On Day 1 (iNovation® Day) of the 42nd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2024), prominent figures in the field of ophthalmology shed light on the transformative impact of digital technologies in the operating room (OR).
To kick start the session, Dr. Roger Zaldivar (Argentina) emphasized the importance of data integration for improving efficiency and saving time. However, he acknowledged the challenges of managing increasing amounts of data from various sources, which can lead to time constraints and potential errors. Despite these challenges, he believes that digital processes will ultimately enhance efficiency, reduce mistakes and improve predictive accuracy in outcomes.
Dr. Cathleen McCabe (USA) echoed this sentiment, highlighting the importance of improved visualization for better OR outcomes. She discussed how enhanced visual feedback could refine procedures such as capsule access and overall situational awareness during surgery. Dr. McCabe stressed the concept of the “digital OR,” which encompasses the automation and digitization of data across the surgical workflow. This includes advanced instrumentation like 3D visualization devices and the integration of data and images throughout procedures, aiming to optimize data aggregation and application.
The panel also explored the advantages and challenges of digital ecosystems. Dr. Seba Leoni (Switzerland), another panelist, pointed out that digital technologies have been instrumental in reducing variability in cataract surgery. He emphasized that digital connectivity, from preoperative planning to intraoperative guidance, significantly reduces transcription errors and enhances surgical outcomes.
“One of the key advantages of this digital connectivity is the ability to capture input from measurement devices into a smart planner. This enables interconnectivity between devices and integration with PACS (Picture Archiving and Communication System) and EHR (Electronic Health Record) systems. As transcription errors are a leading cause of refractive error, this connectivity minimizes the number of manual steps and entries required from nurses and staff. Once the data is aggregated into the planner, technologies like the Smart Cataract DX we’re launching at the ESCRS, facilitate easy access to advanced formulas, impacting outcomes and streamlining data transfer from the clinic to the operating room,” he said.
AI’s role in the digital OR was another key topic. The discussion highlighted how AI-driven tools, like those embedded in modern devices, can optimize surgical settings and enhance astigmatism management. AI (artificial intelligence) not only aids in real-time decision-making but also supports postoperative analysis, leading to more informed and effective future procedures.
“AI can seem like such a big concept. AI sounds like magic and it’s a little bit scary, but it’s really just big data analysis,” said Dr. McCabe. “The more data we have coming in, the better we can anticipate achieving our outcomes, and the more significant those small steps of improvement will be. So, I think the real focus should be not only on integration but also on ensuring the user experience is absolutely seamless.”
Dr. McCabe also addressed the impact of these advancements on training. She noted that digital mentors and haptic feedback systems could vastly improve the training of new surgeons. By providing trainees with extensive virtual practice and feedback, these technologies promise to accelerate skill acquisition and enhance surgical proficiency.
Showcasing innovations: Emerging digital solutions in eye care
The session also included presentations on cutting-edge digital solutions set to revolutionize eye care in the near future.
CEO and co-founder Ran Yam of NovaSight (Tel Aviv, Israel), provider of pediatric digital vision care solutions, highlighted his company’s product TrackSightTM — a software as a service (SaaS) solution utilizing computer monitors’ embedded webcams to perform eye-tracking designed to run on any device. Myopia prevention is achieved by blurring the peripheral area of the screen while keeping the center of vision clear according to the momentary gaze position.
“TrackSight stimulates both myopic contrast reduction and myopic blur into the digital space. If you look away from the center of vision, you will notice slight degradation of the image which is protecting the vision of children throughout childhood on any device using our technology, even delaying the onset of myopia,” he said.
Next, Dimitri Chernyak from Intelon Optics (Massachusetts, USA) presented BOSSTM, an advanced imaging technology that utilizes non-contact, point-by-point measurement techniques based on Brillouin scattering principles. By harnessing light energy to measure reverberations at varying tissue depths, BOSS provides critical insights into the structural composition of ocular tissues. He emphasized that this innovative approach addresses unmet needs in multiple areas, including the early diagnosis of corneal diseases like keratoconus, screening and treatment customization for refractive surgery, customization of arcuate keratotomy (AK) and limbal relaxing incisions (LRIs) for cataract surgery, presbyopia drug discovery and the early detection of progressive myopia.
Meanwhile, Dr. John C. Berestka of Lightfield Medical (Minnesota, USA) addressed the limitations of the traditional slit lamp, which has long been the cornerstone of ophthalmology. He noted that it requires both the doctor and patient to be physically present at the same time, the exam is analog and fleeting, and the doctor must rely on memory to document the findings in the medical record.
“Our solution is Captura. We’ve taken high-speed computational photography to design a brand-new ophthalmic instrument where a technician with minimal training can capture the exam for the doctor. The doctor can review the images and explore them using intuitive gestures, preview the exam before seeing the patient, or use the images to explain technology. For the first time, we have true telemedicine in ophthalmology,” he said. This cutting-edge imaging system is set to be launched in 2026.
Lastly, Phil Norris from machineMD (Bern, Switzerland) introduced neos®, the world’s first neuro-ophthalmoscope designed for quick and efficient assessment of visual field, pupil reactions, eye alignment and movement. Combining proprietary software and consumer hardware, neos is intuitive, precise and scalable, making clinical workflow more efficient. “We achieve this with a VR headset worn by the patient. The device utilizes high-frequency eye tracking to analyze ocular movements and responses to stimuli. This system is scalable, enabling data interoperability through a power-based system,” Mr. Norris said.
All in all, the advancements and integration of digital technologies and AI in the OR emphasize a pivotal shift towards a more interconnected and technologically advanced field of ophthalmology. As these technologies continue to evolve, they hold great promise in improving workflow efficiency, reducing errors and enhancing treatment outcomes.
Editor’s Note: Reporting for this story took place at the 42nd Congress of the European Society of Cataract and Refractive Surgery (ESCRS 2024), held from 6-10 September in Barcelona, Spain.