**11. Further research**

porous polyethylene dental biomaterial composites and graphene among others, are imple‐ mented as materials for the heart, eye and other organs implants due to their characteristics in improving biological compatibility to be more resistant, to reduce allergies, and improve durability. The future development of the ocular prostheses is focused on the impression of digital measurements, 3D modeling software, and the digital impression of the iris [21].

Many implants are being studied around the world. Some patents and other humans have been implanted to help in visual rehabilitation. Some of these examples are divided into two categories according to design or operations principles, some use an external camera and image processing drive implanted electrodes. Another example is the use of 1500 small units in microphotodiode arrays (MPA by Retina Implant AG) and Stanford retinal prosthesis. Some required external energy to drive the stimulators, while others are wireless. The Stanford array projects a high intensity infrared image on the implanted photocells and generates a sufficient current to excite the secondary neurons. In addition, the classification must be made according to the implant site e.g., in the inner retinal (epiretinal) or outer (subretinal) retinal surface; if the implant is inserted below the choroid plexus (suprachoroidal) or if the implantation take

Before the production of visual implants, many studies should be performed to verify the noise pattern, the extraction processing of the temporal space, monitoring to check the quality of the image, the spatial resolution, the circuit architecture, and advanced intelligent functions.

The future smart 3D image sensor architectures will most probably consist of a sensor layer at the top and various processing layers below. Each layer will be organized into locally con‐ nected cellular arrays with additional global communication/operation mechanisms. Layers will be vertically interconnected using bi-directional parallel channels implemented by through-silicon-vias (TSVs). Images at different scales and abstract information about salient points and features will be transmitted top-down across the stack, while commands will be

The OCT has revolutionized the clinical management of ophthalmic diseases and promises to be of great help in the surgical rooms. The Prospective Intraoperative and Perioperative Ophthalmic Imaging with Optical Coherence Tomography (PIONEER), a single site multisurgeon prospective is incorporating the OCT to the surgical room because of feasibility, safety, and utility. This study is performed by the Cleveland Clinic. The variables including past ocular history, procedure type, preoperative diagnosis, techniques, and number of imaging sessions are recorded one day before surgery. The structured study follow-up is done after the

The protocol managing for them is next. Disease-specific or procedure-specific imaging protocols (eg. scan type, pattern, density, size, orientation) were outlined for anterior and

, 12mm volu‐

posterior segment applications. Anterior segment imaging included a 12mm3

place outside the sclera (episcleral) [22, 23, 24].

transmitted bottom-up to support adaptation.

surgery [25].

14 Advances in Eye Surgery

**10. Optical Coherence Tomography (OCT) in surgery**

Future research of new innovations in visual implants improves existing research for best results. The early implementation of refractive surgery and cataract surgery is recalled, however, it is important that the increase of that research is conducted in global scientific communities where you can monitor patients and have access to people with visual impair‐ ment that requires the surgery. High costs should be borne by health systems, according to the laws of each country, so that they can be taken advantage by the patients who need them. Some of the challenges that are presented in eye health are the cost of the technology transfer, more high-level training in surgical procedures, and the establishment of protocols according to the clinical findings. Just as eye surgery has been the pioneer in the world among many techno‐ logical advancements, it becomes a possible reality in the near future to restore vision for visual rehabilitation and to provide a better quality of life for visually impaired patients.

Likewise, due to the interaction of the new sciences, ophthalmologists around the world should have comprehensive training from his clinical practice in various branches of medicine, biomedical engineering and electronics, and nanotechnology. Team groups with different point of views must be formed to answer the needs of patients, such as applying science to the clinic, establishing protocols to prevent errors, and improve processes in eye surgery and thus, optimizing costs, human resources and effectiveness for patients. All these innovations must be reimbursed by health insurance systems around the world.

So that these advancements reach patients, there should be access to global insurance to cover the population that needs them. Germany and the United States are already doing this. However, in underdeveloped countries, this possibility does not even exist and is yet to be built.

The truth is that in the near future, these new surgeries may have results that help reduce blindness, improve the coverage and quality of life for patients with myopia, astigmatism, presbyopia, cataracts, and retinitis pigmentosa among others. The inclusion of contact lenses has always been considered as one of the most important innovations for mankind. But this technology is linked to new projects and has developed new biopolymers. The challenge for innovators and surgeons in the next decades is the immersion with electronic chips. The accuracy of current studies is required and must be taken advantage by the academic com‐ munity for the scientific needs and reading of the general population.

Another important area in future work on education to transfer this technology and provide updates with experts and developers for the patients' safety, must be worked in partnership with the different industries and academia.
