new technology user guide
The Allegretto Wave Laser: How Can it Benefit Your Practice?
A comprehensive look at how to integrate this laser into your practice.
BENNETT CHOTINER, M.D., F.A.C.S.

Integrating any new technology into a practice requires both a commitment to use this technology to its best advantage and an expectation that such a commitment will achieve the desired results. Successful practices do not commit to new technology simply for the sake of its newness, nor do they commit to new technology with which they are uncomfortable. Our industry is replete with expensive new products that gather dust in office and surgicenter storerooms.

Quality equipment does not require overly persuasive salespersons, nor are "deals du jour" required to close the sale. However, in an era of cost consciousness, major equipment purchases must bring value to a practice.

New Technology

The Allegretto Wave Laser (WaveLight Tehnologie AG, Erlangen, Germany) is a perfect example of new technology that brings value to a practice. As one of the 11 WaveLight Food and Drug Administration (FDA) investigational sites, we have had the pleasure and the privilege of using this plat-form for almost 5 years, and, since its FDA approval in late 2003, we have used this platform almost exclusively. In our experience, and, I believe, in the experience of all of the groups and individuals who have subsequently committed to this technology, the Allegretto Wave has set new standards for patient, physician and staff satisfaction.

While the initial cost to implement the Allegretto Wave into an individual or group practice may be significantly higher than other platforms, the long-term benefits to both patients and providers make this investment a prudent choice. The Allegretto Wave is fast, precise and reliable. The laser's speed and precision, combined with its wavefront optimized algorithms, give it the ability to achieve spectacular results. One-day postoperative visual acuity of 20/20 or 20/16 and enhancement rates lower than 1% to 2% ("See Keep Enhancements Rates Low, on page 54.") are the rule rather than the exception. When even your patients with 10 D of myopia see 20/20 on postop day 1, the "wow" factor is enormous.

Market Conditions

Market conditions vary in different locales, but it is our belief that in almost any market, superior results with fewer enhancements translate into better LASIK practices. Varying market conditions may affect whether they translate into larger LASIK practices, but it is our experience premium products and services can and will drive demand, and at the same time justify premium prices. It is obviously beneficial to be the first to bring superior technology into a market.

Practice volume at which a WaveLight purchase is practical and affordable will also vary with individual market situations and procedure pricing strategies. We would certainly price this as a premium product and service and leave the discount market to older platforms.

Laser Platforms

Most individuals or groups contemplating purchase of the Allegretto Wave will have experience with one or more other laser platforms.

Ergonomically, the Allegretto Wave looks and feels somewhat different than older platforms, and may take a brief period of adjustment on the part of both surgeons and technicians. However, the transition period is rapid. The Allegretto's footprint is reasonably compact, and space should not be an issue for most facilities. However, surgeons who use IntraLase femtosecond laser (IntraLase Corp., Irvine, Calif.) to make their LASIK flaps and who may have rotated the patient bed between the IntraLase and other excimer platforms, will find that this is not possible with the Allegretto. We have been using IntraLase for over 2 years and do not find this to be a problem at all. In fact, we have placed our IntraLase in a separate room adjacent to the excimer suite. Having the Allegretto in one room and the IntraLase in an adjacent room actually speeds up patient flow since we can be working in one room while patients are prepared in the other room. My particular routine is to do the IntraLase flaps on the first three patients of the day, and then to alternate between the Allegretto and the IntraLase. So while patient #3 is having his/her IntraLase procedure, patient #1 is being readied in the WaveLight room. And while patient #1 is having his/her Allegretto procedure, patient #4 is being readied in the IntraLase room. A third room adjacent to the other two is fitted out with reclining lounge chairs and a high-end music system which helps patients to rest and relax between the IntraLase and WaveLight procedures. The time period between the two procedures allows the opaque bubble layer to completely clear in almost all patients. In those rare cases where some opaque bubbles persist, the Allegretto still performs well. Using this flow pattern, we are able to average three to four patients per hour at a very reasonable pace.

Both the IntraLase and WaveLight rooms are fitted with video monitoring equipment, and we encourage family members to participate in the overall experience if they so desire. Patients and their families are particularly impressed with the speed and ease of the procedure. Our technical and support staff are particularly impressed with the consistency, accuracy, and reliability of the Allegretto. Our staff morale has never been higher and we attribute this in large part to the superior results that we achieve using this platform.

Our older excimer platform does have wavefront-guided capability, and prior to WaveLight's FDA approval we were offering wavefront guided "custom" procedures to most of our patient who were candidates for them. However, it quickly became apparent that our results with our WaveLight wavefront-optimized FDA study procedures were at least as good and perhaps even better than our results with our wavefront-guided "custom" procedures on our older platform. Equally important, from a patient flow standpoint, preoperative and intraoperative workups and surgical planning are significantly less cumbersome and more consistent and reliable using WaveLight wavefront optimized ablations as compared to using wavefront-guided ablations on our older platform. This too contributes to improved staff morale and overall patient satisfaction.

Wavefront-optimized vs. Wavefront-guided

During the past 2 years since "custom" procedures were first introduced on older platforms, prospective patients have been well educated about wavefront technology. We do not try to confuse or mislead patients with regard to "wavefront-optimized" vs. "wavefront-guided" procedures. We do explain the difference and discuss our experience and results with both approaches and our reasons for preferring the Allegretto Wave platform. Our results speak for themselves and are our most important and effective marketing tool. For almost 28 years, Memorial Eye Institute has been dedicated and committed to excellence and innovation in eye care and eye surgery. For the past 10 years, our practice motto has been "The Passionate Pursuit of Perfection." WaveLight's "Perfect Pulse" technology has become an important part of this pursuit.

Our experience with the WaveLight Allegretto Wave Laser has certainly not been unique. While our participation in the WaveLight FDA Study did give our staff the advantage of hands-on experience with this platform prior to FDA approval, more recent purchasers of the Allegretto Wave have reported no significant difficulties in integrating this laser into their practices. In fact, their ongoing enthusiasm for this platform continues to be infectious.

Bennett Chotiner, M.D., F.A.C.S., is medical director at Memorial Eye Institute, Harrisburg, Pa. Dr. Chotiner has no financial interest in this article and can be reached at drc@memorialeye.com and his website is www.memorialeye.com.