Improved Visualization of the Anterior Chamber Angle with Proveo 8

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In this interview, Michael G. Richie, MD offers his expert opinion on the Proveo 8 from Leica Microsystems as a means for outstanding visualization of the anterior chamber during MIGS. He describes how he has increased workflow efficiency, enhanced his techniques, and improved his surgical experiences while utilizing the Proveo 8.

Dr. Richie is an Ophthalmologist and Cataract Specialist based in Faribault, MN. The opinions expressed in this video are those of the physician and do not necessarily reflect any institution with which they are associated.

Transcription of the interview

Dr. Michael Richie (00:13):

Hi. My name is Dr. Michael Richie, Richie Eye Clinic and LASIK Center. So I'm a general ophthalmologist in Southern Minnesota. I always try to stay on the cutting edge. And so I evolved very quickly. I got very interested in MIGS procedures, minimally invasive glaucoma surgery, for some of my glaucoma patients. And as I started to dabble in MIGS, I realized the angle, the anterior chamber angle, is a very difficult area to visualize with the usual microscope technology that I'd been accustomed to.

Dr. Michael Richie (00:49):

And so at some point, I started to realize if I'm going to do this, I need to upgrade my equipment. It's got auto tilt. So when I want to do my angle procedures and I adjust the microscope, I hit a button. The microscope will adjust. While it's tilting, I can make other adjustments in the microscope, and it makes the whole positioning, change of position, patient positioning process so much easier.

Dr. Michael Richie (01:26):

As part of that, there are multiple options for the oculars, the eyepieces, that you can have the conventional eyepieces. I'm a big fan of the ultra low eyepieces, because I have a relatively short torso. And so it allows me to get the scope up where it belongs. I don't have to have my chair up so high, and it just works out better.

Dr. Michael Richie (01:50):

In addition, when I tilt the scope, the ultra low oculars move up to make my positioning that much easier. This has made a huge difference in my ability to visualize the anterior chamber angle. And that has made MIGS procedures so much more enjoyable and reproducible and effective.

Dr. Michael Richie (02:19):

The Proveo has a tremendous Red Reflex. The Red Reflex gives me such a good perspective on the cataract. It's made making my capsulotomy much more reproducible and effective, but it's also made me far better at cortical cleanup. So I removed the cataract and I start cleaning up the cortex. And with the Red Reflex as large and well described as it is, it allows me to see where I've got residual cortex that I need to clean or polish.

Dr. Michael Richie (03:02):

Now, in addition to that, the illumination is phenomenal. And I have always been a surgeon that operates with relatively low illumination, because I try to keep the patient as comfortable as I can. I get a tremendously improved view with low illumination. The low level of light, but the clarity of this scope is phenomenal. Whereas with my old scope, I had to turn the light up brighter, and that's a lot harder for patients.

Dr. Michael Richie (03:30):

In addition, the fusion optics feature of this microscope provides tremendous resolution and high depth of field in a single large field of view. So what that really translates in for me as a surgeon is I don't have to adjust my scope nearly as much in order to keep the eye focused to do what I need to do. I don't have to adjust forward, back, the XY, or up and down on the Z axis, because I can stay with the microscope in one spot. I can just have a tremendous field of view.

Dr. Michael Richie (04:10):

What I didn't realize, as that car junkie looking at a Tesla, is that this is an affordable microscope, and that made all the difference in the world for me. I was able to buy a piece of equipment that I really wanted, that can do all of the things that I hoped it could do, and that didn't break the bank. It has been one of the best investments that I've ever made. It's made our operating room so much more efficient. It's easy for the techs to set up and take down when we're done. It's made my surgical procedures smoother. And overall, I think this makes me a far better surgeon.

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