New 3-D guidance system targets improved cataract surgery outcomes

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A new digital image guidance platform (Surgical Navigation System, Cirle) for cataract surgery is an open-source system designed to enhance accurate execution of cataract incision placement, capsulorhexis sizing and centration, toric IOL alignment, and limbal relaxing incision placement.

By Cheryl Guttman Krader; Reviewed by Richard Awdeh, MD

Miami-A new digital image guidance platform (Surgical Navigation System [SNS], Cirle) is a first-in-kind system for improving efficiency in cataract surgery and patient outcomes, according to its inventor, Richard Awdeh, MD.

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Using optical and digital technology, the system integrates preoperative data and images to provide intraoperative three-dimensional (3-D) image guidance through the oculars of the surgical microscope that enhances the accurate execution of four critical surgical steps:

• Cataract incision placement

• Capsulorhexis sizing and centration

• Toric IOL alignment

• Limbal relaxing incision placement

The system was designed to allow easy transfer of data from the clinic to the operating room and to be open source so that surgeons can use their existing diagnostic systems and microscope as well as their preferred IOLs.

“The [platform] was built with the goal of giving surgeons access to the data they care about at the time they need it so that they can deliver more accurate refractive results to their patients,” said Dr. Awdeh, founder and chief executive officer, Cirle, Miami.

In developing the system, Dr. Awdeh collaborated with other practicing surgeons in order to create a system that would provide efficient and effective solutions for addressing surgeons’ needs and at the same time would be easy to integrate into their existing environment.

“We thought about the sequence of steps performed for a typical case and tried to come up with creative ways to enable data transfer and accessibility, in a seamless and efficient manner,” he said.

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“We decided to create an open-source system to enable all surgeons the opportunity to have access to the technology regardless of the type of microscope or phacoemulsification machine they have in their practice,” Dr. Awdeh said.

As a means to provide accurate and efficient data transfer, the Surgical Navigation Guidance Console features a built-in QR code reader that allows for uploading of the surgical plan. 

A prototype of the system was presented at the Bausch + Lomb booth at the 2014 American Academy of Ophthalmology meeting in Chicago.

In addition to allowing for easy data input, the Surgical Navigation Guidance Console is used for selecting surgical preferences and monitoring key phacoemulsification parameters throughout the procedure. Those tasks are enabled with its large and highly intuitive touchscreen graphical user interface, Dr. Awdeh said.

The system is already compatible with a number of surgical microscopes marketed by Leica and Carl Zeiss Meditec, and that list will also be expanding. Its navigation overlays appear in both oculars as full color, 3-D images that are registered to the underlying anatomy of the eye.

“The heads-up display design means surgeons do not have to move their head away from the microscope while operating, and with the stereo 3-D image, the display guides surgeons through each task at the appropriate anatomic level,” Dr. Awdeh said. “So, the marks for surgical and astigmatic incisions are seen on the cornea, the capsulorhexis guidance is projected at the level of the anterior capsule, and lens alignment marks are seen at the IOL level.”

For surgeons using the Stellaris Vision Enhancement System (Bausch + Lomb), the platform can also display key phaco parameters in the microscope oculars. This feature brings surgeons increased monitoring ease during the entire phaco portion of the case, Dr. Awdeh said.

Bausch + Lomb, a division of Valeant Pharmaceuticals, has acquired an exclusive license to this product in the United States.

Richard Awdeh, MD

E: Richard@cirle.com

Dr. Awdeh discloses relevant financial interests in Cirle and Bausch + Lomb.