Proveo 8: Advantages in Retina

For posterior segment surgery, Leica’s new microscope platform represents a major step forward.

By Seenu M. Hariprasad, MD

As a retina surgeon, I rely on my ophthalmic microscope for high-resolution visualization during surgery. I am excited about Leica’s newest scope, the Proveo 8, which offers the latest visualization technologies while incorporating a host of features in a sleek, modern design. A range of next-generation features may well make the Proveo 8 an essential scope for posterior segment surgeons.

Expandable, versatile, long-term utility: Eleven years ago, my hospital purchased a scope for retina surgery that could not be upgraded. In contrast, the Proveo 8 can be expanded and upgraded through time. Furthermore, it has all the latest technologies and can be used by both anterior and posterior segment surgeons.

The versatility for different ophthalmic surgeons is an enormous advantage because it doubles the potential use and return on a very large investment, while potentially eliminating the need for two microscopes, depending on the setting and volume. Hospitals are happy to get something that all doctors can use.

The ability to expand the scope is essentially the ability to extend its life. A facility makes a major investment in a microscope, and when a new technology comes along in a few years, a new component can be added to the scope. If the scope is not expandable and cannot accept the new component, then the facility has to replace the scope at a much greater expense. With rapidly evolving medical technologies, we do not know what will come along — even in the near future — so it makes sense to have the ability to expand.

One example is integrated OCT, an exciting new development from a retina perspective that is in its infancy today. The Proveo 8 is built to accept an integrated OCT component. Other additions for the Proveo 8 — such as sophisticated recording devices, Toric Alignment Navigation, and 3D Viewing — are available now or will be soon.

Increased depth of field in high resolution: The Proveo microscope uses Leica’s patented FusionOptics to provide one optical pathway with high resolution and a second pathway with increased depth of field. The brain merges the two pathways into a single, clear, three-dimensional image with 40% greater depth than Leica’s previous ophthalmic microscopes, as well as sharp, high resolution views that allow surgeons to see fine clinical detail, such as the ERM. Retinal surgeons can see the retinal floor, detachment, and tip of the surgical instrument in focus, as can the assistant.

Depth of field is vitally important for retina surgeons, which makes this advance especially valuable. When a retina is detached, the surgeon can see the top and the bottom. Working in the middle of the vitreous cavity, surgeons can also see the floor of the retina. Rather than continually readjusting the focus to see one thing at a time, surgeons can see a depth of 5 mm to 10 mm in the eye at once, which means they can often perform an entire surgery with little or no refocusing.

The FusionOptics of the Proveo 8 microscope deliver a better view of texture than Leica’s previous scopes, as well. Combined with the improved depth of field and lighting, the overall visualization presents an enormous improvement for the surgeon.

Automated electronic inverters: Retina surgeons are accustomed to inverting an image by putting in the binocular indirect microscope (BIOM), and then finding and pressing the BIOM pedal. With the Proveo 8, when the surgeon slips in the BIOM, the system realizes it is there and automatically inverts the image, saving a step. Furthermore, surgeons have one less foot pedal because they control the Oculus BIOM through the foot pedal of the surgical microscope. The inversion is visible to both the surgeon and the assistant, and the system automatically returns to the original view when the BIOM is removed.

Integrated full HD camera: In retina, we work under very low light levels, so only a handful of cameras can capture retina surgery well. The Proveo 8 microscope comes with the option of a fully integrated 1080p HD camera that provides excellent retinal and anterior video. The camera is very sleek and modern, making it a substantial upgrade from the bulk and exposed wires of older cameras. Surgeons also have the option of using an integrated video adapter for a c-mount attachment of external cameras.

The system’s removable laser filter protects the video camera from laser scatter, enhancing the quality of the video and ensuring that there is no disturbing flash of laser light. For all of us who have presented and watched many videos with this detrimental green flash, this is an exciting improvement.

Shorter stack height, excellent ergonomics: As a retina specialist, a problem I see with most microscopes is the stack height, which puts too much distance between the patient’s eye and the oculars when we add the laser filter, BIOM, and other components. The integrated components of the Proveo 8 mean fewer additions to the stack, which make the stack shorter and setup easier. The system was designed with ergonomics in mind as well. Leica increased the reach by 21%, while decreasing the footprint 33% compared with the previous model. The sleek design makes the Proveo 8 comfortable for both the surgeon and the assistant, and less cumbersome for everyone in the room.

Enhanced teaching environment: In a teaching institution like mine, often a fellow is doing surgery while I sit at his/her side. For 11 years, I have done this with a system that gave us different lighting and magnification. In contrast, the Proveo 8 displays full stereo views for surgeon and assistant, 100% lighting, and the same magnification. This promises to be an enormous support in the teaching and learning process. Observers and nurses can see the same view on the Proveo 8 video screen. In addition, the assistant arm can rotate to either side of the optics head without removal of any optical components, and the assistant has independent fine focus capability. For retina specialists working in a teaching setting, these features of the Proveo 8 represent a major step forward. •

Seenu M. Hariprasad, MD, is Chief of the Vitreoretinal Service, Director of Clinical Research and Shui-Chin Lee Professor of Ophthalmology and Visual Science at University of Chicago.