Why I Choose ZEISS ARTEVO 800: A Surgeon's Perspective on Enhanced Visualization and Workflow

I've always considered myself an early adopter when it comes to digital-assisted ophthalmic surgery. In the summer of 2020, I made the switch to the ZEISS ARTEVO 800 digital visualization microscope. What drew me in was the promise of a fully integrated system – the microscope and the digital platform developed by the same company, ZEISS, known for its optical excellence. Since adopting ZEISS ARTEVO 800, I haven't looked back: I've used ZEISS ARTEVO 800 exclusively for each of my cases since then, totaling well over 1500 procedures. Working in an academic center, I've also seen firsthand the benefits it brings to training the next generation of surgeons.

ZEISS ARTEVO 800 has become indispensable in my OR for several key reasons, primarily revolving around its flexibility, seamless iOCT integration, and distinct advantages in surgical training.

One of the standout features of ZEISS ARTEVO 800 is its inherent flexibility, particularly regarding the oculars. Surgeons have the option to keep the oculars attached to the microscope. While I personally prefer to remove them and operate fully "heads-up,” this option is fantastic for several reasons:

• Transitioning Surgeons: For colleagues who are new to heads-up surgery or only comfortable using it for certain cases, the oculars serve as familiar territory, allowing a smoother transition. They can switch between the heads-up display and the ocular view as needed. 
• Collaborative Cases: If you're performing a combined case with a surgeon who prefers traditional oculars, they can operate comfortably without disruption. 
• OR Workflow: In a busy OR with multiple surgeons using the same microscope throughout the day, keeping the oculars on means no downtime switching visualization equipment between a heads-up user and a non–heads-up user.

This flexibility doesn't compromise the core benefits of the heads-up display, but rather enhances the system's utility across different scenarios and user preferences.

Intraoperative OCT (iOCT) has evolved from a research interest to a valuable clinical tool, and ZEISS ARTEVO 800 makes accessing it incredibly straightforward. The fact that the microscope and the digital visualization system are designed together by ZEISS provides a seamless experience. Unlike with add-on systems, everything about this ZEISS-centric setup feels cohesive, which contributes to its overall performance and ease of use.

• Elegant Integration: The iOCT is beautifully integrated into ZEISS ARTEVO 800. Instead of needing to look away from the surgical field into the oculars or at a separate monitor, the iOCT image is displayed directly on the main heads-up screen, simultaneous to your surgical view.
• Foot Pedal Control: Full control of the iOCT – activating it, changing scan types, and adjusting focus – is managed via the foot pedal. This means you can acquire the images you need without interrupting your surgical flow or requiring extra assistance.
• Increased Usage and Confidence: The ease of use has significantly increased how often I utilize iOCT. Previously, the effort involved might have deterred me from using it in more routine cases or for confirmation of what heads-up visualization depicted. Now that the friction is gone, I seamlessly incorporate iOCT not only in complex cases requiring critical surgical decisions (such as delineating tricky tissue planes in NF2-related ERMs), but also in more standard procedures, simply because it's so accessible. This constant use helps us learn more about subtle intraoperative findings and refine our techniques. It empowers us to better visualize tissues we might otherwise miss, ultimately boosting surgical confidence.

As someone heavily involved in training fellows, ZEISS ARTEVO 800 has proven to be an invaluable teaching tool.

• Enhanced Visualization: The view quality on ZEISS ARTEVO 800 is exceptional. Fellows consistently tell me they feel more comfortable, especially during challenging cases like macular surgery, because they can simply see better compared to traditional oculars. Better visualization makes everyone a better surgeon.
• Shared Perspective: Everyone in the room wearing 3D glasses sees the exact same high-definition view that the primary surgeon sees. This eliminates the variability and potential inferiority of views through observer scopes (Figure).
• Improved Guidance: Because I know my trainee is seeing precisely what I'm seeing, I can guide them much more effectively. I can use pointers and verbal cues with the confidence that we share the same visual reference point. This allows me to teach not just maneuvers, but the critical skill of visualization itself – how to look and what to look for. 

Helping fellows overcome the visualization hurdle, which is often the hardest part of learning VR surgery, is incredibly rewarding.

^{The statements of the author reflect only his personal opinions and do not necessarily reflect the opinions of any institution with whom he is affiliated.
The author has a contractual or other financial relationship with Carl Zeiss Meditec, Inc. and has received financial support.}