title: MINIMAL ENDOILLUMINATION LEVELS AND DISPLAY LUMINOUS EMITTANCE DURING THREE-DIMENSIONAL HEADS-UP VITREORETINAL SURGERY.
abstract: OBJECTIVE
  To determine minimal endoillumination levels required to perform 3-dimensional heads-up vitreoretinal surgery and to correlate endoillumination levels used for measurements of heads-up display (HUD) luminous emittance.
  
  
  METHODS
  Prospective, observational surgical case series of 10 patients undergoing vitreoretinal surgery. Endoillumination levels were set to 40% of maximum output and were decreased at set intervals until the illumination level was 0%. Corresponding luminous emittance (lux) of the HUD was measured 40 cm from the display using a luxmeter (Dr. Meter, Model #LX1010BS).
  
  
  RESULTS
  In 9 of 10 cases, the surgeon felt that they could operate comfortably at an endoillumination level of 10% of maximum output with corresponding HUD emittance of 14.3 ± 9.5 lux. In the remaining case, the surgeon felt comfortable at a 3% endoillumination level with corresponding HUD emittance of 15 lux. Below this threshold, subjective image dimness and digital noise limited visibility. Endoillumination levels were correlated with luminous emittance from the 3-dimensional HUD (P < 0.01). The average coefficient of variation of HUD luminance was 0.546. There were no intraoperative complications.
  
  
  CONCLUSIONS
  With real-time digital processing and automated brightness control, 3-dimensional HUD platforms may allow for reduced intraoperative endoillumination levels and a theoretically reduced risk of retinal phototoxicity during vitreoretinal surgery.
authors.affiliation: *Mid Atlantic Retina / The Retina Service of Wills Eye Hospital at Thomas Jefferson University, Philadelphia, Pennsylvania; and †Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: Murtaza K
authors.initials: MK
authors.lastname: Adam
authors.forename: Sarah
authors.initials: S
authors.lastname: Thornton
authors.forename: Carl D
authors.initials: CD
authors.lastname: Regillo
authors.forename: Carl
authors.initials: C
authors.lastname: Park
authors.forename: Allen C
authors.initials: AC
authors.lastname: Ho
authors.forename: Jason
authors.initials: J
authors.lastname: Hsu
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D021621:Imaging, Three-Dimensional; D008029:Lighting / Q000379:methods*; D011446:Prospective Studies; D012164:Retinal Diseases / Q000601:surgery*; D057586:Vitreoretinal Surgery / Q000379:methods*