The Norlase LION laser indirect ophthalmoscope brings untethered innovation to eye care.

Patient portals. Paperless health records. Tele-health. These are just a few of the ways digital and wireless technologies have transformed eye care over the years.

Now enter the LION, a new laser indirect ophthalmoscope (LIO) from Norlase that combines a green laser photocoagulator with a Keeler indirect ophthalmoscope.

Unlike other LIOs that require a fiber-optic connection to a laser source, the battery-powered LION requires no fiber tether and utilizes an advanced wireless interface with voice control of parameters, according to Norlase. As a result, ophthalmologists can experience an untethered, lightweight and portable laser treatment solution virtually anywhere.

“I think this is one of those developments that’s going to change the game in ophthalmoscopy,” says John Kitchens, MD, of Retina Associates of Kentucky. “I would compare it to when the iPhone came out, how it changed the phone game.”

Dr. Kitchens is an early adopter of LION, which Norlase launched in October 2020 soon after receiving FDA 510(k) clearance. The device offers six major features:

• Fully integrated green laser and LIO
• No fiber tether
• Compact and portable design
• A rechargeable battery
• Parameter settings that can be set through a wireless tablet
• Optional voice recognition.

COMPACT AND CABLE FREE

Standard combination laser and indirect ophthalmoscopes utilize a heavy, AC-powered laser box with a large footprint and a lengthy fiber-optic cord that connects the laser box to the headset of the LIO.

“Our laser box is about 12 inches by 18 inches by 10 inches, and it’s very heavy, so it’s not something that you could just pick up and carry,” says S.K. Steven Houston III, MD, of the Florida Retina Institute, another early adopter of LION. “It sits on a rolling cart, so that if we want to move it, it has to be unplugged from the wall and rolled into another room.”

Standard laser/indirect ophthalmoscope combos also utilize fiber-optic cables, which are prone to breakage and expensive to replace. “We are constantly having to replace the fiber-optic cables on our in-office lasers,” says Dr. Kitchens.

Dr. Houston agrees, noting that fiber-optic cables can easily be stepped on and cost as much as $4,000 each to replace. “Even if I just replace it once, that adds up. If I replace them twice, that’s as much as $8,000 a year,” he says.

The fully integrated LION eliminates those drawbacks with one compact, portable unit that doesn’t require the box to be plugged into a wall outlet or a headset that needs to be connected to the freestanding box with fiber-optic cables.

“It truly is a wireless solution. You can take it anywhere in clinic, you can travel with it, you can take it internationally if you’re doing missions, so there’s a lot of potential utility to having a nice compact unit that fits in a carry-on suitcase,” says Dr. Houston. Whereas a laser box can weigh 20 pounds or more, LION weighs no more than a diagnostic indirect.

In addition, the LION’s rechargeable lithium-oxide battery is built into the unit’s foot pedal and has a larger charge capacity than most batteries found on competing portable indirect ophthalmoscopes, says Dr. Kitchens.

“It will last for several hundred thousand shots. If it does run out, you can still plug it into a wall outlet; it will function like a standard indirect laser ophthalmoscope,” he says.

TOUCH, VOICE CAPABILITIES

LION can be connected to the supplied Android tablet through Bluetooth technology, which can be used to change parameter settings through an intuitive graphic user interface.

Dr. Houston points out that touchscreens integrated into indirect ophthalmoscopes often struggle with the touch reactivity and breakdowns are not uncommon.

“But with an Android device, that touchscreen is as good as you get on any tablet or iPad,” he says. “With one touch, and within a second, you can adjust the power or the interval up or down.”

LION also offers optional voice recognition capabilities. “All you have to do is say, ‘OK, Norlase,’ and you can power on, power off, increase your interval, increase your duration or increase or decrease your aiming beam,” Dr. Kitchens says.

NEW EFFICIENCIES

Drs. Kitchens and Houston agree that LION’s features result in a device that delivers unparalleled efficiency. “With LION, you no longer need a dedicated laser room,” says Dr. Kitchens.

“It’s a quicker unit for my staff to get started,” adds Dr. Houston, whose practice spans 19 offices. “I can perform lasers more quickly because of the enhanced visualization and optics and the depth of focus, and I can take it to different rooms and clinics.” All that flexibility increases practice efficiency, “which is significant especially during the current pandemic, as we’re trying to move patients through the clinic more quickly to decrease their potential exposure.” OM