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Armstrong: McKinsey &
Company, Ocular Technologies,
Optomed, Xenon Ophthalmics
Chang: Alcon, Apple, Verana
Health, Zeiss
Dhaliwal: None
Eippert: Alcon
Hovanesian: Alcon,
Bausch + Lomb, Zeiss
Hura: Alcon
Kitchens: None
Packer: Amaros, Oculotix
Rosenberg: Alcon, Beyeonics
Schallhorn: Zeiss
Singh: Alcon, Bausch + Lomb, Zeiss
Smith: Bausch + Lomb, Beyeonics
Weikert: Alcon, Zeiss
Weinstock: Alcon, Beyeonics, Zeiss
Contact Relevant disclosures
Light toxicity
Eric Rosenberg, DO, highlighted the effects of light toxicity,
noting that only a small percentage of surgeons generally
titrate the microscope light intensity.
It was in the 1980s when we started converting from
loops to the operating microscope, he said. Now, we
wouldn't think about not using an OR microscope because
the view and detail are enhanced, and surgery is safer.
Dr. Rosenberg noted a 1970s Irvine and McDonald
paper examining how much light intensity was needed to
disrupt the architecture of the retina. Everyone should reas-
sess their technique to minimize risk for light-induced macu-
lopathies. "But to this day, we haven't really studied the
full deleterious extent of light toxicity," he said, adding that
microscope manuals will note guidelines, and the maximum
amount of light that should be used at the time of surgery is
often exceeded.
We've improved on the short-term complications of light
by modulating five areas of concern, he said:
1. Illumination characteristics/spectral composition
2. Illumination intensity
3. Angle of illumination
4. Focus of the light source
5 Exposure time to light
But we still have yet to realize what the long-term
effects may be and how to go about continuing to provide
the safe and effective cataract surgeries we have all come to
appreciate while improving system-based approaches where
we can, Dr. Rosenberg said.
Intraoperative OCT
Julie Schallhorn, MD, presented on intraoperative OCT.
When we plan for surgery, we plan with the preop view,
which is the slit lamp, she said. This is a great instrument
that can show multiple angles, but the problem is when
you get into the OR, you don't have that view. You're using
peripheral illumination and coaxial red reflex lights. You
can't move around and shift. That is great for doing routine
cataract surgery, but once you start getting more complex
pathology, it becomes trickier.
"OCT is a great way of doing an optical section of the
eye," Dr. Schallhorn said. You shoot coherent light into the
eye, and it bounces back and gives a cross-sectional view
and eliminates light scatter, she said, adding that this pen-
etrates opacities well. You can see fine, delicate structures
much easier than with direct illumination.
Dr. Schallhorn showed several case examples. One
involved a membrane tracking through the incision onto
the back of the cornea. OCT is nice to visualize fine, deli-
cate structures, she said, and in this case, it was a sheet of
epithelial downgrowth coming through the incision from
a prior surgery. She said she wouldn't have done this case
without OCT.
Armstrong: grayson_armstrong@meei.harvard.edu
Chang: viroptic@gmail.com
Dhaliwal: dhaliwaldk@upmc.edu
Eippert: geippert@gmail.com
Hovanesian: DrHovanesian@harvardeye.com
Hura: arjan.hura@gmail.com
Kitchens: jkitchens@gmail.com
Packer: mark@markpackerconsulting.com
Rosenberg: ericr29@gmail.com
Schallhorn: julie.schallhorn@ucsf.edu
Singh: ipsingh@amazingeye.com
Smith: Ryangsmithmd@gmail.com
Weikert: mweikert@bcm.edu
Weinstock: rjweinstock@yahoo.com
Dr. Rosenberg, Dr. Singh, and Jennifer Loh, MD, members of the ASCRS Digital
Clinical Committee, at the "Digital Visualization in Eye Surgery – Is It Time to
Adopt?" symposium
Source: ASCRS
