Sorkin et al. reported their preliminary experience of using a three-dimensional head-mounted display (Beyeonics Vision, Israel) in cataract surgery [1]. The authors conducted a well-designed interventional case series on 60 consecutive patients who underwent cataract surgery with the head-mounted display platform in Tel Aviv, Israel and found the system can easily be used in routine cataract surgery, with benefits in image control, picture quality and ergonomics. Improved ergonomics during ophthalmic surgery is essential, as over 50% of ophthalmologists in numerous studies around the world report having neck and back pain [2].

This novel head-mounted display visualization during cataract surgery represents a large potential advancement in ophthalmic technology. Merging this technology for surgery visualization with rapidly emerging techniques in extended reality (XR) may be the next frontier in advancing surgical proficiency with head-mounted visualization. While currently not included, eye tracking technology has been introduced into XR technology and can be integrated into this cataract surgery technology to provide useful metadata for surgeons, as well as be useful for ophthalmic surgical trainees by showing the exact gaze location of the surgeon. Gaze tracking can provide unique insights into the decision-making process of surgeons and may even become a future area of study. Foveated rendering is another emerging XR technology can also be integrated into the head-mounted display framework. This technique allows for concentrated resolution at the fovea to optimize GPU delivery. Utilization of this technique can provide extremely high-resolution images at the location of the surgeon’s gaze while optimizing performance of the hardware during surgery to prevent any small lags, an important consideration in the operating room and performing microsurgeries with millimeter precision.

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