University of Rochester Medical Center (URMC), Associate Professor of Ophthalmology, Mina Chung, MD, has been on the URMC Faculty for 15 years. Dr. Chung is an early adopter of new and innovative technology in her operating room. RetinaLink contacted Dr. Chung to gain her perspective and impressions of the ZEISS RESCAN® 700 which provides retinal specialists a new dimension in visualization and intraoperative HD-OCT diagnostics for decision making throughout their surgical procedure. Overall, the ZEISS RESCAN allows surgeons to bridge the gap from the clinic OCT diagnostics to their operating room.
In our interview, Dr. Chung shares several ways RESCAN has assisted in both her surgical management and training surgical Fellows at URMC over the last eight months.
RetinaLink (RL): In your opinion, what is the optimal way to get started with RESCAN in your operating room?
Mina Chung, MD (MC): Proper set up is paramount and a cornerstone for the RESCAN platform. Your staff is the most critical component to the implementation and success for the RESCAN technology. At Flaum Eye Institute we are fortunate to have a specialized diagnostic technician in the OR who has helped to implement and operate the intraoperative OCT properly. This dedicated person in the OR can be an ophthalmic photographer, circulating nurse or technician. The “key” is an individual in your OR who understands OCT diagnostics and imaging.
RL: Describe the learning curve that you experienced with RESCAN.
MC: The Io-OCT can be operated by the surgeon using the microscope foot pedal. Once the OCT mode is on, the foot controls switch to operating the OCT, so you want your operating microscope view to be in best focus before turning on the OCT. The joystick can then be used to center the OCT scan area onto the target area you want you want to image.
The OCT images appear within the microscope view in windows to the right of the fundus image, and are also projected onto the monitor screens in the room. Once you have the OCT on the target area, you can move the OCT scan area around to sweep across the lesion you want to image. The OCT’s appear as a video stream as you navigate around. You may notice a tiny delay. The assisting technician is very helpful to select a scan pattern, assist with focus, and record either video or still images.
Any new technology has a learning curve. Initially, it will take some time, but once everyone is trained up, it adds very little time to your cases, and can provide very valuable information.
RL: When do you find RESCAN most advantageous during surgery?
MC: For example, if there is a question of pseudocyst versus full thickness macular hole, the RESCAN can provide “instant feedback”. I can confirm the pathology and alter my surgical management, as needed, since I have the opportunity to view everything intraoperatively.
We have implanted the ARGUS® II Retinal Prosthesis, which has an array of electrodes that need to lie flat on the macula in order to work. With the regular surgeon’s microscope view, it’s very hard to tell looking down on the array that there’s no gap. The Io-OCT is extremely helpful in this situation to make sure that the array is tacked down flat.
Io-OCT has also been beneficial for cornea keratoprosthesis (KPro) surgeries. Optically, the small pupil in KPro patients makes any imaging challenging and I wasn’t certain if Io-OCT would be possible, but the RESCAN does work through the KPro. It has allowed me to check for membranes, cysts and the like in these complex patients, helping to ensure a better patient outcome.
RL: Is RESCAN helpful when training Fellows?
MC: Absolutely. The Fellows have the opportunity to see important retinal landmarks during their training. For example, while peeling a membrane, they can double-check with the Io-OCT vs. thinking they have peeled the membrane properly and effectively. Quite frankly, it’s very cool and provides a checkpoint to ensure there’s not a stray strand that’s not visible without Io-OCT, and makes my job a lot easier.
RL: Can you only use the office OCT diagnostic to assist in your surgical management?
MC: The office OCT diagnostics are certainly important in pre-operative diagnosis and decision making. However, the benefit of Io-OCT is it provides me the opportunity to “double-check” in real time. This can be beneficial to retina specialists who have operated for decades or in their first year of their retina fellowship. That ability to “double-check” your result while still in the OR could prevent a need for re-operation.
New technology can be expensive; however, URMC invested in the RESCAN approximately eight months ago and is helping to provide our retina specialists better patient outcomes.
Dr. Mina Chung can be reached at mina_chung@URMC.Rochester.edu