New system helps cataract surgeons improve refractive precision

TAKE HOME: The Verion Image Guided System (Alcon Laboratories), composed of the Verion Reference Unit and the Verion Digital Marker, allows cataract surgeons to deliver better refractive outcomes.

Dr. Lane

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

Fort Collins, CO-A new platform incorporating digital planning and surgical positioning tools (Verion Image Guided System, Alcon Laboratories) is an important step forward for increasing cataract surgery efficiency and improving patient outcomes, according to surgeons who have used the technology.

“[The platform] is designed to avoid the multitude of errors that can occur along the entire pathway from initial patient evaluation to execution of the surgical plan, and it allows surgeons to deliver more accurate refractive results and higher patient satisfaction with greater consistency,” said Gary Foster, MD, private practice, Fort Collins, CO.

“In addition, it allows for seamless and synergistic integration of our different surgical technologies,” Dr. Foster added. “[It] not only decreases opportunities for error, but it also augments overall efficiency.”

“Verion is a multifaceted technology that has been designed to accurately measure the eye, image anterior segment landmarks, perform IOL calculations, including astigmatic corrections, and then guide the surgeon in the placement all corneal incisions and IOLs, including both toric and multifocal IOLs, by seamlessly exporting the information to other synergistic technologies,” said Stephen S. Lane, MD, medical director, Associated Eye Care, Twin Cities metropolitan area, Minnesota, and adjunct clinical professor of ophthalmology, University of Minnesota, Minneapolis.

“[The system] is essentially the ‘glue’ that integrates the preoperative planning phase of a cataract procedure to the intraoperative guidance of the surgeon during key steps in the cataract procedure. This allows for improvements in efficiency, accuracy, and precision, all key factors in improving the surgeon’s ability to hit the refractive target.”

The components of Verion include the Verion Reference Unit, the Verion Planner, and the Verion Digital Markers. The Verion Reference Unit is a diagnostic and planning tool. In a single step, it measures both keratometry and pupil size and captures a high-resolution reference image of the eye, detecting anatomical landmarks (scleral vessels, limbus, pupil and iris features) that are used for intraoperative tracking and registration.

Dr. Foster explained that with the Verion system, patient data are entered one time into the Verion Reference Unit and then carried forward through each stage of the process until the surgery is complete. The data are automatically transferred to the Verion Digital Marker, which is compatible with the LenSx Laser (Alcon Laboratories) and most surgical microscopes.

“Use of the Verion system eliminates the possibility for entry errors that can occur when it is necessary to be re-input patient and surgical information at different steps along the surgical pathway. In addition, it provides a database for analyzing postoperative outcomes so that surgeons can refine their nomograms to improve results for future patients,” Dr. Foster said.

The data measurements obtained with the Verion Reference Unit are imported into its surgical planning software that includes a range of IOL power calculation formulas, including the SRK-T, Haigis, and Holladay II formulas. Verion also features software for astigmatism management planning that helps surgeons with decisions on methods for astigmatism correction and guides incision placement and IOL implantation axis.

“Verion increases surgeon flexibility in astigmatism management decisions as they can choose to correct the patient’s existing astigmatism with a toric IOL only, with only limbal or arcuate incisions, or by combining incisional and IOL approaches. The system also has a built-in nomogram for astigmatic correction by arcuate incisions using the LenSx femtosecond laser that is based on data provided by a number of surgeons,” Dr. Foster said.

Dr. Lane also commented. “The Verion has powerful and versatile surgical planning capability. It lets surgeons choose if they want to under- or overcorrect refractive error, determine which IOL power calculation formula they wish to use, and optimally correct astigmatism if a combination of incisions and a toric IOL will give the best result,” he said.

Dr. Foster noted that another benefit of the system is that it gives surgeon’s increased latitude in choosing where they want to center the capsulorhexis because the Verion Reference Unit identifies the center of the undilated pupil and the location of the visual axis in an image acquired with the patient in an upright position.

Optimizing the surgical plan

The reference image which is essentially a “fingerprint” of the eye and surgical plan from the Verion Reference Unit is electronically transferred to the Verion Digital Marker that then creates a computer-generated tracking overlay for the LenSx laser (Alcon) and the LuxOR LX3 with Q-VUE Ophthalmic Microscope (Alcon), as well as most other surgical microscopes. The overlay provides a real-time visualization guide for creation of the incisions, capsulotomy, and IOL alignment. By registering the preoperative image of the eye taken with the patient sitting upright at the Verion Reference Unit to that of the eye with the patient lying supine on the table, the system tracks for eye movement and automatically adjusts for cyclotorsional rotation.

Dr. Lane said, “The Verion digitized information can also be imported into the LenSx laser where it further increases the precision of capsulotomy and incision creation through eyetracking and registration. For surgeons who are not using the LenSx laser, Verion presents the registration image with capsulotomy and incision templates in the microscope oculars and as a heads-up display to increase accuracy in completing these steps.]

“By eliminating the need for manually placed, astigmatic ink markings and all of the imprecision inherent with that technique, the Verion system greatly increases the accuracy of toric IOL alignment and arcuate incision placement to deliver improved refractive outcomes,” Dr. Foster said.

The footpedal of Alcon’s new phacoemulsification unit, the Centurion Vision System, also connects wirelessly to the Verion Digital Marker and allows surgeons to toggle between displays of the different IOL implantation approaches.

Gary Foster, MD

E: gjlfos@gmail.com

Dr. Foster is a consultant to AcuFocus, Alcon Laboratories, and WaveTec Vision.

Stephen S. Lane

E: sslane@associatedeyecare.com

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

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