Eyeworld Supplements

4 EW San Francisco 2013 Sunday, April 21, 2013 4 when they pulse the energy into the cornea. Each pulse creates small bubbles inside the eye that coalesce to cleave the tissue, but leave gas trapped in the flap. Surgeons need to create a channel that allows the gas to egress from under the flap into the periphery. The way this laser docks creates very symmetric pres- sure on the eye. The FS200 allows us to modify our treatments to ensure we get that channel so we're sure the gas escapes into the periphery. Pearls for use For refractive surgeons who are con- sidering upgrading to the FS200, here are some "real use" advantages. This laser allows you to use both the operating microscope and the monitor. I appreciate the ability to align the microscope with the treat- ment and then move to the monitor to align the patient's eye. Being able to go back and forth makes it easier for me to evaluate the applanation on the corneal surface. The precision of the flap cuts has allowed me to immediately move to a reverse side cut, with a beveled outside edge. Once you move the flap back, this type of cut helps the flap to settle into position better and may allow patients to heal faster. Far and away, the most unique feature of this laser is its precision— treatment-to-treatment variability is minimal. The laser head is extremely robust so we very rarely change our treatment parameters. This laser makes our lives relatively boring— but when it comes to creating fem- Seeing is believing by Michael Jones, MD Please refer to pages 7 and 8 for important safety information about the Alcon products described in this supplement. Precision continued from page 3 tosecond laser flaps, being "boring" is the highest compliment I can pay. When we're evaluating patients, we tell them we're using the best equipment in the world. With the FS200, I know I can back that state- ment up. *Based on typical treatment parameters; Alcon data on file. Reference 1. Mrochen M, Wüllner C, Krause J, Klafke M, Donitzky C, Seiler T. Technical Aspect of the WaveLight FS200 Femtosecond Laser. J Refract Surg. 2010;26:S833-S840. Dr. Clinch is in private practice, Eye Doctors of Washington. He can be reached at 301-215- 7100. Michael Jones, MD " For me, it was a no-brainer: The 'wow' factor of this microscope and the superior visualization made other microscopes we demoed pale in comparison. " red reflex, and its superior depth of focus truly set this microscope apart, and it has increased the efficiency of our practice. Red reflex technology The LuxOR microscope features Illumin-I technology, a patented three-beam collimated light configuration that generates bright, homogenous light over a larger surface area than other microscopes. This visibility is not contingent on pupil size, centration, lens tilt, or eye movement. During capsulotomy, cataract surgeons are dependent upon red reflex for visibility, and in cases of very dense cataract, visibility be- comes crucial. Our inability to see a red reflex in those difficult eyes is why we have special dyes for use in cataract surgery. But the LuxOR scope produces a red reflex zone that is six times broader than that of other microscopes, which provides a much more stable red reflex during the entire case. Because of those two features, we're able to save surgical time as well; it was not uncommon for us to lose red reflex if the patient's eye moved too far one way or the other. We would then need to spend time repositioning the patient's head or moving the microscope to get the red reflex right back in the center. But the wider zone of red reflex of- fered by the LuxOR means we're never repositioning the patient. I didn't realize how much time I spent on this seemingly menial as- pect of surgery until I realized I was- n't spending time on it any longer. We have a large number of patients on tamsulosin in our prac- tice, so the brightness of the LuxOR is particularly helpful with these small pupils. Depth of focus Depth of focus is another surgical aspect that, in older microscopes, is at the mercy of patient movement. We found ourselves continually zooming in or out even with the smallest of patient movements. Most microscopes have an extremely nar- row focus, limiting the surgeon to concentrate on just the part of the eye that's being operated on at the time. So when we need to move from the cornea to the anterior capsule, it's another adjustment, a few seconds here and there that add time to the surgery. The LuxOR has a superior depth of focus, however, and I've yet to change focus at any point during the surgery. The supe- rior visualization with the LuxOR microscope allows me to see all lay- ers of the eye without zooming in or out. Watch this video on your smartphone or tablet using your QR code reader. (Scanner available for free at your app store.) Improved red reflex and depth of focus with the LuxOR microscope* I n a cataract surgery center, the microscope is often the last piece of equipment we think about updating. It's easy to be complacent in this regard—the microscope isn't necessarily a dra- matic or high profile instrument. We don't let our patients know we have the "latest, greatest" microscope like we would our lasers or premium lens offerings, probably because we don't give our microscopes the attention they deserve ourselves. This complacency certainly affected my center; before we invested in the LuxOR microscope (Alcon, Fort Worth, Texas), we had been using a 30-year-old micro- scope. Yet we had updated our phaco units about six times and never thought twice about the importance of the microscope. It wasn't until we tried the LuxOR that we truly understood what we had been missing. For me, it was the equivalent of transition- ing from a TV built in the 1990s to a 1080 plasma screen, high-definition TV. The superior visualization of the LuxOR system, the stability of the Alcon Sunday_SF2103 8pages-DL2_Layout 1 4/20/13 8:12 PM Page 4

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