each surgeon performed 20 phacoemulsification cataract surgeries: 10 surgeries on the 3D heads-up display microscope, and 10 surgeries using a TM system. Data were collected from a total of 400 patients operated on by 20 surgeons. Outcome measures were recorded and graded according to the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric-Phacoemulsification system. The main outcome measure was mean surgical competency scores. RESULTS Overall, 400 data points were equally distributed between TM (200) and 3D (200) surgeries. The mean surgical competency scores were 60.19 (11.41) for TM surgeries and 62.99 (11.11) for 3D surgeries. 3D surgeries had significantly higher surgical competency scores than TM surgeries ( P = 0.013). The mean surgical duration for TM and 3D surgeries was 35.98 (6.02) min and 34.31 (7.12) min, respectively. 3D surgeries took significantly less time than TM surgeries ( P = 0.012). The overall mean best corrected visual acuity in the logarithm of the minimum angle of resolution units was 0.27 (0.42); in TM and 3D surgeries, it was 0.28 (0.43) units and 0.26 (0.41) units, respectively. CONCLUSION The 3D heads-up display system enhances stereopsis in cataract surgery, making it a valuable training tool for novice surgeons in phacoemulsification procedures.
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Affiliation(s)
| | | | - Dinesh Balakumar
- Department of Cataract and Refractive Surgery, Uma Eye Clinic, Chennai, Tamil Nadu, India
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Huang JJ, Waldner D, Huang JJ, Huang JM, Huang P, Teichman JC, Darvish-Zargar M, Gooi P. Comparison of 3D heads-up display system with conventional surgical microscopy for minimally invasive glaucoma surgery on an artificial eye model. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e338-e342. [PMID: 37369358 DOI: 10.1016/j.jcjo.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To survey ophthalmic surgeons' opinions comparing a novel three-dimensional (3D) heads-up display system with a conventional surgical microscopy for minimally invasive glaucoma surgery (MIGS) on an artificial eye model. MATERIALS AND METHODS Twenty-one ophthalmologists at the 2021 Canadian Ophthalmological Society Annual Meeting in Halifax, Nova Scotia, underwent a 90-minute skills-transfer course on MIGS. Using an artificial eye model (SimulEYE iTrack Model; InsEYE LLC, Westlake Village, Calif.), participants engaged in hands-on practice of MIGS via both a 3D heads-up display system (3D HUDS) (Zeiss Artevo 800; Carl Zeiss Meditec, Jena, Germany) and a conventional surgical microscope. Following completion, participants and instructors answered a 16-question survey comparing the 2 systems (3D HUDS vs conventional surgical microscope). Survey responses were recorded on a 9-point double-headed Likert scale ranging from strongly favour 3D HUDS (1) to strongly favour conventional surgical microscopy (9). Mann-Whitney U nonparametric analysis was used to compare instructor versus participants and experts versus nonexperts. RESULTS Survey ratings favoured the 3D HUDS over the conventional surgical microscopy, with respondent ratings for all survey questions ranging from a response of 1 (strongly favour 3D HUDS) to 5 (equal). Mann-Whitney U statistical analysis revealed no significant difference between instructor versus participant as well as between expert versus nonexpert. Most ratings for the 3D HUDS were received for ergonomic setup of the surgical modality, depth of field (or) field of view, and usefulness in training residents for MIGS. Equal ratings for the 3D HUDS and conventional surgical microscope were received for system malfunctions and lag during surgery. CONCLUSIONS The 3D HUDS was favoured over conventional microscopy for the performance of simulated MIGS by ophthalmologists with varying levels of experience. The survey results suggest that the 3D HUDS in an artificial eye model is useful for teaching minimally invasive glaucoma surgery, particularly with the advent of competency-based ophthalmology education programs.
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Affiliation(s)
- Jordan J Huang
- Cumming School of Medicine, University of Calgary, Calgary, AB.
| | - Derek Waldner
- Cumming School of Medicine, University of Calgary, Calgary, AB; Division of Ophthalmology, University of Calgary, Calgary, AB
| | - Jaxon J Huang
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Joshua M Huang
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Paul Huang
- Cumming School of Medicine, University of Calgary, Calgary, AB; Division of Ophthalmology, University of Calgary, Calgary, AB
| | - Joshua C Teichman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Division of Ophthalmology, Trillium Health Partners, Mississauga, ON
| | | | - Patrick Gooi
- Division of Ophthalmology, University of Calgary, Calgary, AB
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Jeon HS, Kim MH, Joo K, Park SJ, Lee EJ, Hyon JY, Kim TW, Park KH, Woo SJ. Comparison of posterior capsule rupture rates during phacoemulsification using 3D heads-up visualization system and traditional microscopes. J Cataract Refract Surg 2024; 50:328-332. [PMID: 37919836 DOI: 10.1097/j.jcrs.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To compare the posterior capsule rupture (PCR) rates of cataract surgery using a traditional ophthalmic surgical microscope (OSM) and a 3D heads-up visualization system (HUVS). SETTING Single tertiary referral center. DESIGN Retrospective study. METHODS This study included 10 101 eyes that underwent phacoemulsification cataract surgery. Surgeries were performed using either 3D HUVS (1964 eyes, performed by 2 surgeons, HUVS group) or traditional OSM (8137 eyes, performed by 6 surgeons, OSM group) from February 2018 to June 2022. Data were collected based on the diagnosis-related group system, and the rate of PCR requiring vitrectomy and the surgical time were evaluated. RESULTS The PCR rates were not significantly different between the OSM (n = 63; 0.7%) and HUVS (n = 19; 0.9%, P = .392) groups. The mean surgical time was significantly longer in the HUVS group (14.7 ± 10.6 minutes) than in the OSM group (12.9 ± 9.9 minutes, P < .001). In the 3D HUVS group, there were no PCR cases among the initial 100 patients. In both groups, no significant difference was observed in the PCR rates over time. Although the difference was not statistically significant, the PCR rate decreased over time in the HUVS group. CONCLUSIONS The results indicate that 3D HUVS-based cataract surgery performed by experienced cataract surgeons had a PCR rate similar to that of traditional OSM-based surgery during the 4-year study period. Although the surgical time was slightly longer with 3D HUVS, cataract surgery using 3D HUVS can be performed safely by experienced surgeons.
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Affiliation(s)
- Hyun Sun Jeon
- From the Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea (Jeon, M.H. Kim, Joo, S.J. Park, Lee, Hyon, T.-W. Kim, K.H. Park, Woo); Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea (Jeon, Joo, S.J. Park, Lee, Hyon, T.-W. Kim, K.H. Park, Woo); Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea (K.H. Park)
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Shetty N, Aishwarya, Nayak RP, Kaweri L, Kanaradi RK, Pisharody AA. 3D visualization system and standard operating microscope for ease of visualization and surgeon comfort during phacoemulsification surgery. Indian J Ophthalmol 2024; 72:56-62. [PMID: 38131570 PMCID: PMC10841793 DOI: 10.4103/ijo.ijo_1332_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To compare the ease of visualization and comfort of the surgeon during phacoemulsification surgery using NGENUITY® 3D (NG) visualization system and standard operating microscope (SOM). METHODS In this prospective, randomized, single-blind, single-center study, patients undergoing phacoemulsification surgery by one of the five surgeons were randomly assigned to two groups based on the visualization modality-NG and SOM. Ease of visualization and comfort of the surgeon was assessed using a 27-parameter in-house Surgeon Comfort Score questionnaire. RESULTS A total of 224 phacoemulsification with intraocular lens implantations were performed in senile immature cataract (SIMC, n = 174) and mature cataract patients (MC, n = 50). Surgeon's ease of visualization (4.92-5.00) and hand-eye coordination score (4.97-5.00) were comparable between the NG- and SOM-groups. Postoperative neck discomfort was lower in both the groups, with a relatively lower discomfort in the NG-group (score: 1.04 vs 1.56). The Spearman rank correlation coefficient (r) between illumination of the operation theatre room and the surgical field revealed a weak negative correlation for most of the patients in the NG-group, and a positive correlation for patients in the SOM-group. No correlation was obtained between brightness of the surgical field and comfort with the surgical field brightness. CONCLUSIONS Similar ease of visualization was experienced by the surgeons using NG- and SOM-system. Neck discomfort postsurgery was numerically lower in the NG-group, although not significant. Additionally, the NG-system permitted the safe performance of phacoemulsification using a lower surgical field illumination.
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Affiliation(s)
- Naren Shetty
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Aishwarya
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Rohitha P Nayak
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Luci Kaweri
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | | | - Anchana A Pisharody
- Imaging Biomechanics and Mathematical Modelling Solutions Lab, Narayana Nethralaya, Bommasandra, Bengaluru, Karnataka, India
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Razavi P, Cakir B, Baldwin G, D’Amico DJ, Miller JB. Heads-Up Three-Dimensional Viewing Systems in Vitreoretinal Surgery: An Updated Perspective. Clin Ophthalmol 2023; 17:2539-2552. [PMID: 37662647 PMCID: PMC10473403 DOI: 10.2147/opth.s424229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
Three-Dimensional (3D) heads-up visualization systems have significantly advanced vitreoretinal surgery, providing enhanced detail and improved ergonomics. This review discusses the application of 3D systems in vitreoretinal surgery, their use in various procedures, their combination with other imaging modalities, and the role of this technology in medical education and telementoring. Furthermore, the review highlights the benefits of 3D systems, such as improved ergonomics, reduced phototoxicity, enhanced depth of field, and the use of color filters. Potential challenges, including the learning curve and additional costs, are also addressed. The review concludes by exploring promising future applications, including teleophthalmology for remote assistance and specialist availability expansion, virtual reality integration for global clinical education, and the combination of remotely robotic-guided surgery with artificial intelligence for precise, efficient surgical procedures. This comprehensive review offers insights into the current state and future potential of 3D heads-up visualization systems in vitreoretinal surgery, underscoring the transformative impact of this technology on ophthalmology.
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Affiliation(s)
- Peyman Razavi
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | | | | | - Donald J D’Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
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Ramírez Mejía M, Arroyo Muñoz L, Medina Perez AB, Mendoza Velasquez C, Ceja Martínez J, Camacho Ordonez A, Guerrero-Berger O. Magnification and Refocusing Comparison in Cataract Surgery Using a Heads-Up Three-Dimensional Visualization System versus Conventional Binocular Microscopy. Clin Ophthalmol 2023; 17:2333-2339. [PMID: 37600146 PMCID: PMC10439775 DOI: 10.2147/opth.s423372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose To compare magnification and refocusing during phacoemulsification with the NGENUITY® 3-D Visualization System (3-D) versus the conventional microscope (CM) OPMI LUMERA 700. Setting This study was performed in the Department of Anterior Segment of the Fundación Hospital Nuestra Señora de la Luz. Design Prospective, randomized, cross-sectional, multi-surgeon, and comparative study. Methods This study enrolled 100 patients (eyes) scheduled for phacoemulsification to measure the number of times changes in focusing and magnification were needed during cataract surgery. Results Our study included 100 patients. From the endpoints evaluated, "zoom-in" showed statistically significant differences for all of the four predefined cataract surgery steps (means: Step 1, 0.38 (CM) vs 0.08 (3-D); Step 2, 0.36 (CM) vs 0.06 (3-D); Step 3, 0.54 (CM) vs 0.22 (3-D); Step 4, 0.56 (CM) vs 0.24 (3-D); all comparisons, p <0.05). In Step 4, there was a statistically significant increased use of "focus-out" for the 3-D system (mean 0.16 (CM) vs 0.58 (3-D); p <0.05). "Focus-in" and "zoom-out" showed no group differences for all steps. The duration of surgery with the 3-D system was longer at each step and overall. The percentage of light intensity did not show a statistically significant difference between both systems, with a mean of 99.45 for CM vs 98.43% for the heads-up system. Conclusion The heads-up 3-D system is a safe option that offers excellent magnification for anterior segment visualization. The surgical time is longer, but adjusting settings like light intensity and brightness may facilitate some surgical steps early in the learning curve.
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Affiliation(s)
- Mariana Ramírez Mejía
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Leticia Arroyo Muñoz
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Ana Beatriz Medina Perez
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Cristina Mendoza Velasquez
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Jimena Ceja Martínez
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Azyadeh Camacho Ordonez
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Oscar Guerrero-Berger
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
- Centro Oftalmológico Mira, Mexico City, México
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Gualino V, Pierne K, Manassero A, Bruneau S, Couturier A, Tadayoni R. Comparing microscope light-associated glare and comfort between heads-up 3D digital and conventional microscopes in cataract surgery: a randomised, multicentre, single-blind, controlled trial. BMJ Open Ophthalmol 2023; 8:e001272. [PMID: 37493673 PMCID: PMC10314628 DOI: 10.1136/bmjophth-2023-001272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/27/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To compare subjective levels of comfort and visual experiences related to microscope light in patients undergoing their first cataract surgery with topical anaesthesia using a digital microscope (the NGENUITY three-dimensional (3D) visualisation system) or a conventional microscope. METHODS AND ANALYSIS A prospective, randomised, single-blinded, parallel-group, multicentre, interventional study. Patients (n=128) were randomly assigned to one of two treatment groups: the experimental group (n=63) had surgery using the digital microscope and the control group (n=65) had surgery with a conventional microscope. The primary outcome was patients' subjective experience of glare from the microscope light during surgery on a numerical scale from 0 to 10. Key secondary outcomes were patients' subjective levels of comfort and visual experiences related to the microscope light. RESULTS The experimental group reported significantly lower levels of glare; median levels were 1.0 (0.0-4.0) for the experimental group vs 3.0 (0.0-6.0) for the control group (p=0.027). They also reported higher levels of comfort; median ratings were 8.0 (6.5-10.0) in the experimental group and 7.0 (5.0-9.0) in controls (p=0.026). There were no group differences in ratings of subjective pain or visual disturbances. Median microscope light intensity was lower in the experimental group than controls; 3425.0 (2296.0-4300.0) Lux vs 24 279.0 (16 000.0-26 500.0) Lux (p<0.0001), respectively. CONCLUSION Compared with conventional microscopes, the NGENUITY 3D visualisation system allows surgeons to operate with lower levels of light exposure, resulting in significantly less glare and improved comfort in patients undergoing cataract surgery. TRIAL REGISTRATION NUMBER NCT05085314.
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Affiliation(s)
- Vincent Gualino
- Department of Ophthalmology, Clinique Honoré Cave, Montauban, France
| | - Kevin Pierne
- Department of Ophthalmology, Clinique Honoré Cave, Montauban, France
| | - Anthony Manassero
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
| | - Sébastien Bruneau
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
| | - Aude Couturier
- Department of Ophthalmology, Université Paris Cité, AP-HP, Hôpital Lariboisière, Paris, France
| | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
- Department of Ophthalmology, Université Paris Cité, AP-HP, Hôpital Lariboisière, Paris, France
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Giansanti F, Nicolosi C, Bacherini D, Soloperto F, Sarati F, Giattini D, Vicini G. Three-Dimensional Visualization System for Vitreoretinal Surgery: Results from a Monocentric Experience and Comparison with Conventional Surgery. Life (Basel) 2023; 13:1289. [PMID: 37374072 DOI: 10.3390/life13061289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE To describe the experience of our centre (Careggi University Hospital, Florence, Italy) in using a heads-up three-dimensional (3D) surgical viewing system in vitreoretinal surgery, making a comparison with the conventional microscope surgery. METHODS We retrospectively analyzed data taken from 240 patients (240 eyes) with surgical macular diseases (macular hole and epiretinal membrane), retinal detachment or vitreous hemorrhage who underwent vitreoretinal surgeries, by means of the NGENUITY 3D Visualization System (Alcon Laboratories Inc., Fort Worth, TX, USA), in comparison with 210 patients (210 eyes) who underwent vitreoretinal surgeries performed using a conventional microscope. All surgeries were performed with standardized procedures by the same surgeons. We analyzed data over a follow-up period of 6 months, comparing the surgical outcomes (best-corrected visual acuity, anatomical success rate and postoperative complication rate) between the two groups. RESULTS the 3D group included 74 patients with retinal detachment, 78 with epiretinal membrane, 64 with macular hole and 24 with vitreous hemorrhage. There were no significant differences in the demographic and clinical characteristics between the 3D group and the conventional group. We found no significant differences in outcome measures at three and six months follow-up between the two groups (p-value ≥ 0.05 for all comparisons). Surgery durations were similar between the two groups. CONCLUSIONS In our experience, a heads-up 3D surgical viewing system provided comparable functional and anatomical outcomes in comparison with conventional microscope surgery, proving to be a valuable tool for vitreoretinal surgery in the treatment of different retinal diseases.
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Affiliation(s)
- Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Daniela Bacherini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Federica Soloperto
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Federica Sarati
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Dario Giattini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Giulio Vicini
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
- Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
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Tan NE, Wortz BT, Rosenberg ED, Radcliffe NM, Gupta PK. Impact of Heads-Up Display Use on Ophthalmologist Productivity, Wellness, and Musculoskeletal Symptoms: A Survey Study. J Curr Ophthalmol 2022; 34:305-311. [PMID: 36644468 PMCID: PMC9832462 DOI: 10.4103/joco.joco_115_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 12/11/2022] Open
Abstract
Purpose To explore how ophthalmologist productivity, wellness, and musculoskeletal (MSK) symptoms are affected by heads-up display (HUD) use. Methods A digital survey was emailed to the United States ophthalmologists. Questions covered topics including MSK health, surgical output, work hours, wellness hours, and factors related to HUD use. Results One hundred and forty-four ophthalmologists responded, and 99 completed all eligible questions. HUDs were utilized by 33 respondents, 29 of whom submitted complete surveys. HUD users worked 353 more hours annually (P = 0.01) and performed 673 more cases (P = 0.07) than nonusers. MSK symptom presence (P = 0.79), severity (P = 0.80), and frequency (P = 0.86) were independent of use. Over half (n = 16/29) of users identified symptomatic improvement attributable to the device, mostly in the cervical and lumbar regions. Mean job stress was moderate-severe for both users and nonusers (P = 0.10), and there was no significant difference in wellness hours (P = 0.44). Retina specialists (P = 0.02) and males (P = 0.03) were more likely to have operated with the technology. Nearly half of heads-up surgeons (n = 12/29) had obtained new equipment to target MSK symptoms, versus 1.4% of nonusers (n = 1/70; P = 0.0009). Most of those who operated with HUDs would recommend them to others (69.0%, n = 20/29), but 44.8% (n = 13/29) indicated ergonomic challenges. Primary concerns included awkward viewing angles, setup difficulties, and a lack of access. Conclusions HUD surgeons reported greater work output versus nonusers without significant compromises in wellness or MSK health. User feedback suggests that the technology may lessen neck and low back pains, but barriers including cost and system inconveniences may impede adoption.
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Affiliation(s)
- Nicholas E. Tan
- Department of Ophthalmology, College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Brayden T. Wortz
- Department of Chemistry, Wake Forest University, Winston-Salem, NC, USA
| | - Eric D. Rosenberg
- Department of Ophthalmology, New York Medical College, Valhalla, NY, USA
| | - Nathan M. Radcliffe
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA,New York Eye Surgery Center, Bronx, NY, USA
| | - Preeya K. Gupta
- Triangle Eye Consultants, Raleigh, NC, USA,Tulane University, New Orleans, LA, USA,Address for correspondence: Preeya K. Gupta, 2075 Renaissance Park Pl, Cary, NC, USA. E-mail:
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10
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Muecke TP, Casson RJ. Three-Dimensional Heads-up Display in Cataract Surgery: A Review. Asia Pac J Ophthalmol (Phila) 2022; 11:549-553. [PMID: 36417680 DOI: 10.1097/apo.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Intraocular visualization in cataract surgery is currently achieved using the ophthalmic surgical microscope (OSM). Three-dimensional (3D) heads-up display is a burgeoning intraocular visualization technique for cataract surgery, which projects the surgical view to a 3D monitor. A number of theoretical advantages of this system over the OSM have been proposed. 3D visualization is reported to provide improved depth perception and the heads-up display promotes a more ergonomic surgical position while providing an enhanced view for the entire surgical team. The modern OSMs, however, already allow for safe and efficient cataract surgery, and 3D heads-up display visualization is limited by a steep learning curve. We critically review the literature around 3D heads-up display cataract surgery and compare its safety profile to traditional visualization techniques.
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Affiliation(s)
- Thomas P Muecke
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Ophthalmology & Visual Science, University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia
| | - Robert J Casson
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Ophthalmology & Visual Science, University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia
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Ripa M, Kopsacheilis N, Kanellopoulou K, Nomikarios M, Motta L. Three-Dimensional Heads-Up vs. Standard Operating Microscope for Cataract Surgery: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:2100. [PMID: 36140501 PMCID: PMC9497825 DOI: 10.3390/diagnostics12092100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The surgical time duration, the postoperative best-corrected visual acuity (BCVA), and the incidence rate of intraoperative complications, alongside the vision and posturing parameters, were estimated by systematic review and meta-analysis to compare the three-dimensional (3D) heads-up visualization system (HUVS) and standard operating microscope (SOM) in cataract surgery. METHODS A literature search was conducted using PubMed, Embase, and Scopus on 26 June 2022. The weighted mean difference (WMD) was used to present postoperative BCVA and the mean surgical time duration, whereas the risk ratio (RR) was used to present the incidence rate of intraoperative complications. Publication bias was evaluated with Egger's test. The Cochrane Collaboration's Tool for randomized clinical trials, the methodological index for non-randomized, and the Newcastle-Ottawa Scale were used to assess the risk of bias. The research has been registered with the PROSPERO database (identifier, CRD42022339186). RESULTS In the meta-analysis of five studies with 1021 participants, the pooled weighted mean difference (WMD) of the postoperative BCVA showed no significant difference between patients who underwent HUVS versus SOM cataract surgery (WMD = -0.01, 95% confidence interval (CI): -0.01 -0.02). In the meta-analysis of nine studies with 5505 participants, the pooled WMD of mean surgical time duration revealed no significant difference between patients who underwent HUVS versus SOM cataract surgery (WMD = 0.17, 95% CI: -0.43-0.76). In the meta-analysis of nine studies with 8609 participants, the pooled risk RR associated with intraoperative complications was 1.00 (95% CI, 1.00-1.01). CONCLUSIONS 3D HUVS and SOM provide comparable surgical time duration, postoperative BCVA, and incidence rate of intraoperative complications.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Nikolaos Kopsacheilis
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury CT1 3NG, UK
| | - Kanellina Kanellopoulou
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury CT1 3NG, UK
| | - Mikes Nomikarios
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK
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Kaur M, Nair S, Titiyal JS. Commentary: Three-dimensional heads-up display system for cataract surgery. Indian J Ophthalmol 2021; 69:2309-2310. [PMID: 34427207 PMCID: PMC8544079 DOI: 10.4103/ijo.ijo_1321_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sridevi Nair
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Madanagopalan VG. Heads-up surgery in ophthalmology. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_179_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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