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Edward Korot, Mark Rolain, George A. Williams; Noninferiority of a Head-Mounted 3D Display in Ophthalmic Microsurgical Skill Performance. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6128.
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Intraoperative microscopic visualization provides challenges in ergonomics, 3D depth of field, size, and cost. We evaluate the use of a head mounted 3D retinal projection display (HMD) to address these issues and enable novel digital data integration. We quantitatively compared microsurgical skill performance using this visualization method against the standard operating microscope to demonstrate noninferiority.
We performed a prospective study to compare time spent on microsurgical corneal suturing. We timed 9 surgeons, of which 7 were surgeons in training. The surgeons each performed four corneal sutures tied with square knots using 10-0 nylon suture on an iatrogenicly induced laceration of porcine corneas. This task was performed up to 2 times by each surgeon via standard ophthalmic operating microscope, and 2 times with the HMD connected to a 3D camera attached to the microscope. The surgeons were timed from first needle pierce to completion of the fourth suture knot.
Noninferiority of the HMD vs operating microscope was demonstrated in a paired comparison (p=0.013). Noninferiority is defined as the state where the difference between the means is not greater than 3.00 minutes (upper equivalence differential), representing the accepted standard 50% of the upper 95% CI for the comparison group of operating microscope [6.00]. Mean [CI] number of minutes to complete the microsurgical task was higher in surgeons using the HMD 6.90 [5.66-8.14] as compared to the operating microscope 5.07 [4.13-6.00]. When tasks were performed twice, the lower of the two times was used for paired comparison between visualization methods.
We demonstrated noninferiority of the HMD in time to perform a common anterior segment ophthalmic microsurgical skill. Use of HMDs to perform surgery may provide ergonomic, cost, and qualitative advantages in visualization. Furthermore, transitioning to a digital display technology enables intraoperative digital overlays for additional surgical information such as OCT. We are performing further studies and generating objective data to validate the potential of this technology.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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