Academic/Industry Partnership for Next-Generation Robotically Guided Intraoperative Ophthalmic OCT - PROJECT SUMMARY/ABSTRACT This application brings together a highly collaborative and experienced team of ophthalmic surgeons, engineers, and an industry partner to develop a next-generation ophthalmic microscope to maximize visualization in the dynamic ophthalmic surgical environment. We seek to overcome limitations inherent to the decades-old ophthalmic surgery stereomicroscope which limits the true integration of modern visualization technologies like optical coherence tomography (OCT). Over the past decade, members of our team developed the leading intraoperative OCT program in ophthalmic surgery in the US. Under initial R21 support, our first-generation microscope-integrated OCT (MIOCT) design enabled live cross-sectional imaging during surgery and has been the approach adopted by multiple vendors in current commercial offerings. Our subsequent Bioengineering Research Partnership (BRP) funded work introduced the first live “4D” (volumetric imaging through time) MIOCT technology which images microsurgery with micrometer-scale resolution at several rendered volumes per second, interactively viewable by the surgeon from an arbitrary perspective through a novel stereoscopic heads-up display. We have demonstrated and documented the performance of these systems in hundreds of live human eye surgeries at the Duke Eye Center, with innovations and results documented in over 100 peer-reviewed publications and hundreds of presentations by the Multiple Principal Investigators and other team members. Our prior foundational work in intrasurgical OCT has resulted in a state-of-the art capability; however, the technology still requires considerable effort on the part of both the surgeon and a dedicated engineering operator. Unlike the outpatient clinic with stabilized patients, the dynamic surgical environment currently requires a dedicated engineering operator to assist the surgeon with image tracking and optimization to keep OCT at the surgical point of interest. Current stereomicroscopy is also insufficient to provide the depth resolution needed to keep the OCT depth window in frame for tracking solutions. The overall goals of this proposed project, then, are to develop a compact multi-camera array microscope capable of supporting and tracking the surgical scene at high spatial resolution and pair it with an active robot-based scan head to maintain the surgical point of interest in a dynamic scene. Together, these will allow true integration with OCT, dynamically placing the OCT view where the surgeon needs it – such as for monitoring a microneedle as it advances in depth through the retina and into the subretinal space. Each of these developments are motivated by specific current needs in ophthalmic surgery visualization based on our ophthalmic surgical and industry partners and will be developed through our well-established multidisciplinary translational methodology of incorporating constant feedback between multidisciplinary team members. We believe these developments will improve ophthalmic surgical visualization and also potentiate novel ophthalmic and other microsurgeries not currently possible due to limitations in surgical visualization.
