As Ophthalmology Management celebrates 30 years of chronicling innovation within the specialty, OM board member Eric Rosenberg, DO, MScEng, reflects on how digital microscopy has evolved—from the first heads-up visualization systems to today’s data-rich, artificial intelligence-enabled platforms—and why it’s poised to transform the OR more over the next decade than it has over the past 50 years.
This transcript has been lightly edited for clarity.
My name is Eric Rosenberg. Thank you for giving me a couple of minutes to talk about one of my favorite things in this world: digital microscopy. I’m a complex anterior-segment surgeon based in Long Island, New York, an associate professor of ophthalmology at Westchester Medical Center, and a partner at SightMD. I’d like to take a few minutes to appreciate digital microscopy—something that’s been completely rewiring how we operate in the OR.
Ten years ago, if you walked into most ORs, you would have seen the same thing: analog oculars, surgeons hunched over with their feet fixed to pedals on the ground, and residents/fellows squinting through the assistant microscope, trying to follow along on a stereoscopic view that was never nearly as good as the surgeon’s.
Visualization was a solo sport. It was designed around the primary surgeon and lived in one person’s eyepiece. That started to change with TrueVision, the first 3D heads-up display system, invented in 2007. I remember watching those early Rob Weinstock, MD videos of the technology—it started with 2 projectors and a projection screen, with the projectors interestingly mounted behind the screen. Rob was a true pioneer in digital microscopy, and that was the moment heads-up visualization went from novelty to real clinical standard. Alcon later acquired the technology, now known as Ngenuity. Not long after, Zeiss launched its own 3D heads-up microscope.
Now it’s not just a 2-player game. In the last 2 years alone, we’ve seen more new entrants into this space than in the previous 8 years combined. Leica has the Proveo 8, Haag-Streit has the Metis 3D digital heads-up system, and Bausch + Lomb has SeeLuma—the market is validating the trend. But why? The answer lies in AI. As artificial intelligence-enabled ophthalmic imaging and visualization enter the field, we’re looking at a market projected to grow at a compound annual growth rate somewhere between 30% and 40% through the mid-2030s, and digital microscopy will be the key delivery mechanism for a lot of that value which it in of itself has a projected CAGR of nearly 20%.
When I first started in private practice, a partner of mine looked at the heads-up display and said, “Oh, this is a cool toy.” That comment stuck with me, because it’s not about a bigger screen—it’s about what you can layer onto that screen. As a fellow, I had the privilege of working with Kimberly Sippel, MD, who let me start using Ngenuity when almost no one else was. I didn’t see it as a 4K TV with better depth of focus and impressive magnification; I saw it as a missing piece of a much wider ecosystem—the future of our surgical field and our patients’ outcomes. I imagine Rob felt something similar when he broke the mold years earlier.
So why does this matter clinically now? Three reasons.
First, ergonomics. It’s the thing surgeons care least about—ourselves. But it matters enormously for longevity, for making sure we can sustain our careers over the long term.
Second, education. The heads-up display means the whole room—residents, fellows, scrub techs—sees exactly what the surgeon sees, in real time, in 3D. That collapses the learning curve in a way a teaching microscope never could.
Third, and this is where I think the real revolution lies: data. A digital feed is a data stream, and once you have a data stream, you can layer intelligence on top of it.
It is here that I’ve planted my flag, and I’ve been working persistently on a new exciting project: ScopeXR. We’re not trying to build another microscope company. We think the next phase of this evolution isn’t about who has the sharpest optics—we’ve gotten very good at that over the last hundred years. It’s about who can turn a live surgical feed into real-time guidance, structured data, and connected education. We’re doing that in partnership with people who are already redefining adjacent pieces of this ecosystem. Ophthalmology is full of brilliant people, and that’s what makes this so exciting. Partners like Ophthalmology Management, celebrating this 30-year milestone, only underscore how important this evolution in surgical education, surgical training, and data gathering has become.
Here’s how I’d frame where we are: the last decade was about getting surgeons off the eyepiece and onto 3D digital microscopes. The next decade is about what we do with the feed now that they’re off it. That means real-time AI overlays during phaco and vitrectomy, remote proctoring that doesn’t require anyone to get on a plane, and surgical data that actually teaches the next generation instead of being watched once or twice and forgotten.
Digital microscopy didn’t just change how we see the eye—it built the pipe. What flows through that pipe over the next 10 years is going to change ophthalmic surgery more than the last 50 years combined. It’s a genuinely exciting time to explore the digital systems entering the OR.
My advice to everyone out there: it’s good to learn to fly a Cessna 172 before jumping into a 737, and we’re going to see that same evolution play out in our ORs. So if you get the chance, reach out to these companies and see what their systems can do—because I guarantee the next generation of the OR is going to be a digitally connected one.
