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Purpose-built, head-mounted 3D display for ophthalmic microsurgery: surgical skill performance and evaluation: a pilot study
  1. Edward Korot1,2,3,
  2. Matthew Mark Rolain4,5,
  3. Allan Evans6,
  4. Aristomenis Thanos7,
  5. Christos Bergeles8,
  6. Edward H Wood3,
  7. Mark A Rolain1
  1. 1Beaumont Eye Institute, Beaumont Health System, Royal Oak, Michigan, USA
  2. 2Moorfields Eye Hospital, London, UK
  3. 3Byers Eye Institute, Stanford University School of Medicine, Stanford, California, USA
  4. 4Ophthalmology, University of Virginia Health System, Charlottesville, Virginia, USA
  5. 5Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
  6. 6DoctorGoggle, Grand Cayman, Cayman Islands
  7. 7Legacy Devers Eye Institute at Legacy Good Samaritan Medical Center, Portland, Oregon, USA
  8. 8King's College London, London, UK
  1. Correspondence to Dr Edward Korot, Beaumont Eye Institute, Beaumont Health System, Royal Oak, Michigan, USA; ekorot{at}

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Summary box

What are the new findings?

  • We highlight the need for purpose-built, head-mounted displays tailored to the specific demands of ophthalmic surgery.

  • Our paper demonstrates the potential of using head-mounted displays in ophthalmic microsurgery.

How might it impact on healthcare in the future?

  • The widespread implementation of these devices will help alleviate musculoskeletal pain commonly seen in ophthalmologists who operate with traditional microscope.

  • Digital visualisation devices will allow for enhanced visualisation of the surgical field and digital overlays not attainable with a traditional analogue visualisation.

  • We demonstrate a collaborative iterative device design approach between clinician users and device manufacturers.


Surgical microscopes are necessary for the performance of a majority of ophthalmic procedures. However, the use of traditional microscopes often leads to abnormal body positioning, musculoskeletal pain and fatigue.1–3 Furthermore, pain in the back, neck and shoulder is disproportionately reported among ophthalmologists as compared with other medical specialties. The resulting injuries sustained may lead to chronic pain and decreased career longevity.4 Increasing use of three-dimensional (3D) heads-up display (HUD) monitors has been reported for both anterior and posterior segment ophthalmic procedures, as well as in several other surgical fields.1 HUD implies visualisation through a digital 3D display panel rather than through a traditional operating microscope.5 These systems, such as the TrueVision 3D Visualization System (TrueVision Systems, Santa Barbara, California, USA), use glasses with polarised lenses in conjunction with a consumer 3D monitor to create a stereoscopic image.6 7 Several use cases for image overlays have been explored, including image-guided toric intraocular lens positioning during cataract surgery and intraoperative ocular coherence tomography for posterior segment procedures.1 8 HUDs have been reported to decrease surgeon fatigue by allowing ergonomic body posturing without compromising visualisation, technical difficulty, surgical time, visual outcomes or complication rates.5 9 10 Additional benefits of moving from optical to digital visualisation include high-resolution digital zoom, increased depth of …

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  • EK and MMR contributed equally.

  • Contributors EK contributed significantly to research design, data acquisition, research execution, data analysis and interpretation, and manuscript preparation. MMR contributed significantly to data acquisition, research execution, data analysis and interpretation, and manuscript preparation. AE contributed significantly to manuscript preparation. AT contributed significantly to research design and manuscript preparation. CB contributed significantly to manuscript preparation. EHW contributed significantly to data analysis and interpretation and manuscript preparation. MAR contributed significantly to research design, data acquisition and research execution.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests EK reports non-financial support from DoctorGoggle, during the conduct of the study. The evaluated device was provided by DoctorGoggle.

  • Provenance and peer review Not commissioned; externally peer reviewed.