Ophthalmology is known for having a strong technology pipeline, with many new devices and platforms brought to market every year. When other physicians see an ophthalmology office, they are amazed at the “fancy toys,” as a colleague put it. We have devices that can measure ocular structures within microns; even our laser ablations have that micron level of accuracy.
A red blood cell has a diameter of about 7.5 μm, and when we ablate corneal stroma, that 7.5 μm would equate to about a half-diopter of correction. For cataract surgery, the posterior capsule can be half that thickness, and we must avoid damaging it during the procedure. Ocular coherence tomography (OCT) has revolutionized treatment of macular disease owing to its ability to accurately image and measure tissues within a few microns.
These new devices are costly, and a fully equipped office can quickly surpass a million dollars’ worth of technology. This is especially challenging in the setting of declining reimbursements for patient care, but I’m convinced that it is still worth it. These technologies allow me to deliver better and safer care and provide more accurate results for patients. Recently, we purchased a new surgical microscope with intraoperative ocular coherence tomography as well as an integrated retinal viewing system. It is more expensive than the average home the United States, but it allows for an unprecedented degree of surgical viewing and imaging.
When teaching my resident surgeons, especially those who are earlier in the learning curve, the ability to perform an OCT scan of the phaco incision helps to understand the wound architecture and makes for a great learning experience. When an incision is leaky, the OCT image allows us to pinpoint the reason. A focal detachment of the Descemet layer is easily seen and then promptly addressed, and a repeated OCT scan then shows complete closure.
Overlay systems also improve surgical planning with the ability to align the astigmatic treatment appropriately over the correct axis. An outline of an ideal capsulorhexis can be projected to make it easier to create the correct diameter and centration. Video recording of the surgeries allows us to analyze and study the cases the same way that an athlete would dissect game day footage. These videos can then be shared with colleagues to spread the learning, all via our cell phones. In short, advanced technologies, such as this microscope, help make our surgeons, particularly the novice ones, better.
We are certainly willing to invest the funds to improve our skills and provide better outcomes for our patients.