**3. Go green diagnosing and counseling stations**

Practicing ophthalmology in a sustainable way begins with a focus on prevention and wellness. Considering the environmental consequences may need more commitment but can be initiated through innovative ideas. There are many creative ways to effectively counsel patients by conserving energy; we have discussed two such innovative ways for ophthalmic patients' counseling and diagnostic procedures. They are three-dimensional (3D) augmented reality (AR) and four-dimensional (4D) holographic diagnosing and counseling platforms. During this fast-paced global era, face-to-face counseling with two-dimensional (2D) images has many challenges, and it is hard for the patients to comprehend their disease. At the same time, the impetus of 3D models in AR and 4D holograms will pay rich dividends (**Figure 6**). The use of such innovations helps reduce the need for conventional paper pamphlets and plastic eyeball models, which makes a significant reduction in the consumption of paper and plastic.

#### **3.1 3D augment reality**

AR has progressed from a science-fiction concept to a science-based reality [29–31]. It has slowly but surely become a significant aspect of modern life over the last decade with increasing applications in the field of medicine, especially in ophthalmology [32–34]. AR is a view of the real, physical world in which the elements are enhanced by computer-generated inputs and available on mobile handsets, which constitutes an essential patient e-counseling platform. During COVID-19, the impetus for AR in ophthalmology is stronger than ever. Recently, an AR program named "Eye MG AR" was innovated for diagnostic procedures and counseling patients by showing different anatomical and pathological structures related to the eye (Video 1, https://www.youtube.com/watch?v=LC7VMI56hLo). The patients' own pathological real-time TrueColor confocal images have been used in 3D, with multiple customized angles of the viewer's choice to simplify counseling procedures (**Figure 7**) [35, 36].

#### **Figure 6.**

*Image showing (a) two-dimensional (2D), (b) three-dimensional (3D), and (c) four-dimensional (4D) TrueColor confocal fundus images used for patient diagnosis and counseling.*

**Figure 7.** *Image showing the "Eye MG AR" app being used for e-counseling.*

For immersive visual experiences, simple structures such as the eyeball and its parts and complex systems essential to the eye (cerebral and dural venous sinuses) were also constructed using advanced real-time 3D photo-real visuals. This app, built on an innovative interactive 3D touch interface, has a significant influence on improving ophthalmic diagnostic procedures, especially in patient counseling.

#### **3.2 4D extended reality holograms**

Extended reality (XR) is one of the leading futuristic concepts, which is still slowly evolving to set foot into the field of ophthalmology [37, 38]. What makes this device cutting-edge is the spatial recognition, eye-tracking, and hand-tracking concepts. Spatial recognition senses the world around the user, and eye-tracking recognizes where the user is seeing [39–41]. It also projects the holograms into the eyes of the user as light rays. The hand-tracking concept helps the user to touch, move, rotate, and scale the holograms. Using extended reality technology, especially in ophthalmic diagnostics procedures and counseling, will revolutionize the face of counseling on

**Figure 8.**

*(a & b) Image showing doctor counseling a diabetic patient with the help of 4D hologram of TrueColor confocal fundus image and optical coherence tomography (OCT) image by using Hololens 2 before and after treatment, respectively.*

a whole new level. We have used this novel technology and have created holographic counseling platforms for various anatomical structures such as the eyeball, cerebral venous system, cerebral arterial system, cranial nerves and multiple parts of the brain in fine detail and diseases related to the eye (Video 2, https://www.youtube.com/ watch?v=XkHYTzYRHYU). Suppose the patients can see the 4D holographic models related to ophthalmology right in front of their eyes; it can change the way of counseling to a whole new level (**Figure 8**). Ophthalmic institutes and practitioners can invest in this cutting-edge technology to provide their neophyte ophthalmic residents and allied ophthalmic personnel with a real-time understanding of the concepts involved in patient care and diagnosis.
