Phaco platform proving positive in physician’s practice

Take-home message: Features of a new phacoemulsification platform provide surgeons with improvements to outcomes, safety, and cost and time effectiveness.

By Francis S. Mah, MD, Special to Ophthalmology Times

La Jolla, CA-A surgeon in any field might consider a major new surgical device for three reasons-to achieve better outcomes, to improve safety or reduce complications, or to be more cost effective or time efficient.

Recent experience with a new phacoemulsification system (WhiteStar Signature Pro, Abbott Medical Optics [AMO]) shows that this device satisfies all three criteria.

Outcomes

Outcomes from cataract surgery in the United States are among the best for any medical procedure. Ophthalmologists are fortunate to have had excellent phacoemulsification technology for some time. The latest iterations continue to improve outcomes, especially in the immediate postoperative period.

With this particular system, I routinely have excellent outcomes on postoperative day 1, with minimal to no edema and inflammation. This is likely due to the combination of dual-pump fluidics and transversal ultrasound, both of which reduce the amount of phacoemulsification time and energy required to cut through denser nuclei, for faster recovery of visual acuity.

This might seem like a small improvement-outcomes at 1 month are routinely excellent, anyway-but having good vision in the first few days or week is a major contributor to the “wow factor” that surgeons want patients to experience. It is something that translates directly into increased patient satisfaction.

The transversal ultrasound handpiece (Ellips FX, AMO) moves in a continuous elliptical pattern that makes it easy to cut through the nucleus with reduced intraocular trauma.

Like its predecessor, the device has both peristaltic and venturi vacuum pumps that allow surgeons to switch back and forth between the two. This means one can take advantage of the strengths of each pump style, rather than adapting one’s technique to compensate for the disadvantages.

Making the most of the capabilities

As a formerly peristaltic-only surgeon, I am still exploring how to make the most of these capabilities. I am currently using peristaltic vacuum-which offers a high level of intraoperative control-for sculpting and chopping the nucleus into four quadrants.

Then, I switch to venturi vacuum-which offers more speed and better followability-for the latter portions of the procedure, including removal of cortex, epinucleus, and viscoelastic.

The powerful venturi vacuum allows me to maintain the phacoemulsification tip in a safe, central zone and just let everything be drawn to the tip. As gain experience with this dual-pump device, I will keep refining settings and parameters to optimize the capabilities of both pumps.

The system also connects wirelessly to a new mobile analytics tool (Cataract Analysis and Settings Application [CASA, AMO]). This tool allows clinicians to review performance and procedure metrics from this phacoemulsification system in graph form on a tablet. This has the potential to help ophthalmologists better use their own data to improve outcomes.

For example, by tracking how long my sculpt takes, I might be able to fine tune my technique or adjust the device settings to be more efficient. In a group setting, we can identify which surgeons are achieving the best outcomes and learn from their techniques and settings.

Safety

Safety

The ability of the device’s fluidics to promote anterior chamber stability is impressive. Like its predecessor, the new device has occlusion-sensing technology that anticipates and proactively adjusts to IOP changes to help maintain chamber stability, even at higher vacuum and flow settings.

However, previous-system users will find that the new system is more responsive, in several ways.

First, the vacuum sampling rate has increased from once every 20 ms to once every 4 ms, which can reduce complications and surgical time. The wireless foot pedal is also 2.5 times more responsive, significantly improving its performance. It reacts in as little as 40ms (down from 100 ms), which further improves performance of the fluidics.

One of my first cases nicely illustrates the impact of this on chamber maintenance. The patient had a dense cataract, combined with a smaller, 5-mm pupil, and was taking tamsulosin (Flomax, Boehringer Ingelheim Pharmaceuticals). I performed standard phacoemulsification with the phacoemulsification system, with no femtosecond laser.

In cases like this, one often finds a lot of chamber “bounce” with floppy iris, and the need for a Malyugin ring.

In this case, the chamber was rock solid throughout the case, which proceeded smoothly without pupil-stretching devices. I was able to cut easily through the nucleus with the transversal handpiece.

Cost

Cost

Many factors go into the cost effectiveness of phacoemulsification, starting with (but not limited to) the most obvious one-the price of the device and consumables.

Reducing complications and/or the need for additional surgical devices, as in the case described above, is a significant element in reducing surgery center costs.

Better patient outcomes can lead to patients becoming better “ambassadors” for the surgeon and the surgery center, increasing referrals and cataract surgery volume.

A faster procedure time can enhance efficiency throughout the day.

Every little improvement in cost effectiveness helps. One feature of the system that my staff particularly likes is the ability to prime and tune the device, handpiece, and tubing with a single button push for a little greater efficiency, which reduces the turnover between cases.

As surgeons, we tend to gravitate toward what we learned in residency or just after, and what is most familiar. It is worth keeping in mind, however, that there are good reasons to investigate new technology when it holds the potential to make one a better, safer, or more efficient surgeon.

Francis S. Mah, MD

P: 858/554-7996

E: Mah.Francis@Scrippshealth.org

Dr. Mah is director of cornea and external diseases and co-director of refractive surgery at the Scripps Clinic Torrey Pines, La Jolla, CA. He is a consultant to Abbott Medical Optics, Alcon Laboratories, and Bausch + Lomb/Valeant.