Practice Makes Progress

It’s always fascinating when trendy technology seeps into health care. While working on this issue, our news feeds were overrun with stories of surgeons using Apple’s new Vision Pro in the OR.¹ According to the press release, a nurse used the device to help with instrument selection, data visualization, and procedure monitoring.¹ Cool stuff, and even if you aren’t an Apple aficionado, you have to admit this “spatial computer” is impressive.²

The news caught our eyes, but it didn’t surprise us because the field of retina was way ahead of the curve with this technology. The first ophthalmic exoscope—the Beyeonics One visualization system—that integrates augmented reality into a surgical headset was installed into an ophthalmic surgical suite years ago.³ Not only that, but the company recently announced the integration of intraoperative OCT into the headset, making it something of a spatial computer itself—for the surgeon.⁴

Retina has always been a field defined by technologic advancement, and our imaging tools are a great example. In an explosion of innovation in the early 2000s, we saw the advent of 3D visualization in the OR, intraoperative OCT, and OCT angiography (OCTA). Since then, it has been a slow march of improvement. For example, the January/February issue highlighted the addition of fluorescein angiography to surgical 3D heads-up displays. Other issues have touched on scanning laser ophthalmoscope-based multimodal fundus imaging and ultra-widefield technologies for the detection of diabetic eye disease. To catch up on these articles, see Further Reading. Some technology still in the pipeline may be poised to hit the clinic in the next few years; K. Bailey Freund, MD, and others have been lecturing on high-resolution OCT for a while now, with Retina Today following closely since its inaugural issue in 2006.⁵

While researchers work on fine-tuning the next generation, we asked experts to share their insights to help you perfect your skills with the imaging tools at your disposal. Two articles discuss why you should be using multimodal imaging for geographic atrophy and uveitis. We also have two articles detailing the benefits of OCTA for diabetic retinopathy, AMD, and other conditions. OCTA is the newest kid on the block, and although we have all played around with it, few of us are using it regularly in the clinic. We hope these articles help you gain enough confidence with your case selection and image interpretation to change that.

Lastly, Judy E. Kim, MD, FARVO, FASRS, partnered up with cardiologist Jagmeet P. Singh, MD, ScM, PhD, FHRS, FACC, to provide pearls for integrating home monitoring into the ophthalmology space—something cardiologists have been comfortable with for years. We can lean on the lessons learned with remote monitoring of implanted cardioverter-defibrillators and avoid many of the pitfalls, Drs. Kim and Singh share.

We are practicing in a high-tech world, and our clinics (and even some of our patients’ homes) are chock-full of technology designed to help us document and monitor retinal changes like never before. And we bet the next decade will see yet another explosion of innovation. Who knows, we might one day see patients while wearing a headset rather than carting around a laptop, floating OCTs all over the place.

– Marion Munk, MD, and Justis P. Ehlers, MD