3D Visualisation Systems: Advantages For Cataract Surgery

Cataracts are the leading cause of blindness globally, and second leading cause of visual impairment. As ageing demographics across the globe increase the demand for eye care services, incremental improvements in the efficiency and cost-effectiveness of cataract surgery will be key. Furthermore, technological advancements that enhance the surgical experience are increasingly of importance for surgeons. Heads-up 3D visualisation systems compatible with existing surgical microscopes have been shown to provide advantages in retinal surgery, however, there is a paucity of evidence in other ophthalmic surgical procedures. As such, a literature review was conducted to understand potential benefits of 3D visualisation systems in cataract surgery.

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MEDLINE was searched without language restriction from Jan-01-2001 to Sept-30-2021 using terms related to cataract surgery (eg, cataract, lens implantation, anterior segment) combined with terms related to a digital device (eg, 3D visualisation, heads-up, computer-assisted, digitally-assisted) and outcomes (eg, visual acuity, surgery time, complication). Reference lists from relevant articles were also scanned.

Of 445 sources screened, seven studies compared 3D visualisation systems with traditional microscope in cataract surgery. Three studies reporting safety and efficacy revealed similar complication rates and visual acuity with each method. Two studies reported 3D displays required less than half the light intensity of optical microscopes (P<0.001), suggested to reduce the risk of patient photophobia. One study reported faster recovery of vision (P=0.04) and another reported faster cataract surgeries compared to traditional methods (P=0.007). Additionally, several advantages for 3D systems were noted by anterior-segment surgeons, including pain reduction, improved posture and comfort, and better visualisation compared with optical microscope.

The current body of evidence demonstrates that 3D visualisation systems can provide considerable advantages for cataract surgery when compared with conventional microscopes. Benefits were wide-reaching across a broad range of outcomes including light-intensity, visual recovery, and ergonomics. Importantly, these benefits could be realized without impacting critical surgical outcomes such as complication rates and post-operative visual acuity, indicating that the technological advancement of 3D visualisation systems can provide benefits for the patient, surgeon, and practice alike. Future studies assessing surgical time and recovery with 3D visualisation systems would bolster these observed trends.