Cirle: A Digital Tool for Surgical Navigation and Guidance

Game-changing developments in the field of cataract surgery are rapidly taking place. New technologies have focused on using digital tools to integrate the preoperative planning phases of cataract surgery into the intraoperative setting, specifically for assisting in the positioning of toric and multifocal IOLs. Cirle, a medical technology incubator based in Miami, has been building capabilities and expertise in surgical navigation to deliver advanced solutions for cataract surgeons.

At the 2014 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting in Boston, Cirle announced a licensing agreement with Bausch + Lomb for its Surgical Navigation System (SNS; Figure 1). The Cirle SNS is an integrated surgical guidance tool designed to provide cataract surgeons with three-dimensional (3D) imaging in their microscopes. This technology can be used to help guide them through the stages of cataract surgery—from incision placement to IOL selection and placement to confirmation of IOL placement at the correct anatomic position.

COMPONENTS FOR DIGITAL SURGERY

The Cirle SNS has the potential to incorporate several unprecedented and cutting-edge features in digital surgery, such as the display of 3D marks on anatomic features, eye-tracking technology, and seamless integration of operating room components. The Cirle SNS’ components include the Surgical Navigation Guidance Console and the Microscope Interface Module.

The interface of the Surgical Navigation Guidance Console intelligently guides surgical planning, allowing the surgeon to view patient data within the microscope’s oculars. It also creates 3D images that highlight the anatomic layers that are most important to the execution of the steps of a procedure, a feature called holotagging. This feature generates displays at the level at which the surgery is being performed: corneal incisions at the corneal level, capsulotomy guides at the capsule level, lens alignment marks at the IOL level, and surgical equipment parameters at the limbal level.

The Microscope Interface Module component of the system contains a sophisticated optics system that is designed to capture 3D images of the eye through StereoCapture. This advanced technology displays the surgical plan that has been entered into the Surgical Navigation Guidance Console, along with information from the Stellaris PC (Bausch + Lomb), all through a 3D perspective within the microscope.

PLATFORM FOR FUTURE APPLICATIONS

The Cirle SNS is designed to work with a surgeon’s preferred microscope, IOLs, and techniques. The system is intended to be a platform for future applications, yet it has the versatility to integrate with existing operating room technologies. The SNS is undergoing production and commercialization, and expected outcomes include improved accuracy of toric IOL alignment, placement of corneal and arcuate incisions, and creation of the capsulorrhexis as well as overall improvements of the doctor’s surgical experience.

In addition to the SNS, Cirle is leveraging its resources to develop a robust pipeline of medical devices and products. I established this company in 2010 in order to focus on curing diseases that lead to blindness through the use of translational medical research and innovative technologies. We entered a relationship with Bascom Palmer in 2011 and have developed and acquired earlystage technologies, applied specialized capabilities to refine and test them, and continually pursued industry collaborations in order to bring these early-stage technologies to market rapidly.

Offering a highly interactive environment for interdisciplinary innovation, Cirle has engaged leading eye health experts, engineers, and researchers who are engaged in development projects.

Richard M. Awdeh, MD, is a professor, surgeon, and the Director of Technology Transfer at the Bascom Palmer Eye Institute in Miami. He is the founder and CEO of CheckedUp, a mobile health company, and the founder of Cirle, a medical technology incubator. Dr. Awdeh may be reached at e-mail: richard@checkedup.com.