Spotlight on Technology and Technique
Fine-Tuning Phaco
Upgraded software and a unique handpiece raise the bar for precision, efficiency and surgeon control.
BY CHRISTOPHER KENT, SENIOR ASSOCIATE EDITOR

For cataract surgeons working in a climate of declining reimbursements, every advance in technology that makes surgery safer and less time-consuming is a welcome development. In that spirit, Alcon recently began offering two upgrades to its popular LEGACY cataract system -- AdvanTec software and the NeoSoniX handpiece. Advan-Tec significantly increases the options and capabilities of the LEGACY system; NeoSoniX is the first handpiece to combine sonic, nonlinear oscillation with linear ultrasound. Together, they make it possible to remove a cataract in less time, using less energy.

The graphical user interface of the AdvanTec LEGACY system, showing new submodes available under AdvanTec mode. NeoSoniX amplitude and threshold controls are activated.

The AdvanTec advantage

AdvanTec enhances the LEGACY cataract system in two ways: It adds a number of new options and features to the system, and its improved sensory feedback system increases the accuracy and consistency of the ultrasound energy.

Maximizing ultrasonic performance. During cutting, low power levels are ideal for maximum control and precision. But when a phaco tip encounters tissue at low power levels, the heavier load can cause major fluctuations in power. Traditionally, surgeons have compensated for this by increasing power levels, which undercuts control and precision.

AdvanTec's new ultrasound driver board eliminates this problem by providing consistent power at any level, from 0 to 100%. AdvanTec incorporates a high-efficiency feedback loop that samples more data points at the tip than ever before, and samples them more frequently. It instantly compensates for resistance, ensuring that power is maintained at the level you intended, regardless of load.

This makes it possible to continue precise, effective cutting -- without stuttering -- at low power. It also increases followability, minimizes chattering, decreases the risk of thermal damage and allows you to complete surgery in less time.

Occlusion power management. This feature shifts the instrument into an alternate phaco mode or lower power level (preset by you) during pre-occlusion and/or occlusion. Automatically switching to pulse mode, for example, may allow the material to reposition on the tip, while reducing the risk of thermal injury.

Global linear flow. AdvanTec gives you linear control of flow in footswitch position #2. Surgeons report that the new parameters make the peristaltic pump in this instrument respond much like a Venturi system. This feature also gives you linear control of flow in burst and pulse phaco modes -- not just in continuous phaco mode -- using the footpedal.

Mode sequencing. This feature allows you to customize each procedure by presetting different parameters for different steps. (The footpedal or remote control can be used to move forward or backward through the series of modes you've preset.) The instrument provides an auditory cue to confirm that you've changed from one mode to the next.

Viscoelastic mode. This is an optional mode that prevents ultrasound from being used at full power until viscoelastic around the tip has been aspirated and replaced with fluid. This mode minimizes the risk of viscoelastic blockage and the resulting danger of thermal injury.

Other practical features of AdvanTec include:

• AdvanTec allows the LEGACY to sense (and respond) when the user accidentally tunes in air, or when the tip isn't properly connected.
• AdvanTec's new Pentium processor responds more quickly to commands and provides four times more memory for customized settings than the original LEGACY system.
• AdvanTec ensures that data and settings in memory can't be accidentally erased in case of an incorrect startup by a technician.

AdvanTec has been designed to work with ABS tip technology, but it will work with any tip.

	The NeoSoniX handpiece from Alcon is the first to combine sonic, nonlinear oscillation with linear ultrasound.

The NeoSoniX handpiece

The NeoSoniX handpiece makes surgery faster and safer by allowing the tip to oscillate, rotating it back and forth up to ±2°. (It's the only handpiece that can combine sonic, non-linear oscillations with linear ultrasound.) With the AdvanTec software upgrade (required to operate the NeoSoniX handpiece), you can use oscillation only, linear ultrasound only, or both at once. AdvanTec also lets you control the amplitude of the oscillation and the threshold of ultrasound power at which it engages.

Having this option accomplishes two things:

• First, it helps you control how and when occlusion occurs. During sculpting, for example, you can set the threshold to 0%; NeoSoniX comes on immediately with the ultrasound, helping to prevent occlusion. If you want occlusion during chopping or segment removal, you can set the threshold onset to delay until you reach a specific level of ultrasound power.
• Second, when the tip is oscillating, the ultrasonic effect is distributed across the face of the nuclear material. This increases the efficiency of energy delivery and disruption of the natural micro-fissures in the lens material.

Other advantages of the NeoSoniX handpiece include:

• Some cataracts can be removed using oscillation alone. This reduces thermal energy as much as 99.7% compared with conventional ultrasound.
• The NeoSoniX handpiece can be used with any
  LEGACY phaco tip, except a Mackool tip.
• This technology works to your advantage regardless of the phaco technique you prefer to use.

The bottom line? The NeoSoniX handpiece allows you to perform more efficient phaco using less energy. (This has been confirmed in ongoing studies being conducted by several surgeons.)

Comments from the field

Ronald Salvitti, M.D., who practices in Washington, Pa., has used the upgraded LEGACY system for several months. "I used to have the LEGACY system in one room and another system in the other room. After adding the AdvanTec upgrade and the NeoSoniX handpiece, I decided to put a LEGACY system in both rooms.

"The upgraded system is great for a number of reasons. For one thing, it's made me more efficient. I'm probably using 20% less operating time. It's also increased my staff's efficiency; setup is faster, and because I preprogram modes and parameters, my assistant doesn't have to remember settings or change them manually.

"The upgraded system has also made the procedure safer. I need less ultrasound to get the same amount of work done.

"Best of all, you don't have to change your tips, incision or technique to use the improved system. In fact, you can fine-tune the instrument to meet your needs.

"As I think you can tell, I'm very happy with the upgrades."

For more information about the LEGACY system, AdvanTec or NeoSoniX, contact Alcon at (800) 862-5266, or visit www.alconlabs.com on the Web.

Are you aware of new products or technology that have made (or are likely to make) a significant difference in practice? Contact Christopher Kent at kentcx@boucher1.com to find out about possible coverage in a future issue.