Eyeworld Supplements

innovations advancing cataract surgery Robert Cionni, MD Integrating technologies from the clinic and OR for cataract surgery Robert Cionni, MD the wrong implant going into a pa- tient's eye. Another chance for error is when information is printed out but put in the wrong chart or doesn't end up in the chart. Alcon's answer to that is the VERION Image Guided System. VERION digitally captures the data from your biometry and populates a surgical planning program, elimi- nating the need for transcribing the data. VERION, which dovetails with the ORA SYSTEM Technology, links to the operating room, provid- ing the correct numbers and the cor- rect implant for the correct patient without the need for a printout. In addition to decreasing opportu- nities for mistakes, the VERION plan helps me improve my clinic efficiency. Not long ago, I had a case where I didn't have this technology avail- able so we were working off a paper chart and plan. The calculation in this chart ended up being another patient's calculation, resulting in the wrong implant going in. Had we been using the VERION technolo- gy, that would not have happened. In another case, a patient presented with differing K measurements due to a significant head tilt. This was an extreme example of a real issue that happens every day as small degrees of misalignment result from ocular rotational uncertainty. How do we know that the measured steep axis in the clinic will be properly identified in the OR? VERION manages this by capturing a reference image along with the keratometry. That reference image is digitally sent to the LENSX Laser and LuxOR microscope, where the image is matched to what is seen by the laser and microscope, thus the true steep axis is properly identified. The final step in all this is the outcome. With the ORA SYSTEM with VerifEye Lynk technology that incorporates aberrometry with VERION, when the patient is seen postop, the postoperative result is entered into the ANALYZOR da- tabase. That information is used by Alcon to continually refine the IOL calculation formulas and stratify the data to specific case types such as post-refractive surgery, short eyes or long eyes. The more data that gets into the database, the better the cal- culations become and thus the better the predictability. Microscopes present another opportunity for technology inte- gration. The LuxOR has an over- lay display with information from VERION that is seen through the oculars. This can help make toric IOL alignment or placement of manual corneal arcuate incisions or LRIs very precise. There is also a capsulotomy overlay guide that can be set to a specific size and personal- ized centration. Through the integra- tion of the LuxOR microscope with VERION, the microscope now has a tremendous ability to track the eye, not only in the X and Y planes but also rotationally; this can help boost confidence that toric IOLs or arcu- ate incisions are lined up correctly. For toric IOLs, if one incorporates VerifEye Lynk technology, you will find your surgical efficiency and accuracy improves beyond what was possible with either of these technologies on their own. One can choose to follow the surgical plan or the intraoperative aberrometry-sug- gested toric magnitude and align- ment. Either way, the chosen axis of alignment is shown on the overlay and tracked, so it is easy to place the IOL in the desired axis accurately. If the surgeon chooses—and it's what I choose to do—you can run through all the modalities of phacoemulsification and your C linic, operative planning, and surgery: Most of us have come to an understanding that you can't separate the three, and one doesn't hap- pen without the other. In the past, each of these facets has been treated independently by companies that produce the products we need, but that's changing. A few years back Alcon came to the realization that you can't have one without the other and why not integrate the technologies to be more seamless and thereby more efficient, reducing the chance of errors. It started in the clinic; we need- ed a better way to get information into surgical planning platforms. Originally, when we had our pa- tients' preoperative plan and corneal keratometry measurements made, those were transcribed into an IOL planning formula. There are some inherent problems with that. You get different measurements at different machines; there is a real possibility of a transcription error; and there are different formulas from which to choose. In the end, there was a higher probability of making an error that could ultimately result in T echnology integration, personalization, and visualization: These are all areas where there have been significant improvements for ocular surgery. With each iteration of cata- ract surgery equipment, Alcon makes improvements to reduce surge after occlusion break. When these events occur, capsular rupture risk increases, as does the subsequent risk of retinal detachment and CME. You want to get it to zero, but it's not zero yet. Hence, the advantages of improvements like the CENTURION Vision System with ACTIVE SENTRY handpiece and the INTREPID Hybrid Tip. Another area of improve- ment is the Alcon LuxOR Revalia Ophthalmic Microscope, which has a larger and more stable red reflex than other microscopes, backlighting the lens and the cataract so surgeons can better orient where they are, among other innovative features. The NGENUITY 3D Visualization System is a game changer, both for vitreoretinal surgery, my specialty, and in the anterior segment, as my colleagues discuss. In this supplement, Robert Cionni, MD, Lawrence Woodard, MD, Ashley Brissette, MD, and I describe our experiences with some of these technologies—and others—and how they are improving surgery, our out- comes, and ultimately the patient experience. Steve Charles, MD 2 | SUPPLEMENT TO EYEWORLD DAILY NEWS | MAY 4, 2019

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