Development of a High-Contrast Heads-Up Display for Intraoperative Ophthalmic Surgical Guidance

Abstract

Microscope-integrated intraoperative optical coherence tomography (iOCT) enables depth-resolved imaging of ocular structures and tissue-instrument interactions during ophthalmic surgery. Real-time visualization of iOCT data for surgeon feedback has been demonstrated with external monitors in the surgical suite and with heads-up displays (HUDs) optically coupled into the surgical microscope oculars. When iOCT is displayed on external monitors, stereoscopic surgical views are either completely lost or require the use of polarization glasses with limited viewing angles, which hinders surgical workflow. Current intraocular HUDs couple LED/OLED displays with a beamsplitter cube that inherently limits surgical field visualization because display contrast is limited by low panel brightness and display and surgical field brightness trade-offs. Therefore, overlays are generally constrained to dark or unused regions of the surgical field-of-view (FOV), which limits displays of important qualitative information onto the FOV. Here, we demonstrate a digital micromirror device (DMD) based HUD that overcomes the contrast limitations of existing intraocular HUDs. We demonstrate live OCT overlays in benchtop experiments of ophthalmic surgical maneuvers with a preliminary DMD-HUD design using stock optics. We also present a custom optical design for a DMD-HUD that overcomes the limitations of our preliminary design to enable clinical translation. Further development of this technology will enhance real-time iOCT visualization to improve surgical ergonomics and provide augmented reality guidance during ophthalmic surgery.