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innovations advancing cataract surgery 4 | SUPPLEMENT TO EYEWORLD DAILY NEWS | MAY 4, 2019 Lawrence Woodard, MD Lawrence Woodard, MD Dr. Woodard uses the ACTIVE SENTRY handpiece in a cataract surgery. Source: Lawrence Woodard, MD P ersonalization and customi- zation have become the ex- pectation in nearly all aspects of daily life, and the ability to personalize products and customize procedures in medicine is starting to gain a foothold. You can first personalize based on the type of practice you have. We all practice differently as surgeons. Some of us have a more refractive cataract practice, others have a more high-volume surgery practice, and some have a basic, pathology-driv- en practice. Just selecting products, technologies, and procedures that best fit your practice style is a form of personalization. A refractive cataract practice might choose to have the ORA SYSTEM Technolo- gy with VerifEye+ Technology and a LENSX Laser, while a high-volume surgery practice might benefit from the NGENUITY 3D Visualization System for enhanced visualization and surgeon comfort. You can per- sonalize your purchases based on the style of practice you have, resulting in more practice efficiency in addi- tion to better patient outcomes. As far as customization at the product level, we've already had some ability to customize. In cataract surgery, for example, we've always had the ability to change certain parameters to adjust for the intraocular environment. But newer technologies are now allowing us to customize at a greater level because the products are able to adjust the settings more precisely and are better able to detect the changes that are happening during surgery. In that way, we are able to personalize the procedure more. One of the ways Alcon is giving us the ability to customize and con- trol our procedures more than we've ever been able to in the past is with CENTURION Vision System with ACTIVE SENTRY Handpiece •First pressure sensor to be integrated into the handpiece •Detects and adjusts for surge events more rapidly •Provides IOP compensa- tion for average incision leakage •Automated detection of patient eye level INTREPID Hybrid Tip •Rounded polymer edge •Reduces risk of capsular tears* •Cut cataracts up to 3+ densities •Similar in performance and configuration to INTREPID Balanced Tip *Alcon data on file Expanding personalization, customization capabilities in cataract surgery its new ACTIVE SENTRY phaco handpiece, an advancement for the CENTURION Vision System. ACTIVE SENTRY moves the pressure sensors from the phaco machine to the handpiece, allowing the machine to respond more rapidly with ACTIVE FLUIDICS tech- nology to the changing intraocular environment during cataract surgery. Prior to this innovation, it could take longer for the machine to detect and adjust for events such as post-oc- clusion surge and shallowing of the anterior chamber. This was because the sensors are in the machine, connected to the handpiece via sev- eral feet of compliant tubing. Now, immediately the sensors can detect a change in the intraocular environ- ment and relay that to the machine for automatic adjustments. I am now able to keep my anterior chamber environment more stable because the machine can more rapidly adjust to the fluid and pressure fluctuations that happen during surgery. This allows us as surgeons to control the intraocular environment better. With a machine that responds more quick- ly, we now have the ability to use higher vacuum levels and lower oth- er settings, such as the IOP and the aspiration flow rate. We are able to keep the volume inside the eye more constant, reducing movement of the iris and the posterior capsule, while simultaneously using more aspiration and less phaco energy to remove the nucleus. All of these factors allow us to positively influence outcomes. The sensor and subsequent adjustments are so seamless that it even prevents me from noticing that there has been a surge event. Traditionally, when there was a surge event, I would see the posterior capsule moving up toward the phaco tip. Now, there is much less of that movement. I see a benefit of ACTIVE SENTRY in cases with denser nuclei and in eyes that are more affected by fluctuations in the anterior chamber, such as those with floppy iris syndrome, but in the end, any case benefits from this technol- ogy because all of these events hap- pen no matter what type of nucleus the patient has. When initially evaluating the handpiece, I had ACTIVE SENTRY in one room and regular

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