Physics-Based iOCT Sonification for Real-time Interaction Awareness in Subretinal Injection
Abstract
Subretinal injection is a delicate vitreoretinal procedure requiring precise needle placement within the subretinal space while avoiding perforation of the retinal pigment epithelium (RPE), a layer directly beneath the target with extremely limited regenerative capacity. To enhance depth perception during cannula advancement, intraoperative optical coherence tomography (iOCT) offers high-resolution cross-sectional visualization of needle-tissue interaction; however, interpreting these images requires sustained visual attention alongside the en face microscope view, thereby increasing cognitive load during critical phases and placing additional demands on the surgeon's proprioceptive control. In this paper, we propose a structured, real-time sonification framework designed for extensible mapping of iOCT-derived anatomical features into perceptual auditory feedback. The method employs a physics-inspired acoustic model driven by segmented retinal layers from a stream of iOCT B-scans, with needle motion and injection-induced retinal layer displacements serving as excitation inputs to the sound model, enabling perception of tool position and retinal deformation. In a controlled user study (n=34), the proposed sonification achieved high retinal layer identification accuracy and robust detection of retinal deformation-related events, significantly outperforming a state-of-the-art baseline in overall event identification (83.4% vs. 60.6%, p < 0.001), with gains driven primarily by enhanced detection of injection-induced retinal deformation. Evaluation by experts (n=4) confirmed the clinical relevance and potential intraoperative applicability of the method. These results establish structured iOCT sonification as a viable complementary modality for real-time surgical guidance in subretinal injection.
The following analysis is generated by AI and may contain errors. It is separate from the authors’ abstract and is not peer review.
Research summary
This paper presents a novel real-time sonification framework for enhancing surgical guidance during subretinal injections, demonstrating significant improvements in event identification accuracy through innovative auditory feedback mechanisms. The methodology and experimental results indicate a strong potential for clinical impact, although further validation in diverse surgical contexts is necessary for widespread adoption.
Methodology
The proposed methodology introduces a structured sonification framework that effectively maps iOCT-derived anatomical features into auditory feedback, leveraging a physics-inspired acoustic model. The approach is well-defined, utilizing real-time updates based on segmented retinal layers and employing a mass-spring-damper system to reflect dynamic interactions during subretinal injections. The integration of both tool-driven and anatomy-driven excitations is innovative, enhancing the auditory feedback's relevance to surgical contexts. However, the reliance on a specific anatomical model may limit generalizability across different surgical scenarios.
Results & evaluation
The user study involving 34 participants provides robust evidence of the proposed method's effectiveness, demonstrating significant improvements in event identification accuracy compared to a baseline. The statistical significance of the results (p < 0.001) strengthens the claims of enhanced performance. The qualitative evaluations and feedback from expert surgeons further validate the clinical applicability of the framework. However, additional details on participant demographics and the specific experimental setup would enhance the evaluation's transparency.
Reproducibility
The paper provides a GitHub repository link for the code, which is a positive step towards reproducibility. However, the implementation details could be more thoroughly documented to facilitate easier replication by other researchers. The reliance on specific software libraries (e.g., miPhysics) should also be clearly stated to avoid potential compatibility issues.
Limitations
The study's limitations include a small sample size for expert feedback and the potential for bias in participant selection. The framework's performance in diverse surgical scenarios beyond subretinal injection remains untested. Additionally, the auditory feedback's effectiveness may vary based on individual surgeon preferences and experiences, which could affect its adoption in clinical practice.
Broader impact
The proposed sonification framework has the potential to significantly enhance surgical precision and reduce cognitive load during delicate procedures like subretinal injections. By providing real-time auditory feedback, it could improve patient outcomes and streamline surgical workflows. The approach may also inspire further research into auditory feedback systems in other medical domains, potentially leading to broader applications in minimally invasive surgeries. This paper presents a novel real-time sonification framework for enhancing surgical guidance during subretinal injections, demonstrating significant improvements in event identification accuracy through innovative auditory feedback mechanisms. The methodology and experimental results indicate a strong potential for clinical impact, although further validation in diverse surgical contexts is necessary for widespread adoption.
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