New software introduces multiple enhancements to cataract surgery femtosecond laser platform

Take-home message: A software upgrade (Streamline) for the LENSAR Laser System (LENSAR) adds new capabilities for automated data transfer, iris registration, astigmatic correction, and lens analysis and fragmentation that enhance accuracy, efficiency, and outcomes in cataract surgery.

By Cheryl Guttman Krader; Reviewed by Robert J. Weinstock, MD

Tampa, FL-A new software package for a femtosecond laser system (Streamline, LENSAR Laser System) is living up to its name by increasing the efficiency of femtosecond laser cataract surgery while also bringing other advantages that are expected to translate into better clinical outcomes, said Robert J. Weinstock, MD.

The software, which received 510(k) clearance from the FDA in March 2015, introduces these new application upgrades:

• wireless integration with the wireless integration with the Cassini Corneal Shape Analyzer (i-Optics),

• iris registration,

• cataract density imaging,

• customized fragmentation patterns, and

• arcuate incision planning.

“It has been great to see how femtosecond laser cataract surgery is continuing to improve,” said Dr. Weinstock, associate clinical professor of ophthalmology, University of South Florida, Tampa, FL, and director of cataract and refractive surgery, The Eye Institute of West Florida, Largo.

The release of the new software package for the laser “brings a number of valuable new capabilities, and is another example of the ongoing evolution,” he said.

Automated data transfer, astigmatic corrections

Wireless integration of the LENSAR with the Cassini Corneal Shape Analyzer automatically brings the infrared image of the undilated eye captured preoperatively with the Cassini to the femtosecond laser for intraoperative guidance. [Editor’s Note: Compatibility with the OPD-Scan III (Nidek) and other topographic and corneal analyzer systems is forthcoming.]

Once the eye is docked by the laser, the image is used with proprietary iris registration and landmark technology to automatically compensate for ocular cyclorotation, enabling accurate placement of arcuate incisions for astigmatic correction and of corneal intrastromal marks for toric IOL alignment.

“Adjustment for any cyclotorsion of the eye that occurs when the patient moves from a sitting to a supine position is extremely important for proper placement of arcuate incisions or reference marks for toric IOL alignment,” Dr. Weinstock said. “And, the laser-made intrastromal mark is also a far more accurate guide than traditional ink markings for intraoperative guidance of toric IOL positioning.”

These new features “are stepping up the accuracy of laser cataract surgery and certainly stand to improve patient outcomes,” he said.

The software upgrade also brings built-in nomograms for arcuate incisions that are guided by data from the Cassini. Once the surgeon accepts the patient’s diagnostic information, it is imported into the laser and used with the surgeon’s preferred treatment parameters to plan location, depth, and length of the laser-made incisions.

“The automated data uploading avoids any transcription errors and improves efficiency in the operating room,” Dr. Weinstock said. “In addition, it saves time for the surgeon preoperatively since it automates surgical planning a surgical plan.”

Better phacofragmentation

Another feature of the software takes advantage of the laser’s unique Scheimpflug imaging system (Augmented Reality) capability for grading cataracts.

“Compared with the optical coherence tomography technology used by other cataract surgery femtosecond lasers, the Scheimpflug imaging of the LENSAR can see the features of the cataract more discretely, and on that basis it can now automatically categorize cataracts on a scale of 1 to 4,” Dr. Weinstock explained.

The new software not only generates a cataract grading, but it also uses that information to select a pre-programmed, surgeon-customized lens fragmentation pattern. The latter capability is the result of work done by a team comprised of Dr. Weinstock, Jonathan Solomon, MD, Bowie, MD, and engineers at LENSAR.

For example, a soft lens may be fragmented with a simple cross-cut pattern whereas a 3-4+ nuclear sclerotic cataract will be divided into small cubes.

“This automated determination of the fragmentation pattern based on cataract grading is a departure from the one size fits all approach that was used until now,” Dr. Weinstock said “It represents more efficient use of laser energy when treating softer lenses, and it also allows for greater phacoemulsification efficiency when treating harder lenses.”

Robert J. Weinstock, MD

E: rjweinstock@yahoo.com

Dr. Weinstock is a consultant to LENSAR.