Described herein are apparatus and associated methods for the generation of at least one user adjustable, accurate, real-time, virtual surgical reference indicium. A method includes recording an image of an eye and producing a real-time multidimensional visualization using the recorded image. The method also includes determining at least one distinct visible feature within a patient specific pre-operative still image and producing the real-time, virtual surgical reference indicium in conjunction with the patient specific pre-operative still image. The method further includes aligning the real-time, virtual surgical reference indicium with the real-time, multidimensional visualization of the eye using the at least one distinct visible feature.
