TOWARD FASTER RECOVERY The latest ophthalmic lasers target tissue and speed procedures, and can be customized to surgeon preferences.

The latest ophthalmic lasers have features that allow more accurate targeting inside the eye, which is safer in the hands of the surgeon and translates to better recovery for patients. Your facility may even benefit from decreased procedure times, which could let you see more patients in a day or just give your staff and physicians a little breathing room to spend a little extra time with patients and their caregivers. Plus, having the latest technology in place sends a message to patients about the culture of your facility: that you embrace changes that promise better results. With that in mind, here's a look at 5 of the latest options for YAG, retinopathy and glaucoma procedures.

TxCell Scanning Laser Delivery System
Iridex
iridex.com

In the retinal arena, Iridex recently received FDA 510(k) clearance for its TxCell Scanning Laser Delivery System, which enables multi-spot, single-spot and "fovea-friendly" Micro-Pulse, a proprietary feature, for efficient retinal photocoagulation. Micropulse is a laser-delivery method that maximizes tissue sparing, particularly that of the fovea, by electronically "chopping" the laser emission into trains of microsecond pulses. This lets the physician more precisely control the laser effects to target tissues, potentially resulting in less collateral damage than conventional laser treatments.

The TxCell Scanning Laser Delivery System not only enables greater control, it allows multi-spot scanning in addition to the traditional single-spot mode. This can save time in laser photocoagulation procedures, by letting the surgeon do a number of laser pulses at once, instead of one at a time. The company says the user interface is intuitive for the versatile laser delivery.

I particularly like the idea of the pulsed laser delivery, which would speed these procedures. Some physicians sit down, do 1 click at a time, and the team in the laser room knows it's going to wait forever. With this system, I can see how the areas would be more precisely targeted, which would minimize inflammation and the potential for damage around the site. So not only might you be able to decrease procedure time, you also might be able to minimize tissue trauma and smooth the recovery for patients.

LASER FOCUS
Finding the Procedural Balance

BLOCK AND TACKLE With open blocks, Columbia Eye Surgery Center lets surgeons bounce to the laser room between cataract cases in the OR.

At Columbia (S.C.) Eye Surgery Center, we do more than 4,000 procedures a year in 4 ORs and 1 laser room (soon to be 2 laser rooms, when we add laser cataract), so we need to be on our toes at all times to maximize performance. Here are some tips for efficiently managing laser procedures alongside the bread and butter of cataract.

• Set up block times and "open" times. We schedule the laser room out for block times in either the morning or afternoon. If the room is blocked out for morning, we leave it open in the afternoon, and vice versa. Some of our surgeons can do up to 25 cases in a block.

During the open times, the physicians are able to slide in patients from the clinic on the same day as their exams or follow-up appointments. Alternately, if the surgeon isn't going to use a whole block, he can schedule in during the open period on a day that's convenient for the patient. If the surgeon happens to be doing cataracts that day at the ASC, he can duck over to the laser room and take a couple minutes to do an SLT or a YAG while the last case is being turned over and the next patient prepped in the OR.

• Be flexible and be ready. Most of the time, the surgeons go through our scheduler, so we know who's coming and when. In the morning, we print the schedule for the day, in case there have been any changes, so we can plan in conjunction with OR procedures and run the laser room with multiple physicians during any given open stretch.

Sometimes, we only get a couple hours' notice — for example, when a patient's been seen on the clinical side and can stick around, they might go out for lunch then come back in to the ASC side for the laser treatment. Occasionally, though, the physician will just show up with a patient. It's fine when we have only 2 patients scheduled for an open period, but when it's 10, we have to be creative.

We do our best to accommodate these patients because they're elderly, and they often rely on someone for transportation and help reading paperwork. Some days, it's kind of hairy. But this is surgery. "Be flexible and be ready," is the motto. If we can't slide a patient in, the clinic side takes care of scheduling the laser procedure for the future.

— Lisa Waters, RN

GYC-1000 Green Laser Photocoagulator
Nidek
nidek.com

The GYC-1000 Green Laser Photocoagulator for retinopathy offers multiple delivery options, including slit lamps, a binocular indirect ophthalmoscope and endophotocoagulation. The unit is compact, quiet and energy efficient: The diode-pumped, solid-state laser is said to extend life and efficiency at a low heat emission, and the system uses just 1.7 watts of laser energy.

But you don't lose speed and power, says the company, thanks to a digitally controlled instant-duty cycle. The moving filter can improve visualization compared with fixed-filter systems, and a detachable control panel allows for easy adjustments without looking away from the oculars. The GYC-1000 can be combined with Nidek's YAG laser to create a combination system, and can be integrated with Heine or Keeler indirect ophthalmoscope delivery systems.

YC-1800 Ophthalmic YAG Laser
Nidek
nidek.com

The aforementioned YAG laser is the YC-1800 ophthalmic photodisruptor. It features high-resolution optics to let the surgeon zero in on the exact laser-treatment location. Nidek's SmartSwich allows the increase or decrease of treatment energy right from the joystick, without the need to look away from the oculars.

Intraoperatively, the YAG laser allows up to ?500m adjustable offsets in increments of ?25m steps, which reduces IOL pitting, and reduces astigmatic affects via the rotatable dual 635nm aiming beam. The unit produces energy levels from 0.3mJ to 10mJ, adjustable in increments of 0.1mJ.

Ultra-Q Reflex Multi-Functional YAG Laser
Ellex

The use of YAG lasers to treat vitreous strands and opacities dates back to the 1980s — yet the technique remains a contentious topic. The initial European research out of France and Switzerland reported great success, but 10 years later, YAG lasers came to be seen as commodity products, designed exclusively for disrupting posterior capsules and performing iridotomies. The inherent technical and product-design constraints made it difficult to use YAG lasers in the posterior segment.

This is because conventional YAG lasers provide a limited view of the vitreous, which can make it difficult for physicians to identify the targeted membranes and opacities. These conventional YAG lasers also carry a high risk of damage to surrounding ocular tissue. As a result, very few specialists continued the use of YAG lasers to perform vitreolysis.

But the issue of vitreous strands and opacities remains, and patients want a solution. Indeed, a study found that many sufferers rate the disturbance caused by vitreous strands and opacities on the same level as colon cancer or age-related macular degeneration. To fill this market need, Ellex developed a YAG laser designed just for the posterior segment, for the purpose of visualizing and removing these debilitating opacities. But the Ultra-Q Reflex YAG laser can also be used in the anterior segment, so your facility gets expanded procedure capabilities without having to give anything up.

The Ultra-Q Reflex lets surgeons perform anterior or posterior capsulotomy with new-generation IOLs, peripheral iridotomy for glaucoma, or Nd:YAG laser vitreolysis for treating vitreous strands ands opacities. Featuring Ellex's patented Reflex Technology, the unit incorporates a proprietary illumination mirror design that instantly moves out of the way when firing, optimizing aiming and coaxial placement of the treatment beams on the target tissue, which eliminates the risk of beam deflection and clipping, says the company.

COMING SOON
SLT and YAG Laser Combo

This summer, Ellex will launch the Tango SLT/YAG Combination System, for which it recently received FDA 510(k) marketing clearance. Featuring a patented, proprietary, dual-mode laser cavity, the Tango combines a full-featured selective laser trabeculoplasty (SLT) laser with a precise, powerful Nd:YAG laser for performing iridotomy — which can help surgeons better manage POAG and PACG. The physician can switch between SLT and YAG modes at the touch of a button. According to the company, the Tango is the world's fastest SLT laser, with a firing rate of 3 hertz. The device has been life-tested to deliver 400,000 shots.

It seems to me the quicker firing rate could improve healing time and overall patient recovery. But remember that combination systems come with pros and cons. On the positive side, you've got only 1 laser unit, which decreases the need for valuable floor space and can reduce the amount you spend on maintenance. Surgeons love the convenience of being able to sit a patient down and do 2 procedures in 1 session. On the downside, if the unit goes down, you're out of luck for all procedures until it's fixed.

Tango SLT/YAG
Ellex
ellex.com/usa

— Lisa Waters, RN

Vixi Multicolor Pattern Scan Laser Photocoagulator
Nidek
nidek.com

Another retinal procedure offering is the Vixi Multicolor Pattern Scan Laser Photocoagulator, which is customizable in 1, 2 or 3 of the most popular colors: green (532nm), yellow (577nm) and red (647nm), and available with or without a pattern scanner in all color wavelengths. It's also a solid-state laser, which increases unit longevity.

A key feature is the multiple scanning modes with up to 21 patterns and memory function. The shorter pulse durations in scan mode reduce thermal spread and can therefore minimize patient discomfort. Pan-retinal photocoagulation may be completed in 1 or 2 sessions, says the company.

For the surgeon, split-prism optics enhance illumination, decrease lens reflections, and ensure consistent beam profile and power density. Further, the SOLIC (Safety Optics with Low Impact for Cornea) features allow for safe corneal transmission of laser treatments.

As an administrator, I like the small footprint. The surgeon and laser team might enjoy the separate, LCD touch-panel control unit for its clear display of settings.