The future of imaging

Vitreoretinal surgeons in the not-too-distant future will find themselves operating like pilots flying an airplane because they will be pre-planning their entire operative 'route' and will be able to execute it precisely and efficiently thanks to assistance from digital informatics technology. “We are on the precipice of a revolution that will close the loop between what we are able to see in the office and what we see in the OR,” said Pravin Dugel MD, Managing Partner, Retinal Consultants of Arizona, Phoenix, and Clinical Professor of Ophthalmology, University of Southern California, Los Angeles, USA. “Now, all of the information we have from multimodal diagnostic imaging is left behind in the office and we go blindly into surgery. The change that is coming is all about developments in informatics. With implementation of digitalised assistance, vitreoretinal surgery will be much safer and much more efficient, and our patients will have much better outcomes,” he said. Dr Dugel noted that he personally has not used an operating microscope over the past two years. Instead, he wears three-dimensional (3D) glasses and looks at an image that is captured with a 3D high-dynamic range camera appearing on a high-definition large screen monitor. “The reason why I am using this system is not because of its ergonomics and teaching opportunities, although those are both big advantages. Rather, it is all about the informatics,” said Dr Dugel. NEW OPPORTUNITIES While that hardware is in place, the transformation in vitreoretinal surgery still hinges on advances in registration and navigation that will allow image overlay and compensation for eye movement. When those elements are available, full implementation of digitally assisted vitreoretinal surgery will lead to new opportunities. For example, it will allow for automated, navigated tissue sparing laser photocoagulation procedures in which the treatment density, spot parameters, and location will be defined in the preoperative plan based on preoperative diagnostic imaging and completed automatically intraoperatively with the press of a button. Real-time digitalised assistance will also enable intraocular distance monitoring through instrument guidance and feedback. Other technologies that are currently in development will further enhance digitally assisted vitreoretinal surgery planning. For example, 3D optical coherence tomography that can provide precise anatomic information will allow surgeons to plan exactly where to position their forceps and where to cut with their scissors when operating on an eye with vitreomacular traction or a tractional retinal detachment. Pravin Dugel: pdugel@gmail.com