Eyeworld Supplements

4 W e bought our Catalys (OptiMedica/Abbott Medical Optics, Santa Ana, Calif.) in July 2012. At the time we bought it, which was prior to the introduction of the LenSx Laser SoftFit Patient Interface (Alcon, Fort Worth, Texas), we felt that the Catalys system performed capsulo- tomy treatments better than the LenSx Laser system. However, with the introduction of the SoftFit Patient Interface (PI), the LenSx Laser dramatically improved its capsulotomy performance. The LenSx Laser's PI is part of the optical design and is considered the last lens on the laser system; it does not re- quire a liquid interface. Compared to the original LenSx Laser PI, the LenSx Laser with SoftFit PI has not only improved its surgical perform- ance, showing a 66% reduction in laser energy and a 33% reduction in laser time, but more importantly offers improved docking and centra- tion. The SoftFit PI simplifies dock- ing even with deep-set or small eyes due to its smaller diameter (19.8 mm). The diameter of the Catalys patient interface is nearly 5 mm larger than the LenSx Laser and 3.5 mm larger than the IntraLase (Abbott Medical Optics) patient interface. One of the main benefits of the SoftFit PI is that it fixates the cornea, eliminating the need to tape down the patient's head, and reduces IOP rise during the docking process (16 mmHg increase over baseline). There is no longer a contraindication for glaucoma patients with the SoftFit PI. The LenSx Laser has the ability to make great corneal incisions: primary, secondary, and arcuate. In January of this year, I bought the LenSx Laser, and now I use it 100% of the time. The LenSx Laser computer- programmed incisions provide reproducible primary and secondary incisions. Surgeons can easily con- trol depth, length, and position. The user interface displays real-time corneal thickness, allowing us to create true "three-plane" primary incisions. With the LenSx Laser, I routinely use femto-incisions. They are easy to open, without leaking or deformation. Reproducible and accurate arcuate incisions are also a key reason why I use the LenSx Laser. The ability to accurately control arcuate length, depth, curve, radius, and angle of incidence gives me great control and consistency. I am able to create arcuate incisions that are titratable and easy to enhance during surgery or postop. These incisions have proven to be a great adjunct to multifocal IOLs. A key technology that enables the LenSx Laser to perform well in the lens, capsule, and cornea plane is its unique "variable beam angle." The laser focus angle changes for each surgical plane. A wide beam for the cornea gives the LenSx Laser the ability to perform complex incisions. A medium beam angle for the cap- sule provides a free-floating capsulo- tomy with pristine edges in most cases, while the narrow angle for the lens provides effective fragmenta- tion. Most other femtosecond lasers have a single beam angle or aper- ture, which is maximized for either the cornea or the lens. One of the misconceptions I had about the LenSx Laser when I made the initial decision to purchase the Catalys was that its imaging system is not accurate because it is based on imaging single points. I believed that it was fast but not ac- curate. Since purchasing the LenSx Laser with SoftFit PI, I have found that the circle scan enables fully characterized lens shape and orien- tation. It also extracts lens thickness, tilt, and radii of curvature (anterior and posterior capsules). The circle and linear OCT scans together give more information, which can be used to verify observations made with the video microscope in order to help improve accuracy and reduce risk for the patient. While the Catalys performs multiple scans and assembles the images, the LenSx Laser's proprietary full-range inte- grated OCT captures the entire ante- rior segment and all tissue structures in a single, full-range, precise image. This allows me to perform OCT imaging during docking, showing all the internal ocular structures. Importantly, the large depth range of the LenSx Laser OCT covers the entire anterior segment of the eye and does not require multiple scans to be stitched together. The customized treatment planning soft- ware involves complete visualization of the eye. Several OCT images are displayed for a surgeon to verify the placement of the different femto-in- cisions. The LenSx Laser performs a complete 360-degree circle scan and several line scans at very high resolution to precisely position the laser fragmentation pattern. The way you can customize the surgical plan is very user friendly. There are a lot of treatment options with the LenSx Laser. If you wanted or needed to change the treatment plan based on the patient's needs (e.g., make a smaller capsulotomy or move the incisions), you are able to drag and position the incision quickly with a simple click on the interface. I think it is clear that LenSx Laser corneal incisions are placed more precisely and more consistently from the limbus. Dr. Young is the medical director of Vision Care of Maine. He can be contacted at tylercyoung@yahoo.com. EW Boston 2014 Sunday, April 27, 2014 4 Making the switch to the LenSx Laser by Curt Young, MD LenSx Laser high-definition OCT technology: Real-time image-guided planning and monitoring give the surgeon the ability to image anterior cornea to posterior capsule in one single image with low noise and high-contrast resolution. Curt Young, MD " Reproducible and accurate arcuate incisions are also a key reason why I use the LenSx Laser. The ability to accurately control arcuate length, depth, curve, radius, and angle of incidence gives me great control and consistency. " Please refer to pages 6 and 7 for important product information about the Alcon products described in this supplement.

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