Livestream Eye Surgery Enables Training In the Third World

Telemedicine workflows incorporating live video have taken on dramatically greater importance for surgical education during the COVID-19 pandemic, as doctors reduce non-essential personnel in their operating rooms for the safety of patients and staff. Needing a way to continue its mission of improving training for ophthalmology students in underserved geographic regions, non-profit organisation Advanced Center for Eyecare Global (ACE Global) is using the USB Capture HDMI 4K Plus external video capture device from Magewell as a crucial link in delivering live video of surgical procedures to medical residents and fellows around the globe.

ACE Global is a non-profit organization focused on training and empowering the next generation of ophthalmologists in the developing world. “The leading cause of blindness in the world is cataracts, but there are just not enough cataract surgeons that have enough training, particularly in low-income countries,” said Dr. Kevin Barber, president of ACE Global and certified ophthalmologist. “Our major goal is working towards blindness prevention by training more surgeons, better surgeons, and more efficient surgeons.”

For years, ACE Global has been partnering with residency programs in countries such as Honduras, Haiti, and El Salvador, making three or four trips each year to teach surgical students in person. Dr. Barber’s team was packing their bags to leave for Honduras in March 2020 when the pandemic put the brakes on that journey. Needing a way to continue ACE Global’s work, Dr. Barber came across a medical journal article by Dr. S.K. Steven Houston III and Dr. John Miller — partners in eyecare-focused telemedicine solution developer HEALTheia — that outlined their efforts in piloting telesurgery workflows incorporating live streaming technology.

Many ophthalmology operating rooms utilise the NGENUITY 3D Visualization System from Alcon Inc. Designed to provide retinal surgeons with greater depth and detail during surgery than traditional microscopes, NGENUITY lets them operate in a heads-up manner while looking at a large 4K video screen rather than peering through the oculars of a microscope. Dr. Houston had researched solutions for live streaming the output of the NGENUITY platform, choosing Magewell’s USB Capture HDMI 4K Plus for its unique combination of cost-effectiveness, quality, ease of use and reliability.

“Our goal was to balance our technical requirements with the accessibility of an off-the-shelf solution at a reasonable cost,” said Dr. Houston. “We also wanted doctors to be able to implement this workflow themselves, so we needed to make it as simple as possible. “The Magewell capture device has given us a widely-available, plug-and-play option that we can recommend to our colleagues and is affordable to all comers.”

After a successful test run facilitated by Dr. Houston, Dr. Barber purchased his own USB Capture HDMI 4K Plus unit, and began broadcasting live surgeries to medical students in early May. “Since then, we have logged around 150 hours of live surgical training through the Magewell device,” Dr. Barber explained. “Remote surgeons can see exactly what I see, and we can have a live dialog while I am operating.”

The live HDMI output from the NGENUITY system goes into the USB Capture Plus device, which in turn sends the video over a standard USB connection into a computer running OBS (Open Broadcaster Software®) and Zoom®. OBS is used to combine video of the surgeon’s hands from a separate camera with the NGENUITY output, with Zoom delivering the combined result to remote participants with lower latency than available with typical streaming protocols and services.

Dr. Barber agrees with Dr. Houston’s assessment of the Magewell capture solution’s benefits and also applauds its visual fidelity, which is crucial given the precision required for surgical applications. “It’s so inexpensive and simple,” he said. “I am not a technical guy, but I can set it up in the operating room within five minutes and be streaming to a global audience. The image quality is also impeccable, with no degradation of the NGENUITY output.”

Earlier this year, in conjunction with blindness prevention non-profit Orbis International, ACE Global presented a global live surgical stream that was viewed by surgeons in 81 countries. ACE Global has also received a research grant from Alcon to install an NGENUITY system and Magewell unit in Honduras, with a goal of allowing surgical trainees there to stream live surgeries back to experts in the U.S. for mentoring and evaluation.

The Magewell-enabled workflow has proven valuable in enabling ACE Global to continue and expand its mission. “It has become a very powerful educational tool that we didn’t have before,” said Dr. Barber. “We have now streamed to medical students in Honduras, Dominican Republic, Peru, El Salvador, and Mexico, and can connect ORs anywhere in the world.”