SPOTLIGHT ON TECHNOLOGY & TECHNIQUE

New tool makes more time for more patients

Marking pen-alternative quickly inks a patient’s eyes for incision.

By Robert Stoneback, Associate Editor

Days for Jim Loden, MD, are now much busier, and he couldn’t be happier about it.

Thanks to a small device about the size of a cigar, he can now add another three-and-a-half premium IOL cases to his surgery day.

The RoboMarker, from Surgilum, is a self-leveling, pre-inked corneal marker that lets clinics quickly and accurately mark a patient’s eyes. At first glance, the device looks like a large, thick thermometer with a short, two-pronged prod protruding out the top. At the base of the prod is the adjustable “RoboTip,” which can be used to set a desired axis. The RoboMarker will then maintain this axis on its own.

The prongs of the prod, an inked disposable tip, are placed over the eye to mark lines for incision. After marking, the RoboMarker’s tip is replaced to prevent cross-contamination.

Surgilum’s RoboMarker uses a pre-inked probe to quickly make incision marks on eyes.

MORE TIME, MORE PATIENTS

Efficiency is always an issue when preparing patients for premium IOL surgery, says Dr. Loden, of the Tennessee-based Loden Vision Centers. Almost all these eyes need those markings to direct the ophthalmologist where to make the incisions, and creating them eats into time that could be spent with other patients.

With the RoboMarker, this task is not only faster but it can be assigned to a technician to perform. By marking a patient’s eyes in the span of 30 seconds to 60 seconds, the RoboMarker shaves about two minutes off the time Dr. Loden spends with each patient. And that time adds up. At Dr. Loden’s rate of about 40 patients a day, “I could have done 3.5 cases in the time I wasted marking” before switching to RoboMarker, he says.

Dr. Loden used to mark patients’ eyes himself, moving patients to and from a slit lamp in order to use a traditional marking pen. This task was particularly slow for the majority of his patients over 70 years old — it took several minutes just to move them from their pre-operative chair to the slit lamp. “It doesn’t seem like much, but with 75-year-old people, it takes three minutes just to have them stand up and get their head in position,” says Dr. Loden. It’s much more convenient to use the RoboMarker without having to move the patient at all. And the RoboMarker’s disposable tips means the device doesn’t need to be resterilized after each use.

PROPER ALIGNMENT

Referring to the RoboMarker’s learning curve, Dr. Loden says it was “super easy to get” a handle on using it. However, the RoboMarker requires training to use properly, says Dr. Loden. “It’s not a point-and-shoot for a totally untrained technician.” When using the marker, the technician needs to make sure it is properly aligned, that the patient’s head is vertical and that the patient is not blinking or looking away. The technician must recognize when the markers need to touch the cornea at the same time — the marking can be off if one side touches the eye before the other.

Surgilum recommends using a “fingerbreak” technique, which braces the RoboMarker against an outstretched finger so that it doesn’t roll. Dr. Loden found this easy to master.

Dr. Loden previously tried using pendular markers with a self-leveling feature but found they rotated too easily when making asymmetrical contact with the eye. But using the RoboMarker and the fingerbreak technique, his staff did not have this problem.

Technicians with a few years of experience in ophthalmic technology should be able to use the RoboMarker effectively after about 30 minutes of training, says Dr. Loden. In his experience, it’s a matter of having that tech use it on five to 10 patients with the ophthalmologist’s supervision.

RESIDENT-APPROVED

The RoboMarker has also been popular with medical residents.

“Every resident has wondered if the mark they placed is in the right place,” says Khoa Pham, MD, a resident at New York Eye and Ear Infirmary of Mount Sinai. “The RoboMarker makes this critical step more accurate and efficient.”

All programs could benefit from its use, Dr. Pham says.

“There is nothing more nerve wracking for a resident than getting through the case and being uncertain about alignment for the toric,” says Kathleen C. Oktavec, MD, a resident at Columbia University Medical Center.

“I did torics before we got the [RoboMarker], and half the time I had to mark a few times because of the clumsiness of the ring,” she relates. With the RoboMarker’s ease of use, though, “I feel confident the placement is spot-on.”

James Auran, MD, professor of ophthalmology at Columbia University Medical Center, has been a champion of the RoboMarker among his peers and residents.

“The residents love it” for its precision and the sharp, clear marks of its ink, he says. “It seems to me every center that does refractive surgery should have a RoboMarker because it’s the best manual marking system available.”

Dr. Auran’s clinic paid $1,750 for the device when it was purchased a few years ago. The device came with 20 tips, and the single-use tips are about $12 each, he says.

Even clinics that use an electronic means of measuring incisions should have a RoboMarker for back-up, Dr. Auran adds.

“I think it’s a great invention. I can’t believe it hasn’t taken off more.” OM