In ophthalmic surgery, we've refined our techniques to the point that our results are very consistent and very good. We owe a large share of this success to the technology at our disposal. A look around at the latest developments shows how we can become even more precise and how we can take our outcomes even further. Here are some of the impressive innovations I saw while touring the exhibit hall at the American Society of Cataract and Refractive Surgery's annual meeting in Boston.
1. Alcon / Centurion Vision System
Alcon showcased its Centurion Vision System as part of a suite of cataract and refractive surgery technologies, which also included its Verion image-guided measurement and digital marking system, LenSx femtosecond laser and LuxOR LX3 with Q-Vue ophthalmic microscope. The Centurion phaco machine boasts active fluidics that keep the chamber stable without the need to manually irrigate and aspirate or adjust the height of an IV pole. Users select a target intraocular pressure and the machine, by adjusting its compression of a bag of balanced salt solution and monitoring its flow rate, maintains that level throughout the procedure. It lets us focus on cataract removal and lens insertion. The angled, "camel hump" design of the system's new Intrepid Balanced Phaco Tip improves cutting efficiency by minimizing tip movement at the incision but maximizing torsional tip movement at the distal end. Centurion lists for $125,000.
2. Clarity Medical Systems / Holos IntraOp Wavefront Aberrometer
No matter how accurate your pre-op refraction measurements are, they're essentially snapshots depicting information that's bound to change as you go along. In contrast, Clarity's Holos gives you a continuous, real-time movie. Its refractive data is synchronized to streaming video of the patient's eye and it reflects intraoperative changes to provide feedback for astigmatic correction while rotating toric IOLs, titrating limbal relaxing incisions or making femtosecond laser arcuate incisions. You know immediately how much has changed, so there's no interruption to take a measurement and no fudge factor. My only issue with the technology? It gives you cylindrical and axis but not spherical measurements. The company's reps said they're working on that, and that'll be an important addition. The system attaches to and integrates with your operating microscope without interfering with the line of sight or working distance. A built-in digital video recorder allows you to play back the entire procedure. The Holos hardware lists for $60,000; monthly software upgrades add $1,000 a month.