NEW PRODUCT APPLICATIONS

Digital Visualization System Enhances Vitreoretinal Surgeries

Move over, microscopes: a new technology provides much greater detail.

BY KAREN APPOLD, CONTRIBUTING WRITER

Alcon Laboratories’ NGENUITY 3D Visualization System, which establishes a platform for digitally assisted vitreoretinal surgery (DAVS), offers enhanced 3D visualization with high-definition resolution, image depth, and clarity and color contrast.

According to Josh Anderson, global director, Surgical Retina, Alcon Laboratories (Fort Worth, TX), the system addresses the greatest unmet need in vitreoretinal surgery—visualization. “When operating in the back of the eye to repair a detached retina, a retina physician’s view is frequently compromised by opacities and aberrations of the cornea, lens, and vitreous,” he says. “Further, surgeons encounter issues with shadowing, glare from fiber optic illumination, and poor access as they navigate around the crystalline lens to the peripheral retina.”

NGENUITY 3D balances the light and color of images, enabling surgeons to see detail that is difficult to see with traditional analog optics. Additionally, the system has an increased depth of field, which may be advantageous for specific retina tasks and cases.

IMPROVING EDUCATION

The NGENUITY 3D Visualization System combines the power of a high-dynamic 3D camera, advanced high-speed image optimization, polarizing surgeon glasses, and an ultra-high definition 4k OLED 3D display to create a platform for DAVS. “The system delivers an exquisite view of the delicate tissues and pathologies in the back of the eye, which can better help surgeons accomplish their goals,” Anderson says.

The system also allows everyone in the operating room—surgeons, technicians, nurses, and residents or fellows—to see the same view simultaneously, providing an excellent teaching environment and enabling improved communication among the operating team.

“I think it’s an absolute game changer for teaching surgery,” says George A. Williams, MD, professor and chair, Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, MI. “Both the fellow and myself can see exactly what each other is doing with excellent depth. It makes surgical instruction much easier and allows fellows to go further into a case.

“Once surgeons get used to looking at the monitor instead of into the microscope, the learning curve is very short,” Dr. Williams continues. “I find that fellows adapt to the new technology very quickly and operate as well or better than with an operating microscope.”

“It opens up a whole new world of teaching retina fellows,” adds John Kitchens, MD, partner, Retina Associates of Kentucky, Lexington, KY. “The system has dramatically improved my ability to show fellows exactly what is going on inside the eye. It will become the gold standard for training fellows.”

Further, Dr. Kitchens reports that he is able to record surgeries in a high-quality fashion and create videos to document interesting cases to use for training purposes.

CLINICAL APPLICATIONS

Dr. Williams has found the system to be useful in all types of surgical retinal cases. “It particularly shines in patients with macular disease such as macular holes or macular puckers,” he says. “You can obtain high magnification, and simultaneously maintain a relatively wide field of view.”

Surgeons can customize settings to specific tasks within a case. For example, if they encounter a membrane on the retina’s surface, they can select a color channel to highlight specific tissue—providing better visualization to a tissue plane, Anderson notes. Likewise, surgeons can lower the light levels on the surgical console to minimize light exposure to the patient’s eye and mitigate instrument glare—which can compromise surgeon visualization. Lastly, surgeons can customize a color channel in which they are able to better visualize vitreous. This application can prove to be advantageous, especially for retinal cases in which a tear is present.

BENEFITS ABOUND

Improving surgical visualization is the key to improving patient outcomes and reducing re-operation rates, which currently exceed 25%, according to U.S. Medicare claims data.

The NGENUITY 3D Visualization adapts to any traditional microscope setting by attaching the high-dynamic 3D camera. The surgeon uses the same microscope foot pedal control to zoom and focus. The OLED 4K NGENUITY display sits approximately five to six feet in front of the surgeon for an immersive view of the image.

What’s more, the system frees surgeons from being tethered to a microscope in an unnatural position for extended periods of time, which results in stress on the neck and back. “This is important, given that one study¹ showed that 85% of retinal surgeons complain of neck and back pain,” Anderson says. “NGENUITY 3D’s wide screen display offers freedom of movement, which can improve the surgeon’s posture and reduce spinal stress.” RP

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