POST-AAO REPORT
"I'm Ready, Doctor"
Voice confirmation is just one new feature of the Amadeus II microkeratome. Find out how this next-generation device is improving refractive surgery outcomes.

The Amadeus II represents the next stage in the evolution of refractive surgery. Notable new features include:

• Gearless system
• Dual motors
• Smaller, lighter hand piece
• Voice confirmation.

How do these features benefit surgeons and their patients? At the 2004 American Academy of Ophthalmology annual meeting, several top surgeons discussed their experiences with the Amadeus II. Here are some of their impressions.

New robust features

Panelists agree the new design of the Amadeus is giving them an edge in the OR. The gearless system eliminates jamming, and the suction ring decreases ischemic time.

"The suction ring of the Amadeus II has fluted sides," says Y. Ralph Chu, M.D., medical director for the Chu Vision Institute in Edina, Minn. "It's designed to be used without a speculum. The tracks are gearless, ensuring that nothing gets caught inside. Even in patients with overhanging lids, I don't know any other keratome that could perform as safely."

The dual-motor feature on Amadeus II provides power and safety during flap creation. "One motor moves the blade and the other moves the head forward, making for a very powerful unit," Dr. Chu says.

The Amadeus II features a smaller, lighter hand piece than the Amadeus I, reducing the weight traveling across the eye by 65%. "Most of the hand piece weight is stationary so that only the oscillation blade component travels across the eye," says Kerry D. Solomon, M.D., director, Magill Laser Center for Vision Correction, Storm Eye Institute, Charleston, S.C. "Less weight across the eye translates into smoother beds. The Amadeus II is the most predictable device to create flaps."

Another asset of the Amadeus II is the short learning curve, says Eric D. Donnenfeld, M.D., of the TLC Laser Eye Center and Ophthalmic Consultants of Long Island in Garden City, N.Y. "We train our fellows to use the Amadeus II, and after two or three procedures, they're doing perfect LASIK almost every time," he says.

The brief learning curve is due in part to the single-hand design of the Amadeus II, which allows surgeons to perform other tasks, such as applanation tonometry, during procedures.

While surgeons can see and feel the difference with the Amadeus II, so can patients. The combination of rapid wound healing and better flap bed quality allows patients to see better the following day. As Dr. Donnenfeld reports, "We're getting no buttonholes, no irregular flaps, no free flaps and no significant complications. And patients can see the next day."

In addition to these features, the Amadeus II now incorporates an epi-LASIK component, a procedure that some surgeons believe is the future of refractive surgery.

Versatility provides value

The panelists agree the epi-LASIK component of the Amadeus II provides tremendous value to the refractive surgeon. "Epi-LASIK on the Amadeus II will revolutionize what this unit can do," Dr. Chu says. "Combining a tonometer and a pachymeter allows the keratome to compete with, if not beat, the femtosecond laser in surface ablation."

See "Mechanical Keratome vs. Laser" for study results.

"Epi-LASIK, with smooth beds and nice epithelial flaps, promises to be a major advance in refractive surgery," Dr. Donnenfeld says.

Dr. Solomon agrees. "To be a full refractive surgeon, you'll need to have LASIK capability and also be very comfortable with the surface ablation aspect of refractive surgery," he says.

A word about "the voice"

From a technical and mechanical standpoint, the Amadeus II is gaining a foothold in refractive practices. "The new design of the Amadeus II makes it easier for my technician and nursing staff to operate," Dr. Solomon says. "They also appreciate the voice confirmation feature."

The voice confirmation, as well as a printout for each procedure, ensures readiness in a manner that all who use the Amadeus II understand, from surgeon to staff.

"I see the wisdom of verbal commands in the Amadeus II," Dr. Solomon says. "My staff loves it, and it has made them feel a part of the process. My whole staff now says 'I'm ready, doctor.' I can't explain how much it's meant to my practice from a morale standpoint."

Amadeus II for the future

Dr. Donnenfeld estimates that 2 years from now, about 20% of his refractive cases will involve surface ablation, up from the 8% he currently performs. He's confident this will be an industry-wide trend. "As we become more attuned toward ectasia, deeper ablations and peripheral blends, we're going to move more toward surface ablation," he says.

From its lightweight design allowing single-handed use to the integrated pachymeter and tonometer, the Amadeus II is receiving high marks. Add its epi-LASIK component, and this device is poised to take refractive surgery practices into the future.

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