Stereoscopic visualization of real-time intraoperative four-dimensional optical coherence tomography in opthalmology

Abstract

Purpose : Four-dimensional microscope integrated optical coherence tomography (4D-miOCT) has been proposed as an alternative to conventional white-light microscopy during ophthalmic surgical interventions. However, defining the optimum way of presenting images and data obtained from this new modality to the surgeon, is still subject to research. In this work, we explore the use of an autostereoscopic light field tablet and compare it to a large 3D TV in a user study.

Methods : We used a light field tablet (Lume Pad, Leia Inc, Menlo Park, California, US) for autostereoscopic display of 4D-miOCT renderings. Adapting the open-source application multiVNC on the client (i.e., tablet) side and performing the interlacing for the autostereoscopic effect on the server (i.e., CAMPVis rendering engine) side , allowed for low latency live streaming. To compare the visualization quality of the tablet to the traditional light microscope view and a 3D screen of a state-of-the-art digital surgical microscope (ARTEVO 800, ZEISS, Oberkochen, Germany), we performed a user study where 35 participants (14 medical doctors and 21 laypersons) were asked to perform tasks that mimicked eye surgery (Fig. 1). The evaluation of the user study comprised subjective feedback and the assessment of performance measures like e.g., time to complete a task or whether the “retina” was ruptured.

Results : We could successfully live stream the 4D-miOCT videos to the autostereoscopic light field tablet, with a measured delay of 151 ms from server to client at a volume rate of 10 vol/s. The evaluation (Fig. 2) showed a favor for the light microscope and the 3D TV. Yet the subjective feedback suggested that the tablet has large potential as a replacement for the TV due to more convenient placement possibilities, if issues like latency, resolution and quality of the 3D effect are addressed.

Conclusions : This work demonstrated the use of an autostereoscopic tablet for 4D-miOCT. With the feedback collected as part of a user study, we will be able to further optimize how we display 4D-miOCT video stream to the surgeon.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

4D-miOCT renderings (Field of View: 4.5mm) of the two tasks. Additionally screen capture of CALLISTO ® eye recording to the right. Task 1 (top): test orientation and motor skills. Task 2 (bottom): simulate membrane peeling.

 

Result of the user's ranking between left (1) and right (5) visualization via a violin plot.