How new Cataract Refractive Suite helps physicians

Take Home

The CRS’s assortment of technology used in cataract surgery allows interaction between devices to give better results before and after a procedure.

Dr. Lan

By Cheryl Guttman Krader; Reviewed by Stephen S. Lane, MD

Minneapolis -The Cataract Refractive Suite (CRS; Alcon Laboratories) is a collection of advanced technologies that is designed to guide informed surgical decisions, minimize sources of error, and allow surgeons to be more consistent in delivering excellent refractive outcomes.

“The current focus in cataract surgery is toward achieving better refractive outcomes, and the CRS helps to achieve this goal because each of its components enhances accuracy in the many steps of the surgical procedure,” said Stephen S. Lane, MD, medical director, Associated Eye Care, Minnesota, and adjunct clinical professor of ophthalmology, University of Minnesota, Minneapolis. “Through seamless integration of the various surgical technologies, the CRS also improves efficiency, therefore, surgeons can stay focused on the patient and have greater confidence in the outcomes they can achieve.”

Four components make up the Cataract Refractive Suite:

·      A digital imaging, planning, and intraoperative guidance tool (Verion Image Guided System)

·      A femtosecond laser (LenSx)

·      A new phacoemulsification unit (Centurion Vision System)

·      A state-of-the art surgical microscope (LuxOR LX3 with Q-VUE Ophthalmic Microscope)

“Despite the tremendous developments that have occurred in cataract surgery during the last decade, many surgeons feel there is a need to further improve refractive cataract patient outcomes in terms of achieving visual acuity results comparable to those associated with laser vision correction,” said Paul Soye, global head of research and development, cataract franchise, Alcon, Fort Worth, TX. “With the CRS, that increases the efficiency and precision of the steps involved in the cataract procedure.

“Alcon is positioned to meet this need,” he continued. “This set of tools is designed to work seamlessly together to enhance and optimize the surgical cataract procedure and improve upon the refractive outcomes of cataract patients.”

The Verion Image Guided system performs three functions: diagnostic imaging, surgical planning, and surgical guidance. It is comprised of the Verion Reference Unit, which obtains a digital image of the eye, and performs keratometry and pupillometry measurements.

The Verion Planner-including IOL power selection and astigmatism management-uses the data from the Verion Reference Unit. The reference image and the surgical plan are then exported to the Verion Digital Marker that creates a computer-generated tracking overlay for the LenSx laser, the LuxOR microscope, or most other surgical microscopes. The image and overlay support eye tracking and registration while providing a real-time guide for accurate capsulotomy creation, corneal incisions, and IOL positioning.

LenSx updates

Most surgeons are familiar with the use of femtosecond lasers for cataract surgery and recognize that LenSx was the first commercially available platform. However, the laser has undergone continuous upgrades, Dr. Lane said, with the latest being new software for automatic eyetracking and registration using the reference image provided by the Verion Reference Unit.

“This new capability will help account for cyclorotation of the eye and further enhance the precision of capsulotomy centration and corneal incision placement,” Dr. Lane said. “Use of the LenSx laser with the Verion Image Guided System will help to improve our refractive outcomes and spur the use of advanced technology IOLs by increasing our ability to hit our refractive target, thereby meeting our patients’ high expectations.”

A new patient interface (SoftFit) is another improvement to the LenSx laser. Using a hydrophilic contact lens that fits into the suction cup, the new patient interface simplifies the docking procedure and helps to secure the eye while allowing for a more comfortable patient experience.

“Maximum IOP rise with the new patient interface is only about 16 mm Hg, which is much lower than with the previous technology, Dr. Lane said.

A new enhanced lens fragmentation technique is also now available. Known as Matrix, it splits the lens into a series of cubes using a criss-cross or grid pattern. Surgeons have flexibility in setting the number of units in the grid based on lens features and their surgical technique.

“The division of the nucleus into multiple pieces with the matrix pattern reduces the amount of ultrasonic energy necessary to remove the lens,” Dr. Lane said.

Microscope features

The LuxOR LX3 with Q-Vue has been specifically designed to integrate with the CRS. It wirelessly imports data from the Verion system and displays the overlay for guiding manual surgical incisions, IOL alignment, and manual capsulotomy. In addition, the LuxOR LX3 provides superior and highly stable visualization.

“One of the frustrations with other microscopes is that small eye movements can sometimes decrease the red reflex as the eye moves out of the red reflex zone of the microscope illumination,” Dr. Lane explained. “This then necessitates that the surgeon readjust the X-Y position. Compared with competitor microscopes that use focused light, the LuxOR LX3 uses collimated non-focused light that provides a 6-fold larger red reflex zone.”

Phacoemulsification innovation

The Centurion Vision System is a new phacoemulsification machine that stands out from previous generations of Alcon phaco units and other systems because of three significant features: its fluidics system (Active Fluidics Technology), its phaco tip (INTREPID Balanced Tip), and its integration capability (Applied Integration).

The new fluidics technology is a dynamic system that constantly monitors IOP and then automatically compensates for changes by adjusting irrigation fluid inflow to maintain superb anterior chamber stability.

With Active Fluidics, the surgeon presets a target IOP. If the laser controlled sensors in the handpiece detect fluctuations in various parameters, there is an efficient feedback system to adjust compression of the internally located BSS bag and pump flow rate to maintain the target IOP.

“This capability gives unprecedented stability of the anterior chamber,” Dr. Lane said.

The new INTREPID Balanced Tip is designed to increase surgical efficiency and safety.

“The unique geometry of the distal tip maximizes the oscillatory torsional motion and provides precise cutting capacity,” Dr. Lane explained. “However, the rest of the needle is straight and moves minimally. Therefore, less heat generated at the proximal portion, which reduces the risk for thermal damage at the incision site.”

Dr. Lane added that the new straight tip design is an attractive ergonomic change for surgeons who did not like the Kelman-style angled tips previously used for torsional ultrasound with the INFINITI Vision System.

The Centurion Vision System is fully compatible with the Verion Image Guided System, LenSx laser, and LuxOR LX3 microscope. It is also designed to work with the AutoSert IOL injector, and allows for ongoing upgradeability with future technologies.

“With the integration capabilities of the CRS, all the technology used in cataract surgery talks to each other to give better results from the time the measurements are taken preoperatively until the drape is pulled off the eye at the end of the procedure,” Dr. Lane said.

“Alcon continues to set new standards in eye care through its commitment to developing new and innovative products and technologies to address unmet eye care needs around the world, including those for cataract,” Soye said. “The CRS by Alcon surrounds the surgeon with best-in-class innovations that are designed to improve the visual outcomes of cataract patients.”

Stephen S. Lane, MD

E: sslane@associatedeyecare.com

Dr. Lane is a consultant to Alcon, Abbott Medical Optics, Bausch + Lomb, and Wavetec.

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Building the system

Perhaps the first question that comes to mind when surgeons hear about the CRSis whether they will need to invest in all four components. The answer is no, said Dr. Lane, who explained each piece has standalone value and surgeons can choose to upgrade their OR with additional components over time.  He used the assembly of an audio stereo system as an analogy. 

“Some older surgeons might remember wanting to have a great high-fidelity stereo system when they were in college but having only enough money to buy a single component at a time. So, they might start by buying a new tuner while continuing to use their old turntable, speakers, and tape player. The music sounded better with just one new piece, and then improved more with each addition,” he said.

“Similarly, the CRSwill have its greatest benefit with all four of its state-of-the art technologies available as they were designed to work together synergistically. However, each component provides advantages, and while the system is designed to be used in toto, some surgeons may decide they never need the complete platform.”