OBJECTIVES: Trainee ophthalmic surgeons are often impacted by the difficulty in obtaining the best operative view. Visualization and depth perception are critical in surgical teaching, but with conventional microscopes (CM) the surgeon looks through binoculars of the scope, while trainees observe through a secondary monitor, lacking the same resolution or light output as the microscope. A literature review was conducted to understand benefits of 3D heads-up display visualization systems (HUD) for teaching and education in ophthalmic surgery.

METHODS:

MEDLINE was searched without language restriction from Jan-01-2001 to May-26-2022 using terms related to ophthalmology (eg, ophthalmic, eye surgery, cataract) combined with terms related to a digital device (eg, 3D visualization, heads-up, digitally-assisted) and teaching outcomes (eg, education, teaching, learning curve). Reference lists from relevant articles were also scanned.

RESULTS:

Of 508 sources screened, 13 studies evaluating the utility of HUD for education in ophthalmology were identified, all of which noted a benefit or higher satisfaction for surgical training with HUD use. Six surveys comparing surgeon preferences for HUD versus CM reported that most surgeons (69%-100%) expressed greater preference and higher satisfaction scores HUD, with educational advantages noted as a key benefit. A randomized controlled trial found that the HUD group had a significantly higher rating of satisfaction than the CM group (P<0.001) across several parameters. In an evaluation of macular hole surgeries by trainee surgeons, closure rate was significantly higher (P<0.004) when using HUD compared to CM, with viewing technique being the only significant variable between the groups. Moreover, HUD has been used with high satisfaction for telementoring and live training in corneal surgery.

CONCLUSIONS:

This review demonstrates that HUD provides considerable advantages for teaching and education compared to CM. The heads-up 3D display allows surgeons to share the surgical experience with trainees, thus augmenting the educational experience.