Want a good indicator of how technology is shaping the way eye surgery is performed? Check out the new products on display in the ASCRS exhibit hall. Make no mistake: This was the year of the laser.

There were femtosecond lasers, which many say will revolutionize cataract surgery. There were new laser systems that create less heat damage to surrounding eye tissue. And there were laser photocoagulators that let you better penetrate the retina and better control laser spot placement. New laser technology was certainly a theme at ASCRS 2012, but there was much more to see. Let's take a look at some of the exciting new products on display at this year's show in Chicago.

1 IQ 532 Laser System from Iridex
The concept here is to treat the pathology with less collateral damage to adjacent tissues. With pulse durations from 10 milliseconds to 300 milliseconds, this micropulse laser trabeculoplasty (MLT) system could potentially cause much less heat damage to the retina when treating retinal edema, and could also be used to treat glaucoma.

Using a typical system, setting a laser for 0.1 seconds means the laser would remain on for the entire duration of this pulse. This system's micropulse module pauses multiple times during that pulse duration, which means heat doesn't build up, and consequently cuts down significantly on the thermal damage that can be done to adjacent tissue.

2 M822 F20 Ophthalmic Microscope from Leica
Obtaining high-quality images and video is important, but that's just part of the battle. You also have to be able to share images and information from cases. This scope's open architecture allows HD recording, wireless transfer of videos to mobile devices and intraoperative focus of videos through a series of video adapters.

The M822 also combines LED and halogen in a dual illumination system for stable red reflex in all steps of cataract surgery. According to the company, the smallest cortical fragments can be clearly seen even at low light levels. This is important, because the advent of topical cataract surgery means that many of us now perform surgery at lower light levels to increase patient comfort. This new microscope technology improves visibility at these lower levels, which is obviously advantageous for the surgeon and patient alike.

3 Zeiss IOLMaster 500 with Holladay 2 Formula from Carl Zeiss Meditec
Simply put, the integration of the Holladay 2 Formula with the IOLMaster 500 system for biometric measurement is a big deal. The Holladay 2 Formula is the leading IOL calculation formula for U.S. surgeons. But using the formula has always required transfer to an external computer as well as the purchase of a separate software package. This meant the surgeon had to take significant time to manually enter the data, increased the chance of human error and incurred a sizable cost to buy the additional software.

With the formula now inside this unit, users can upgrade their IOLMaster and do calculations within the device, which is a great convenience and spares the surgeon a good 5 or 6 minutes of data entry time per procedure. The software also improves the IOL Master's ability to let surgeons more accurately select the best IOL power for each patient.

4 OASIS Iris Expander from OASIS Surgical
Compared to other iris rings that keep the pupil open for phacoemulsification, this expander is similar in concept but unique in design. The ring is one piece and it doesn't grab the iris, which makes it easier to remove the ring. The OASIS expander is also much quicker to insert compared to iris hooks. This device can greatly simplify cases of intraoperative floppy iris syndrome (IFIS) by stabilizing the pupil size and keeping the floppy iris out of the way.

In addition, the 7mm diameter is ideal, because generally when you make an incision of the anterior capsule in extracapsular cataract extraction, the incision is about 6mm, so this device gives you some extra breathing room to get in and perform the surgery.

5 CapsuleGuard IA Handpieces from Bausch and Lomb
The big addition to the expanded CapsuleGuard handpiece line, which includes 10 single-use instruments, is the smaller, 1.8mm incision option to go along with the 2.2mm to 2.8mm incision ranges. Some surgeons will tell you that removing the cortex can be a particularly tough task, especially with cataracts, smaller pupils and flimsy posterior capsules. The addition of smaller incision options gives surgeons greater confidence that they can go after the cortex more safely, and 3 new tip designs offer a broader range of techniques for irrigation and aspiration. Designed to reduce the risk of capsule rupture, this silicone device's flexible tip enables safer removal of the cortex, and lets the surgeon polish the capsule with less risk of tearing it.

6 Multicolor Scan Laser Photocoagulator MC-500 Vixi from Nidek
This laser lets surgeons select 1, 2 or 3 wavelengths (green, yellow or red) to penetrate the retina, as opposed to most systems that provide either red or green. Having this unique capability could be a real efficiency boost for treatment. In cataract cases, for example, the yellow wavelength (577nm) enables better penetration compared to green. In eyes with retinal hemorrhage, you can achieve better penetration with the red (647nm) wavelength, which is typically used for photocoagulation of deep choroidal pathology.

The system also includes 14 preprogrammed scan patterns to allow treatment of varying retinal pathology. By selecting one of these patterns — a circle, triangle, square, curve or half-circle, for example — the surgeon now has more control over placement of laser spots. You can also change the spacing between spots for each pattern, and rotate the pattern in 15-degree increments using an LCD touchscreen. Surgeons can also save and recall up to 4 frequently used scan patterns in the LCD menu.

7 SMI Surgery Guidance from SensoMotoric Instruments
SMI Surgery Guidance offers the cataract surgeon automated visual guidance without the use of artificial markers. The system automatically links the patient's diagnostic information to the microscope camera's live image and assists the surgeon with a real-time adjusted tracking overlay. This does away with the need for ink markers, and helps support the exact positioning of incision and LRIs, the centering and sizing of capsulorhexis and the accurate centering of multifocal IOLs. Overlays also help the surgeon compensate for the patient's cyclorotation or alignment in the supine position, making placement of toric IOLs or astigmatic incisions more accurate and thus more effective in achieving the needed astigmatism reduction.

8 Refractive Cataract Toolset from TrueVision 3D Surgical
This addition to TrueVision's 3D Visualization and Guidance System combines 3D visualization with patient data and computer-based guidance software to process pre-operative clinical data and 3D images in order to generate toric IOL alignment, limbal-relaxing incision and capsulorhexis guidance templates during surgery. With the ability to overlay the LRI incision, you can see the axis for astigmatic incisions or toric implants. This should improve accuracy when correcting astigmatism at the time of cataract surgery.

More precise surgery is indeed a key benefit of this system, as using virtual guidance on the 3D live image lets the surgeon see precise alignment and centration as well as axis. The ability to work "heads up," looking straight ahead at a monitor instead of down into a microscope makes surgery less physically taxing for the surgeon as well. And it's worth noting that working "heads up" and in 3D should also facilitate teaching, as the view is identical for the surgeon and his resident surgeon.

9 AE-2929 and AE-2930 Electronic Toric Markers from ASICO
These electronic markers are unique in that they use a combination of sight and sound to confirm the eye's horizontal axis for refractive cataract surgery. The concept is pretty simple: When the marker is tilted slightly in either direction, an orange light comes on and the electronic leveling device will beep slowly. If the marker is more severely tilted in 1 direction, a red light will flash and the device will beep more rapidly. Only when held horizontally will the device stop beeping and show a green light.

This technology offers an improvement in terms of the accuracy of astigmatism correction with toric IOLs or astigmatic incisions. By marking the patient with this device in an upright position before surgery, we now know the true axis of astigmatism, even if there is cyclorotation of the eye during surgery, which can occur as the patient changes to the supine position.