With faster preoperative measurements,1-5 easier access to planning data,5-6 better precision,1,2,7,8 and high repeatability for accurate measurements, plus connection among all the systems in the Alcon Vision Suite, the ARGOS® Biometer with Image Guidance (Alcon) is streamlining the surgical planning process for clinics.9
We spoke with Robin R. Vann, MD, an associate professor of ophthalmology and medical director of Duke Eye Center in Arringdon, N.C., and Eva Kim, MD, a cataract and refractive surgeon, a uveitis specialist, the vice president of operations, and medical director of ICON Eyecare in Denver, Colo., about how bringing ARGOS® into their clinics has improved their process, from planning to the operating room.
What do you find the most intriguing about ARGOS®?
Robin R. Vann, MD: I love the fact that it has the ability to plan your surgery and integrate it into the operating room with image registration and guidance for other Alcon technologies, such as LenSx®, the ORA SYSTEM®, and VERION®. The segmented axial length feature is unique and can help further improve our accuracy in extreme eyes.7,10
Eva Kim, MD: We were interested in adopting ARGOS® biometry early on because we were already fans of Alcon cataract equipment. We utilize the Centurion® phaco unit, ORA®, and the LenSx® femtosecond laser. Incorporating the ARGOS® biometry unit just made sense for us, and I knew that one day there would be a remote planner that would tie all our equipment together.
What was the learning curve and Alcon support like—for you and your technicians—when you purchased ARGOS® for your clinic?
Dr. Vann: Alcon’s support was incredible, and they helped set up our IOL preferences and lens constants from previous biometers. They spent a lot of time working on preferred printouts, ensuring our technicians were comfortable with the new technology, and getting great captures. The technicians have found it efficient and easy to capture data. They rarely require a different device to get good axial length readings.
Dr. Kim: While most of our clinics utilized biometry technology that worked well for our ophthalmologists, everyone found the ARGOS® system easy to learn. Our technicians, however, were the ones who really benefited. They loved ARGOS® because it was easy to use and fast when working with patients.1-6 The Alcon trainers were very committed to tech training, and our technicians picked up the workflow very easily.
Can you describe what your pre-op planning process was like before ARGOS® and how ARGOS® has streamlined your “new” workflow?
Dr. Vann: Before ARGOS®, my process was fragmented: exporting biometric information into VERION®, and then creating a plan within VERION® to push into the operating room, and sometimes separately entering information into the ORA® AnalyzORTM database before surgery. I would also create a single-page handout for easy reference in the operating room that was taped to one of the machines.
ARGOS® has simplified this process because it now takes all the biometric readings, as well as reference images, at the time of the original capture. After choosing a lens during patient consultation, I can simply choose the target refraction and the lens model, then push it through the network to be available in the operating room on the surgery day for reference images and any ORA® verification.
How has ARGOS® affected your own surgical workflow?
Dr. Kim: When we first acquired ARGOS®, I noticed an increased efficiency of the technicians prior to me seeing the patient. I wasn’t waiting around as long for the patient to be ready. Now that we have Alcon’s SMARTCataract system, I can access the biometry information from the clinic room while I am simultaneously doing my cataract consultation. If the patient is decisive, I can even pick the exact IOL and power so I don’t have to do this later. I’ve made a habit of opening SMARTCataract the evening before my surgical day to make sure that all of my choices are correct and that everything has been exported to ORA® and LenSx®. To know that all of my information is shared between devices without the risk of transcription error is a great feeling.
Dr. Vann: As a more robust system, it simplifies the disparate processes I had used previously to accomplish the same goal. It is an easier process with less time spent capturing information for patients.2,3,5 It is easier for the technicians’ workflow and it simplifies the work I need to do to be ready on surgery day.
In the OR, which devices are you using in conjunction with the ARGOS® system’s reference imaging and cataract plans for image-guided cataract surgery?
Dr. Kim: I routinely use LenSx®, DML on LenSx®, and ORA®. I am also considering the DMM for patients who undergo toric ICL surgery in the future. However, I am the most excited for the iris registration on our ARGOS® that I can utilize with the DML on the lens for more accurate toric placement. I have never liked having to mark the patient’s eye in pre-op, as it scares the patient and can be inaccurate to do this free hand.
What are the key benefits to using other Alcon devices with the ARGOS® reference image for image-guided cataract surgery?
Dr. Kim: With the ORA®, I enjoy that there are no transcription errors, since the information goes through the cloud.5 It’s also much more efficient for my surgery schedulers to not have to spend time planting this information into the ORA® website like they used to. Though not super common, there were transcription errors that I would have to check over on my OR day. I would routinely come to the operating room about 30 minutes early just to check over my cases.
Dr. Vann: Image-guided cataract surgery is crucial for addressing astigmatism properly, and the ARGOS® system has greatly simplified this process. I no longer sit the patient upright prior to the surgery to create a manual error-prone reference for aligning toric lens implants or astigmatic incisions. The Image Guidance system works with the preoperative pupil measurements captured by the ARGOS® system, ensuring proper centration for extended depth of focus IOLs and multifocal IOLs.5
How has image-guided cataract surgery impacted your practice as a whole?
Dr. Vann: Image-guided cataract surgery has greatly improved my confidence, my accuracy in treating astigmatism, and my ability to provide patients better uncorrected vision with a simple and easy workflow solution.
Dr. Kim: Our patient experience is very important to us, and because ARGOS® allows for more efficient technician work-ups, this shortens our overall cataract consultation time for patients.
References
- Tamaoki A, Kojima T, Hasegawa A, et al. Clinical evaluation of a new swept-source optical coherence biometer that uses individual refractive indices to measure axial length in cataract patients. Ophthalmic Res. 2019;19:1-13.
- Shammas HJ, Ortiz S, Shammas MC, et al. Biometry measurements using a new large-coherence-length swept-source optical coherence tomographer. J Cataract Refract Surg. 2016;42:50-61.
- Hussaindeen JR, Mariam EG, Arunachalam S, et al. Comparison of axial length using a new swept-source optical coherence tomography-based biometer. PLoS ONE.2018;13(12):e0209356.
- ZEISS IOLMaster 700 510k Submission 2015.
- ARGOS® Biometer User Manual. 2019.
- VERION® Reference Unit User Manual Part I. 2019.
- Whang W, Yoo Y, Kang M, et al. Predictive accuracy of partial coherence interferometry and swept-source optical coherence tomography for intraocular lens power calculation. Sci Rep. 2018;8(1):13732.
- Shammas HJ, Shammas MC, Jivrajka RV, Cooke DL, Potvin R. Effects on IOL power calculation and expected clinical outcomes of axial length measurements based on multiple vs single refractive indices. Clin Ophthalmol. 2020;14:1511-1519.
- Woodard L, Wenthold R, Hsiao C-W. Time-and-motion study demonstrating the value proposition for ARGOS®. June 2020.
- Wang L, Cao D, Weikert MP, Koch DD. Calculation of axial length using a single group refractive index versus using different refractive indices for each ocular segment. Theoretical Study and Refractive Outcomes. Ophthalmology. 2019:126(5):663-670.
Important Safety Information
The ARGOS® Biometer with Image Guidance by Alcon® Caution: Federal (USA) law restricts this device to the sale by or on the order of a physician.
Indications: ARGOS® is a non-invasive, non-contact biometer based on swept-source optical coherence tomography (SS-OCT). The device is intended to acquire ocular measurements as well as perform calculations to determine the appropriate intraocular lens (IOL) power and type for implantation during intraocular lens placement.
Intended Use: The Reference Image functionality is intended for use as a preoperative and postoperative image capture tool. It is intended for use by ophthalmologists, physicians, and other eye-care professionals and may only be used under the supervision of a physician.
Warnings and Precautions:
• Only properly trained personnel with experience may operate the device and control software and interpret the results.
• Factors that influence the measurement of patient’s eyes are listed in the User Manual (Table 1): pseudophakic eye, wearing contact lenses, fixation problem, cornea opacity, non-intact cornea, refractive surgery, blood in the vitreous humor, retinal detachment, keratoconus, asteroid hyalosis, ambient light in the room, and deformation of the corneal shape. Please consider the guidance provided in Table 1 when you encounter these factors.
• Optical Radiation - This device is equipped with a Class 1 laser light source.
ATTENTION: Refer to the ARGOS® User Manual for a complete description of proper use and maintenance, optical and technical specifications, as well as a complete list of warnings and precautions.
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