Iridex’s fifth-generation PASCAL Laser System takes laser treatment to a higher level.

It’s been almost 20 years since the first PASCAL Photocoagulator became available, and Yannis M. Paulus, MD, FACS, still considers the device his go-to laser for the treatment of vitreoretinal diseases.

“I have been using the PASCAL laser system for 16 years, and I have used a number of laser systems from other companies,” says Dr. Paulus, a retina specialist with the Kellogg Eye Center at the University of Michigan in Ann Arbor. “But I like the ease of use with the PASCAL and the ability to perform treatments more rapidly through the application of a pattern of laser burns. I also find that patients are more comfortable with the shorter pulse duration.”

Launched by Iridex in April 2023, the fifth generation of the platform now known as the PASCAL Laser System is designed to combine fast, precise pattern-scanning capabilities, endpoint management technology, pattern scanning laser trabeculoplasty, and MicroPulse technology in a smaller, ergonomically optimized and integrated laser platform.

“The realities of today’s clinical practice are pushing for greater return on investment on equipment purchased. This creates the need for increased procedure speed and ergonomic comfort, plus broad treatment capabilities,” says Steve Koufos, vice president, marketing, Iridex Corp.

TISSUE-SPARING TECHNOLOGY

According to the company, PASCAL offers three tissue-sparing technology options:

• MicroPulse, Iridex’s proprietary technology that “chops” a continuous-wave laser beam into alternating sequences of short, low-energy pulses and rest periods that allow the tissue to cool between pulses, minimizing tissue damage.
• Endpoint management, a pattern subthreshold therapy that uses a unique algorithm to control laser power and pulse duration, optimizing the therapeutic effect.
• Pattern scanning laser trabeculoplasty, which provides rapid, precise computer-guided treatment that applies a sequence of patterns onto the trabecular meshwork to reduce IOP.

“Our tissue-sparing options contribute to a less invasive approach, reducing the risk of complications and postoperative discomfort,” Mr. Koufos says. “Additionally, precise, controlled treatment leads to faster recovery times, enabling patients to resume their normal activities sooner.”

MORE RAPID TREATMENT, LESS PATIENT DISCOMFORT

Available in 577-nm (yellow) or 532-nm (green) models, PASCAL employs a four-fiber beam to deliver consistent energy across multiple tissue elevations and in the far periphery of the retina. Its intuitive user interface provides easy access to a wide variety of pattern variations, and its auto advance feature delivers sequential patterns without taking the physician’s eyes away from the oculars.

Dr. Paulus says this latest iteration of PASCAL represents a significant step forward in vitreoretinal treatment as the system addresses two significant pain points in laser treatment: time and patient discomfort, particularly with respect to panretinal photocoagulation (PRP).

“I find the PASCAL system alleviates these by making the treatment more rapid and reducing patient discomfort,” he says. “Previously, I wanted lasers scheduled at the end of the clinic day, both because they took so long and because patients were so uncomfortable afterwards, and I didn’t want to scare the waiting room. The improved comfort and speed have allowed us to integrate lasers throughout the clinic day in a seamless fashion.”

He also noted that while PRP previously required two or three sessions to complete, many patients can be treated with PASCAL in just one session.

REDUCED SIDE EFFECTS — AND MAYBE REDUCED PHARMACOLOGIC BURDEN

Jorge Calzada, MD, a retina surgeon at Deep Blue Retina in Memphis, Tenn., also gives the platform high marks, although he admits to being “cautious” of the MicroPulse technology early on.

“Initially, I only used the pattern generator for PRP lasers,” Dr. Calzada says. “But when presented with patients who were recalcitrant to pharmacologic treatment of diabetic macular edema, I decided to try the MicroPulse grid laser [and achieved] results greater than my original expectations.”

Dr. Calzada adds that he recently used PASCAL to treat a patient with a discrete leaking aneurysm. He was able to close the leak with a single laser session, leading to complete resolution of the edema and termination of intravitreal injections — which the patient had received bimonthly for the previous 8 years.

“Not all patients can have this response, [but] there are clearly patients that do and offering them proper laser treatments is a significant benefit for their care. To me, that is the most significant benefit to patients: the possibility of reduction or, hopefully, stoppage of intravitreal injections.”

Dr. Paulus calls the lower laser power required for treatment with the PASCAL system “a major benefit,” as it helps reduce side effects such as scarring and blind spots associated with more intense laser macular treatment.

“I prefer MicroPulse and endpoint management in patients in which I am treating the macula to reduce scotomas and other side effects,” he says. “I like to engage patients in the discussion, and together we make a decision for a tailored treatment plan that is unique for each individual patient.” OM

For more information about the Iridex PASCAL Laser System, visit www.iridex.com .