What is the most promising application of spatial computing in ophthalmology?
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Surgical navigation and training
Surgical education and training are probably going to be the most beneficial applications of spatial computing and are certainly the most proven. There are also significant advantages when it comes to surgical navigation.
Let’s look away from ophthalmology for a moment for a good example. One of the most complex cases ever on record was a case of conjoined twins in Brazil. The surgeons there had never done a case like it. There were surgeons in London who had some experience, so they worked together by uploading the DICOM images from the twins’ MRI and CT scans, and they charted a surgical course so they could avoid blood vessels and nerve bundles. When it was time for surgery, the surgeons in Brazil had a surgical map to follow that overlayed the surgical field. They were also able to practice the surgery ahead of time using a simulated surgical experience with their uploaded images. The surgery was successful, resulting in two healthy babies.
When we are in unfamiliar areas, we drive our cars with Waze or Google Maps. Why would we operate in an unknown place without surgical navigation?
Now we can think about augmented reality in ophthalmology. We use overlays on the surgical field for degrees of cylinder in astigmatism. Our newest 3D surgical microscopes give us the extra benefit of stereoscopic, high-resolution vision and digital visualization.
There is the prospect of using augmented reality or virtual reality for real-time patient interactions, but I am not the biggest fan of wearing these headsets in front of patients. We already have too many barriers between us and patients, so when someone is wearing a headset in front of a patient, I feel it creates another barrier.
However, the benefit in surgical training is significant. I have used some of the new training software, which allows side-by-side case comparisons with AI segmentation. I have also used systems with haptic feedback to give a lifelike experience. When you put that diamond knife through the cornea, you actually feel the resistance with haptic feedback. I was blown away by that kind of simulated surgical experience.
When you combine that simulation with analytics, you have a system that has the potential to make better surgeons in the future. It also gamifies the process. You want to beat yourself and improve your scores relative to other surgeons. It is not just about speed. The metrics analyze how accurate and how efficient you are, such as how many grasps it took to create the rhexis. Those types of detailed analytics are going to make more efficient and safer surgeons over time.
- For more information:
- Ranya Habash, MD, is with Bascom Palmer Eye Institute.
Patient education and telemedicine
While spatial computing in physician education is critical and something that will be valuable in the future, I am excited about its applications in patient education and telemedicine.
When you consider spatial computing’s augmented and virtual reality capabilities, this technology gives you the ability to simulate a visual state that a patient may not otherwise understand. There has been work to create applications that would give a patient the opportunity to experience what their vision might look like in certain medical conditions or clinical situations.
As a cataract surgeon, one of the things I would find most exciting is the ability to show patients what their vision might look like if they choose certain IOLs. It can be hard to accurately describe to a patient what their vision would look like with a monofocal lens, a multifocal lens or an extended depth of focus lens. However, if you can replicate each IOL’s visual outcome in a simulated environment, patients can look around and experience what their life might be like day to day. It gives them a better sense of what to expect and the ability to make a more informed medical decision.
I am also invested in finding ways to make ophthalmic telemedicine more effective and more appropriate for ophthalmologists and their patients. I foresee spatial computing playing a role in the future of telemedical care. When we are at our stereoscopic slit lamp, we are accustomed to seeing a three-dimensional eye in front of us. Similarly, fundoscopy provides us the ability to see the retina using stereopsis. Three-dimensional examination of ocular tissues is critical for the diagnosis and management of many conditions, ranging from corneal ulcers to glaucomatous nerve cupping to retinal tears and detachments. However, the photographs we take in the clinic are two dimensional. We try to use clues in the photos to give us a sense of stereo vision and stereoscopic evaluation. However, if we were able to take stereo images and stereo video of the eye exam components, we would get a lot more useful clinical information.
Stereoscopic imaging has already made its way into the ophthalmic operating room with three-dimensional heads-up displays enabling surgeons and OR staff to view real-time surgeries in stereo. We are also able to record and subsequently review these surgeries in stereo as well. Ophthalmic imaging equipment in the office may move in the same direction, enabling stereoscopic images and videos of anterior and posterior segment pathology. Spatial computing gives you the ability to visualize this information. The physician can wear a headset and see things as if they were sitting at the slit lamp even if the patient is 100 miles away, and it gives you the same clinical information that you would have in the office. Ultimately, this could lead to better clinical outcomes for telemedical care.
- For more information:
- Grayson W. Armstrong, MD, MPH, is with Massachusetts Eye and Ear.
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