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4 | SUPPLEMENT TO EYEWORLD DAILY NEWS, JULY 24, 2021 STEP FORWARD INTO THE NEXT GENERATION OF CATARACT SURGERY Operating microscopy steps forward E ric Rosenberg, MD, has been using 3D digital microscopy in the OR in the form of the NGENUITY ® 3D Visualization System (Alcon) since his fellowship and "never looked back." "Once I had a taste of using this, I didn't want to do it any other way because it offered phenomenal visu- alization, and that's key to successful cataract surgery," he said. Dr. Rosenberg performs everything from advanced cataract surgery to corneal transplants. His practice has both NGENUITY ® operating rooms and operating rooms that have traditional analog operating microscopes. "I do a lot of complex work and if I have a complicated case, I request it be done in an NGENUITY ® room," Dr. Rosenberg said, explaining that he coor- dinates with staff ahead of time which cases he'll want to be scheduled with this advanced, digital microscopy. "With complex cases, the margin of error is smaller. You have one shot sometimes to get things right, and it's important that I use NGENUITY ® for those cases." In addition to cataract and cornea- based surgery, Dr. Rosenberg said he likes using NGENUITY ® for angle-based MIGS procedures due to the increased level of magnification and depth of field. In general, Dr. Rosenberg described NGENUITY ® as better than traditional analog microscopy on multiple fronts. "The magnification is close to 150% that of traditional microscopy, the depth of focus is significantly enhanced, and I find myself utilizing the focusing pedals a lot less," he said. He said he is able to use lower illumination levels while still having quality surgical visibility, which can make the procedure more comfortable for the patient. It may also have an impact on light-induced phototoxicity. Dr. Rosenberg discussed case studies going back decades regarding light-in- duced maculopathy from operating microscopes. The current generation of microscopes, he said, have tried to mit- igate this with things like corneal shield filters and homogeneous illumination. Most microscopes also have a manufac- turers' maximum recommended dosage of light that should be used for ophthal- mic surgery and for how long, which Dr. Rosenberg admitted he did not realize before engaging in this study. "This is the first time we're being presented with something that decreas- es the amount of light we're using, and that may have a net benefit to the patient," he said of NGENUITY ® . In March 2021, Dr. Rosenberg was the first author on a retrospective study published in the Journal of Cataract & Refractive Surgery that compared coaxial light intensity required during cata- ract surgery and rate of postop visual recovery between a traditional analog operating microscope and NGENUITY ® . 1 With the DATAFUSION technology, Dr. Rosenberg said all the information he needs is on one screen; he doesn't have to shift his head or his eyes from the surgical field to see things like pha- co parameters. "Doing surgery is much like driving a car. If you look at the trend in auto- mobiles, they want everything to be in front of you; they don't want you to take your eyes off the road. They want you to keep focusing on the surround- ing environment while you're monitor- ing the information you need in order to do what you're doing safely. Surgery is no different in that regard. You need to know the parameters in which you are operating. The phaco settings are just as important as anything else. … Taking your eyes off the road in order to look at those metrics can be dangerous," he said. "Having all that data in front of you while you're performing surgery I find to be incredibly valuable." For NGENUITY ® , the learning curve ranges from 0–5 cases at most, Dr. Rosenberg said. "If the learning curve had been too steep, we wouldn't have Eric Rosenberg, MD "You have one shot sometimes to get things right, and it's important that I use NGENUITY ® for those cases." —Eric Rosenberg, MD

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