In the Philippines, where advanced surgical technology is still unevenly distributed, a quiet revolution is unfolding in eye care: the arrival of orbital neuronavigation. This high precision, image-guided system is beginning to transform how eye surgeons diagnose, plan and operate on complex problems behind and around the eye. Even though only a handful of hospitals in the country currently have such equipment, the promise of orbital neuronavigation for improving the quality of eye surgery, repair and treatment is already becoming clear.
High-tech eye care
Orbital neuronavigation combines preoperative CT or MRI scans of the eye socket (orbit) with a realtime computer system that “tracks” the surgeon’s instruments inside the orbit. As the surgeon operates, the navigation platform shows exactly where instruments are in relation to bones, nerves, muscles and tumors, in threedimensional space.
This is especially valuable for retroorbital masses, fractures, tumors and other pathologies where one millimeter can mean the difference between preserving vision and causing permanent damage.
For patients who have suffered eye damage from accidents, tumors or congenital conditions, this technology can mean the difference between merely “saving the eye” and restoring good, functional vision with minimal disfigurement.
In a setting where only a few hospitals have this technology, orbital neuronavigation offers a powerful way to standardize and elevate surgical quality. Also, patients no longer need to travel abroad or put up with high-risk procedures performed without advanced imaging support.
Boosting expertise, specialization
Orbital neuronavigation does more than improve single operations — it also raises the skill level of eye surgeons themselves. When ophthalmologists and eye specialists regularly use navigation systems, they develop a sharper, threedimensional understanding of orbital anatomy.
Last 10 April, Tzu Chi Medical Foundation Philippines president and Cardinal Santos Medical Center chief medical officer Dr. Antonio Say, retina specialist and CSMC Department of Ophthalmology chairman Dr. Carlo Nasol, and orbit specialist Dr. Alex Sua spearheaded the Philippine Orbital Neuronavigation training program held at the Philippine Center for Advanced Surgery in CSMC. Over 30 ophthalmologists from various local hospitals, including the Philippine General Hospital, East Avenue Medical Center, CSMC, Makati Medical Center and Rizal Medical Center participated.
Ophthalmologists, neurosurgeons and ENT surgeons presented different approaches to orbital operations using image-guided surgical navigation and provided participants a hands-on experience in using the ISN on body donors through CSMC’s Silent Mentor Program.
Sua, who served as the workshop’s course director, said that with spaces as narrow as half of a millimeter to one, the orbit, or eye socket, is one of the most challenging areas to operate on. Using ISN, however, surgeons can create a digital map of the patient’s eye and identify the precise location of a tumor, or a minimally invasive route to perform a surgical procedure. The 3D imaging also allows tracking of surgical instruments relative to the patient’s anatomy with precise accuracy. This enables surgeons to remove tumors or perform operations without harming other important eye structures.
For charity use
In the Philippines, image-guided surgery is more commonly used for brain and spine cases. However, Sua had enough experience utilizing it for orbital operations from his training in America. Hence, when he discovered that CSMC has this equipment, he pushed to use it for orbital surgeries, even charity ones.
In 2024, Sua used the technology to save one eye of Maritess Caleon at the CSMC, with Tzu Chi Eye Center covering the expenses. The vegetable vendor, whose right eyeball ruptured due to prolonged elevated pressure in the orbit but can’t afford the very expensive surgery, thanked the doctors and the Foundation. Upon recovery, she was fitted with an artificial eye, which helped restore her self-confidence.
With attendees spanning all generations, the said workshop showcased the progress of orbit and oculoplasty in the country over the years.
Say announced that CSMC is willing to lend their facility and the technical support of its staff to the participants moving forward.
“All of you are welcome to do your surgeries here, because we are all Filipino ophthalmologists. Allow us to work together with you for the better outcome of our patient-care,” he said.
As more eye surgeons in the Philippines gain experience with orbital neuronavigation, the overall competency and confidence of the country’s eyecare workforce will grow, creating a ripple effect that benefits patients and the country’s eyecare sector is moving toward globally competitive, technology-driven eye surgery.