Purpose

Thyroid Eye Disease (TED) often requires orbital decompression surgery to address proptosis or optic nerve compression. Conventional navigation systems are rarely used in this context due to their size, cost, and the need for the surgeon to shift their gaze. Head-Mounted Display Augmented Reality (HMD-AR) systems offer three-dimensional visualization directly within the surgical field, potentially enhancing spatial orientation.
This pilot study evaluated the workload, usability, and surgical accuracy of HMD-AR compared to conventional CT-based planning for decompression surgery using phantom skulls.

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Methods

One experienced orbital surgeon and two inexperienced medical students each performed two AR-guided and two CT-guided three-wall orbital decompressions (N = 12 procedures). Surgical accuracy was quantified using the Jaccard Index (JI), which measured the overlap between planned and executed decompression surfaces. Workload was assessed using the NASA-TLX questionnaire and usability via the USE questionnaire.

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Results

Participants reported a lower overall workload using the AR method compared to the conventional approach. After correcting for technical failures, procedural time decreased by 37% with AR. Regarding accuracy, there was no statistically significant difference between AR (35.2%) and CT guidance (37.5%). However, usability scores improved over time, and the experienced surgeon demonstrated a marked learning effect within the AR condition, improving accuracy from 16.3% to 51.4%.

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Conclusion

Implementing HMD-AR may lead to reduced workload and shorter operative times. While initial accuracy is comparable to standard methods, the observed learning effect suggests that AR may enhance procedural precision and spatial orientation once familiarity is achieved. These findings support further research into AR as a navigational tool in orbital surgery.

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Additional Authors

First name	Last name	Base Hospital / Institution
Dion	Paridaens	The Rotterdam Eye Hospital
Gijsbert	Hötte	The Rotterdam Eye Hospital
Ronald	de Keizer	The Rotterdam Eye Hospital

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