The new VISULAS yag therapeutic laser is bringing new meaning to specificity and precision for postoperative cataract patients.
Oftentimes, optimal surgical specificity and precision are born out of how well workflow occurs preoperatively and postoperatively. Cataract, corneal, refractive and retinal procedures are no different, as recent advances have brought with them an increasing ability to produce more specific and precise outcomes without slowing down surgeons.
“There has been a significant industry shift towards efficiency,” says Steve Schallhorn, MD, professor of ophthalmology at the University of California San Francisco and chief medical officer at Zeiss Meditec. “There had already been a movement towards efficiency and productivity prior to COVID, but the pandemic accelerated the shift to provide better and more efficient care with fewer resources and beginning-to-end workflow solutions for all necessary components.”
This mentality is exemplified in the newly updated VISULAS yag therapeutic laser from Zeiss Meditec. A recent innovation added to the ZEISS Medical Ecosystem, the device is a modern, compact laser workstation designed to assist physicians in the performance of posterior capsulotomy for a variety of IOLs and iridotomy procedures for safe and effective photo-disruption. Through a system that can more effectively, safely and efficiently open the posterior capsule in patients experiencing the typical post-op cloudiness of the capsular bag, the laser is expected to enhance the ability to relieve that cloudiness by taking a more precise corrective action before the condition exacerbates.
CLEAR PATHWAY FOR PATIENTS AND PROVIDERS
Granted 510k clearance by the FDA in October, the VISULAS yag laser is equipped with a high-precision Super-Gaussian beam that focuses the optimal amount of laser energy onto the point of treatment. This allows for the minimum amount of energy required for improved procedural safety. The four-point aiming beam merges into one point at the laser focal plane, enabling high-precision focusing and more precise control to open the opacified posterior capsule,
Dr. Schallhorn reports. (If a multifocal IOL is implanted, it is possible to reduce to a two-point-aiming beam for relative accuracy and sensitivity.)
“In years past, the ophthalmic community tended to address capsular cloudiness when it resulted in significant visual disability,” he says. “But we’re appreciating that addressing symptomatic opacification earlier can result in quicker vision rehabilitation and improvement of symptoms.
Additional updated features of the device include an intuitive graphic interface with high-quality imaging on a large screen and the ability to adjust the laser’s parameters. Based on the selected application, the automated focus shift sets the focal point of treatment in front of, behind, or directly at the focal point of the aiming beam and allows for toggling between anterior and posterior positioning.
“Depending on the surgeon’s particular yag capsulotomy technique, the plane of the yag laser focus can be adjusted to be slightly behind or in front of the four-point aiming beam merge,”
Dr. Schallhorn says. “With the VISULAS, it is readily apparent to the surgeon exactly where the laser will be focused. Microns matter in this regard.”
According to Kaweh Mansouri, MD, MPH, a consultant ophthalmologist at Swiss Visio Montchoisi Clinic in Lausanne, Switzerland, and an adjunct professor at University of Colorado, these amenities make the device especially effective among patients who have multifocal, presbyopia-correcting, monofocal or other premium IOLs. The unit is ergonomically sound as well, says Dr. Mansouri, who has found the workstation also valuable as a teaching tool.
“Junior physicians can follow the laser treatment in great detail on the screen compared to integrated non-stereoscopic oculars, which few centers have, versus no screen at all, which enables them to better understand how this treatment is performed,” says Dr. Mansouri. “In exchange, when they perform their first cases on a live eye, the attending can follow in real time to advise or intervene, if needed.”
A ‘REFRESHING' APPROACH
With connectivity to the ZEISS FORUM software, this application-based laser can be easily integrated into the ZEISS Cataract Workflow, providing a seamless workflow transition to the ZEISS suite of products, says Dr. Schallhorn. “It’s fully compatible and compliant with FORUM, which means there’s full and transparent integration of patient data and the treatment parameters. Every aspect of the treatment is streamlined because it is all essentially online and placed within the FORUM.”
These updated features represent a new direction for the yag laser. The device is intended to improve management of patients after cataract surgery by reducing the length of recovery needed post-op and to assess that visual and refractive outcomes are satisfactory. “The new product takes the existing laser and significantly improves it. The view through the scope is fantastic,” Dr. Schallhorn says. “Surgeons will appreciate the quality of the imaging and the ability to accurately perform the yag capsulotomy quickly and efficiently.”
An intuitive user interface lends itself to being easily incorporated into a practice as well, says Dr. Mansouri. “The workflow integration that it has is an important component, meaning that it’s easy, efficient and quick. It can be readily incorporated into a practice’s workflow through the Zeiss FORUM system. And that lends to it being quickly adopted and used in the clinic.” Depending on one’s experience with laser capsulotomy, Dr. Mansouri estimates that the learning curve to become comfortable with the yag materials is between one to three cases.
REIMBURSEMENT, MAINTENANCE AND TRAINING
Reimbursement rates are available and could vary depending on the location of the procedure, the insurance provider, the patient’s coverage and other factors. Additionally, the equipment requires Zeiss-authorized personnel to perform maintenance and safety checks at least every 2 years, including a laser safety check, a precise optical system check and software updates. However, “these are robust machines that have excellent reliability and usability,” says Dr. Schallhorn.
There is also a need to perform in-house training for the laser itself, and it’s advised that each practice establish patient education around the device, which the manufacturer has materials to assist with. “Patients need to understand the procedure and post-care,” Dr. Schallhorn says. “We have an effective, painless, safe system in this laser to help them experience improved outcomes.” OM
