field of view becomes limited to the central 30 degrees of the retina.
"As they're peeling the macula, surgeons don't want to pull their for-
ceps out of the field of view," says Dr. Hsu. "Heads-up displays provide
a very wide view of the retina beyond the macula, so they can see
where their instruments are at all times. That makes the peel much
more efficient and safer."
With heads-up displays, surgeons can also enjoy great views of
anatomy while using very low levels of illumination, because images
can be digitally enhanced and brightened on the screen. Dr. Hsu typi-
cally performs 25- or 27-gauge surgery with a light setting around 40%.
With the heads-up display, he works with a light setting of only 10%, a
reduction in output that reduces risk of photo toxicity caused by light
shining off the retina, especially during longer cases.
Heads-up displays can also improve case efficiency. OR staff can
watch the action unfold on the displays and prep instruments and
medications before surgeons ask for them. "They're able to anticipate
the surgeon's next move much more quickly than they can when stan-
dard microscopes are used," says John Miller, MD, director of retinal
imaging at Massachusetts Eye and Ear in Boston.
Color and lighting filters can highlight various eye tissues in ways
that aren't possible with standard microscopes, adds Dr. Miller.
3
Intraoperative OCT.
This technology, which provides sur-
geons with real-time snapshots of vitreoretinal pathophysiology
during retinal and corneal procedures, is the gold standard for
retinal diagnosis in the clinic, says Dr. Miller, who adds that there are
barriers to optical coherence tomography's widespread use in the sur-
gical setting. "It's slowly being incorporated into the OR, although
there are issues with cost and how to best integrate the technology
with the microscope and the flow of the operation."
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