Spotlight ON TECHNOLOGY & TECHNIQUE

Victus Takes Femto to The Next Level

Reduced laser energy and real-time imaging, among other features, integrate what the field has learned.

By Bill Kekevian, Associate Editor

A study presented at ASCRS 2012 showed capsulotomies made with the Victus femtosecond laser platform were statistically significantly more precise than those created by hand.¹ That difference is important to a surgeon like Michael J. Endl, MD, a partner at Fitchte, Endl & Elmer Eyecare in Niagara Falls, N.Y. Dr. Endl performs 20 capsulotomies every surgery day.

Days drag on, hands get tired, and humans cannot perfectly replicate the same tasks over and over. “You can be the best surgeon in the world, but when you freehand a capsulotomy, it’s never a perfect circle. Now, with lasers, it is,” he says. The advantage for patients means more accurate predictability of postoperative vision correction, according to Dr. Endl. “It gives you a better prediction of the implant’s final position,” he says.

In Practice

Dr. Endl’s practice obtained the Victus femtosecond laser in September — he says it’s the first practice installation in the United States. The FDA approved the laser in July for creation of corneal flap in patients undergoing LASIK or other treatment requiring initial lamellar resection of the cornea, and anterior capsulotomy during cataract surgery. Victus was developed in a joint venture between Bausch + Lomb and Technolas Perfect Vision (TPV). Bausch + Lomb has since exercised its option to purchase all outstanding shares of TPV.

Victus is not the first femtosecond platform to gain FDA approval (the first was in October 2010), but Stephen J. Dell, MD, of Dell Laser Consultants in Austin, Texas, suggests the gap allowed for B + L and TPV to improve the technology. He said, in a statement, the platform “integrates much of what the field had learned over the first few years.” He added, “I first performed femto-assisted surgery in 2010 with a prior platform, but the Victus incorporates a variety of technological improvements.”

Real-time Imaging

Victus allows the surgeon to make adjustments for individual patients both preoperatively and intraoperatively on two high-definition touch screens with a keyboard option. Dr. Endl says, with this system, “it’s almost like you’re doing a virtual procedure first.” Indeed, all the relevant steps are predefined electronically using a graphic interface. Before surgery begins, the route is mapped out based on the imaging data collected.

The imaging system is more than “a snapshot where you image the anterior segment and then plan your surgery,” says Calvin Roberts, MD, B + L chief medical officer.

The Victus uses real-time OCT ultrasound imaging, perhaps its most distinctive feature, in place of traditional OCT. Dr. Endl sums up the inherent advantage. Victus “shows where the lens is at that moment, not where the lens was,” he says. “If a patient moves, the doctor can follow that instantly.” This real-time OCT ultrasound imaging functions as a replacement for the traditional surgeon’s microscope, he says. “You can’t do an overlay through a microscope,” Dr. Endl says.

Patient Comfort

“This machine doesn’t have an issue with patient discomfort,” Dr. Endl says. The patient interface consists of two components: a suction ring and a proprietary curved interface. The curved interface applies the laser’s energy more efficiently than a flat interface, Dr. Endl says, providing for enhanced patient comfort.

“The suction level is significantly less than other machines,” Dr. Endl adds. Most other suction components cause patients to temporarily lose vision, he says.

Out of the Box

In Dr. Endl’s experience, some devices need to be calibrated specifically to account for room conditions as well as energy settings or even the climate. “The day it’s installed the Victus is working comfortably right out of the box,” he says.

Looking to the future, Dr. Endl notes Victus is only awaiting FDA approval to perform a broader range of cataract incisions. In Europe, it’s already received those approvals. OM

1.Reddy, K.P. Investigation into the precision and accuracy of femtosecond laser cataract surgery. Presented at the annual meeting of the ESCRS in Milan, Italy, 2012.