Comparison of 3D heads-up display system with conventional surgical microscopy for minimally invasive glaucoma surgery on an artificial eye model

Jordan J Huang; Derek Waldner; Jaxon J Huang; Joshua M Huang; Paul Huang; Joshua C Teichman; Mahshad Darvish-Zargar; Patrick Gooi

doi:10.1016/j.jcjo.2023.06.003

Comparison of 3D heads-up display system with conventional surgical microscopy for minimally invasive glaucoma surgery on an artificial eye model

Can J Ophthalmol. 2023 Jun 24:S0008-4182(23)00181-3. doi: 10.1016/j.jcjo.2023.06.003. Online ahead of print.

Authors

Jordan J Huang¹, Derek Waldner², Jaxon J Huang³, Joshua M Huang⁴, Paul Huang², Joshua C Teichman⁵, Mahshad Darvish-Zargar⁶, Patrick Gooi⁷

Affiliations

¹ Cumming School of Medicine, University of Calgary, Calgary, AB. Electronic address: jordanhuang8@gmail.com.
² Cumming School of Medicine, University of Calgary, Calgary, AB; Division of Ophthalmology, University of Calgary, Calgary, AB.
³ John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
⁴ Cumming School of Medicine, University of Calgary, Calgary, AB.
⁵ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Division of Ophthalmology, Trillium Health Partners, Mississauga, ON.
⁶ Division of Ophthalmology, McGill University, Montreal, QC.
⁷ Division of Ophthalmology, University of Calgary, Calgary, AB.

PMID: 37369358
DOI: 10.1016/j.jcjo.2023.06.003

Abstract

Objective: To survey ophthalmic surgeons' opinions comparing a novel three-dimensional (3D) heads-up display system with a conventional surgical microscopy for minimally invasive glaucoma surgery (MIGS) on an artificial eye model.

Materials and methods: Twenty-one ophthalmologists at the 2021 Canadian Ophthalmological Society Annual Meeting in Halifax, Nova Scotia, underwent a 90-minute skills-transfer course on MIGS. Using an artificial eye model (SimulEYE iTrack Model; InsEYE LLC, Westlake Village, Calif.), participants engaged in hands-on practice of MIGS via both a 3D heads-up display system (3D HUDS) (Zeiss Artevo 800; Carl Zeiss Meditec, Jena, Germany) and a conventional surgical microscope. Following completion, participants and instructors answered a 16-question survey comparing the 2 systems (3D HUDS vs conventional surgical microscope). Survey responses were recorded on a 9-point double-headed Likert scale ranging from strongly favour 3D HUDS (1) to strongly favour conventional surgical microscopy (9). Mann-Whitney U nonparametric analysis was used to compare instructor versus participants and experts versus nonexperts.

Results: Survey ratings favoured the 3D HUDS over the conventional surgical microscopy, with respondent ratings for all survey questions ranging from a response of 1 (strongly favour 3D HUDS) to 5 (equal). Mann-Whitney U statistical analysis revealed no significant difference between instructor versus participant as well as between expert versus nonexpert. Most ratings for the 3D HUDS were received for ergonomic setup of the surgical modality, depth of field (or) field of view, and usefulness in training residents for MIGS. Equal ratings for the 3D HUDS and conventional surgical microscope were received for system malfunctions and lag during surgery.

Conclusions: The 3D HUDS was favoured over conventional microscopy for the performance of simulated MIGS by ophthalmologists with varying levels of experience. The survey results suggest that the 3D HUDS in an artificial eye model is useful for teaching minimally invasive glaucoma surgery, particularly with the advent of competency-based ophthalmology education programs.