OBJECTIVES: Cataracts are the leading cause of blindness globally, and second leading cause of visual impairment. Technological advancements enhancing the surgical experience are of increasing importance for surgeons. 3D Heads-up display visualisation systems (HUD) compatible with existing surgical microscopes have been shown to provide advantages in retinal surgery. This literature review was conducted to assess potential benefits of HUD in cataract surgery.

METHODS: MEDLINE was searched without language restriction from Jan-01-2001 to May-26-2022 using terms related to cataract surgery (eg, cataract, lens implantation, anterior segment) combined with terms related to a digital device (eg, 3D visualisation, heads-up, computer-assisted, digitally-assisted) and outcomes (eg, visual acuity, surgery time, complication).

RESULTS: Of 459 sources screened, eight studies compared HUD with traditional microscope in cataract surgery. Four studies reporting safety and efficacy revealed similar complication rates and functional results. Three studies reported HUD required less than half the light intensity of optical microscopes (P<0.001), suggested to reduce the risk of patient photophobia. One study reported faster visual recovery (P=0.04) while another reported faster cataract surgeries compared to traditional methods (P=0.007). Additionally, several advantages for HUD were noted by cataract surgeons, including pain reduction, improved posture and comfort, and better visualisation compared with optical microscope. Moreover, it has been noted that patient installation and surgery performance may be easier with the HUD for cataract patients presenting with spinal deformities.

CONCLUSIONS: This review demonstrates that HUD can provide considerable advantages for cataract surgery. Benefits were wide-reaching across a broad range of outcomes including light-intensity, visual recovery, and ergonomics. Importantly, these benefits could be realized without impacting surgical outcomes such as complication rates and post-operative visual acuity, indicating that the technological advancement of HUD can provide benefits for the patient, surgeon, and practice a like. Future studies assessing surgical time and recovery with HUD would bolster these observed trends.