All the latest cutting-edge technology in cataract surgery – from imaging, measuring and lenses – were revealed at a syposium called “Mastering Your Cataract Surgery Workflow with Next Level Technology” during the 37th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2019).
Automated Measurements & Centralized Data Storage
Dr. Peter Stalmans, MD, PhD, from the Department of Ophthalmology Uzleuven, Belgium, shared how high-tech tools have helped the University Hospitals Uzleuven in managing its 500,000 patients a year. The hospital has over 1,900 beds and 9,000 employees.
Its Department of Ophthalmology alone has 10 full-time staff members, 26 consultants, 25 residents and 300 personnel. It handles 10,000 procedures annually, including 1,000 vitreoretinal surgeries. Some 40 percent of these are combined with lens surgery using intraocular lenses (IOLs), whether spheric, toric, trifocal or extended depth of focus (EDOF).
“Clearly, there is a need for perfection in patient data management,” said Dr. Stalmans. This includes taking accurate measurements, which is the first step in ensuring accurate IOL calculations.
He pointed out that automated measurements can avoid operator-induced errors, while centralized data storage means that all data is accessible within the same software.
“The system is hassle-free as it involves as few steps as possible to do tasks such as order IOLs,” he said.
A centralized data overview allows all the data to be available on the same screen, and an integrated visualization during surgery provides an augmented reality to guide the surgeon.
Within the Zeiss ‘ecosystem’, the IOLMaster 700, which uses swept-source optical coherence tomography (SS-OCT) technology, provides a full-length OCT image for fewer refractive surprises.
Meanwhile, the Cirrus OCT, with its spectral domain-OCT based imaging, allows clinicians to scan patients fast, with increased efficiency and improved imaging detail. The Artevo 800 digital microscope provides depth of field, reduced light intensity requirements and real color impression for increased certainty, as well as access to patient data remotely on the cloud through the Zeiss Cataract Suite.
“The IOLMaster 700 takes accurate SS-OCT based measurements, even in cases of detached retina,” shared Dr. Stalmans.
In short, with a centralized data storage and online calculator, surgeons can look forward to a mistake-free and hassle-free experience. The advanced Zeiss technologies provide integrated visualization during surgery, and integrated intraoperative OCT for corneal and retinal surgeries.
Digital Surgery: Higher Accuracy and Reduced Staff Time
According to Professor Wolfgang J. Mayer, MD, PhD, head of University Eye Laser Center, University Eye Hospital Munich, Germany, “digital surgery allows surgeons to build a secure data trail from biometry to surgery”.
From the IOLMaster, the gold standard in optical biometry, to the OPMI LUMERA with the innovative CALLISTO eye OR management system, these technologies enable surgeons to perform complex procedures with greater confidence to achieve optimal patient outcomes.
The Callisto eye, with its high level of precision, assists cataract surgeons in the precise alignment of IOLs and is an integral part of the Zeiss Cataract Suite. Prof. Mayer shared that the Zeiss FORUM software has been implemented at University Eye Hospital Munich, Germany since 2011.
The FORUM Eye Care Data Management system allows doctors access to diagnostic patient data which is available through central storage. The system boosts workflow efficiency and supports doctors in clinical assessments.
To sum up, there is improved networking of diagnostics with the OR unit. OCT-based biometry and individual lens calculation are done using one platform. The surgical assistance system helps in axis control, rhexis guidance, incision marking and IOL centering.
Surgeons are also able to streamline the refractive cataract workflow using the EQ workplace, from biometry and calculation, selection and ordering of IOLS, to surgery preparation and post-surgery data collection. This can help save time and prevent possible human error.
The EQ Workplace connects the IOLMaster and other DICOM-compatible devices remotely, as well as to Callisto eye. After surgery, the pre- and postoperative refraction can be reviewed and personalized.
“Using the latest technology for higher accuracy and reduced staff time is not a contradiction in terms,” concluded Prof. Mayer.
State-of-the-Art Microscope: The Future Is Now
The Zeiss Artevo 800 – the first and only digital microscope – provides better ergonomics, enables greater visualization of the surgical field, and allows access to data on the digital display . . . all of which can help the surgeon perform a better and more reliable eye surgery.
Dr. Brandon D. Ayres, MD, from the Wills Eye Hospital, US, told delegates about some of the key features of the state-of-the-art tool.
The Zeiss Artevo 800 comes with two 3-chip 4K cameras and can be used with oculars.
Built with 3D surgery in mind, it uses a 56-inch medical grade 3D LCD display. With the change to digital, the microscope is able to link the patient, surgeon, and data with a feature that allows data to be seen on the digital display. Auto adjust allows the microscope to change lighting parameters during cataract surgery.
Orthopedic concerns are important for surgeons. “Neck and back pain are a major concern for ophthalmologists,” said Dr. Ayres, noting that up to 70 percent of ophthalmologists complain of neck and back pain. “Sometimes this leads to the need for surgical intervention,” he cautioned. In some cases, the back pain was enough to cause retirement from the operating room.
With the Artevo 800, there is improved surgeon ergonomics. Not only that, there is also improved visualization of the surgical field. “Visualization of all structures are critical with a minimum of adjustments on the microscope,” stressed Dr. Ayres. “Improved depth of focus means easier transition from one structure to another. In some cases, no refocusing is needed during a case. The ability to incorporate real-time intraoperative OCT (iOCT) saves time and enhances surgical success.”
Although some may hesitate in getting started, he noted that “it in my experience, the idea of operating with no oculars is much worse than actually doing”. Optimizing the screen placement in the OR and having technical staff help with the initial set up is critical. He advised that it is best to start with straightforward cases, as the comfort level will improve with experience.
“The ability to work in a digital format allows the microscope to be the ‘smart hub’ of the operating room, connecting the patient, surgeon and operative data without interruption in workflow. The improved cameras, video processors and displays make 3D heads up surgery a reality today,” concluded Dr. Ayres.
Editor’s Note: The 37th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) took place from September 14 to 18 at Pavilion 7, Paris Expo, Porte de Versailles, Paris, France. Reporting for this story also took place at ESCRS 2019.