The Changing View of Retina Surgery

A look at the evolution, clinical value, limitations, and potential of 3D digital viewing systems in vitreoretinal surgery.

By: Sean T. Berkowitz, MD, MBA, Katherine E. Talcott, MD, FASRS

Retinal Physician January 1, 2026 Vol 23, Issue January 2026 Page(s): 8-11

Clinical Scorecard: The Changing View of Retina Surgery

Category	Detail
Condition	Vitreoretinal diseases requiring surgery such as macular surgery and retinal detachment
Key Mechanisms	3D digital stereoscopic visualization systems providing heads-up or head-mounted display views during vitreoretinal surgery
Target Population	Patients undergoing vitreoretinal surgery; surgeons performing these procedures
Care Setting	Operating room settings for vitreoretinal surgery

3D digital visualization systems offer improved ergonomics, reduced light exposure, and enhanced visualization for the surgical team.
Safety and efficacy of 3D systems are comparable to conventional microscopy with no significant differences in clinical or visual outcomes.
Limitations include latency, image distortion, peripheral viewing challenges, learning curve, and significant cost and logistical considerations.

Use of 3D visualization systems does not alter diagnostic criteria but may enhance intraoperative visualization of membranes and retinal structures.

Consider adoption of 3D digital systems (e.g., Artevo, Ngenuity, Beyeonics One) for vitreoretinal surgeries to improve ergonomics and visualization.
Weigh benefits against limitations such as learning curve, equipment cost, and operating room integration challenges before implementation.

Monitor surgical duration and ease of use during initial adoption to address learning curve effects.
Observe for any ergonomic benefits or musculoskeletal symptom improvements in surgeons using 3D systems.

Potential for latency and image distortion affecting surgical precision.
Peripheral viewing difficulties and color oversaturation may impair visualization.
Physical discomfort from head-mounted displays and operating room space constraints.
Financial and logistical burdens related to equipment acquisition and maintenance.

Patients undergoing macular or retinal detachment surgery

3D visualization systems have demonstrated equivalent clinical, anatomic, and visual acuity outcomes compared to conventional microscopy.

Ensure proper orientation and positioning of 3D display systems to optimize surgical team visualization.
Provide training and allow for a learning curve period when adopting 3D digital systems.
Consider surgeon and team ergonomics to reduce musculoskeletal strain during surgery.
Evaluate operating room logistics and anesthesia access when integrating new 3D equipment.
Leverage 3D surgical videos for enhanced education and potential telesurgery applications.