The faster performance of the VISUMAX 800 — the latest generation of Zeiss femtosecond lasers — is not the only benefit that surgeons are reporting as a gamechanger. Surgeons say it’s also easier to use and producing better outcomes.

Faster cutting speed, less suction loss

Sonny Goel, MD, cataract and refractive surgeon and medical director of Goel Vision with locations in Maryland, says that the faster cut speed of the 800 was a focus in their upgrade from its predecessor, the VISUMAX 500. According to Zeiss, the improved laser pulse repetition rate of 2 MHz, combined with a high-performance laser scanning system, makes it possible to create a lenticule in less than 10 seconds.

The faster cutting speed equates to shorter suction time, which reduces the probability of potential suction loss. Dr. Goel says this leads to a smoother dissection, which means less inflammation. That adds up to patients seeing better, faster.

“One of the quirks with SMILE is that patients have some initial difficulty with up-close vision, but I am seeing less of that with the 800,” he says. “I think that is likely due to easier suction and less inflammation.”

Since suction loss can lead to SMILE being aborted, William F. Wiley, MD, medical director of the Cleveland Eye Clinic in Ohio, says that less risk of suction loss is a big step forward.

“We often also experience suction loss due to patient anxiety and unexpected movement,” 
Dr. Wiley continues. “But the VISUMAX 800 does allow for a more comfortable patient experience. Its smaller footprint and the overall ergonomics of it are more comfortable. Similar to an open MRI, it has a less claustrophobic feeling.”

“A smoother and more efficient process”

Dr. Goel adds that patients also appreciate the speed of the procedure as it’s less stressful for them. While he had anticipated the faster laser speed, Dr. Goel says he was surprised that the VISUMAX 800 makes the entire experience more efficient.

“When you bring a patient into the room and put them on the bed, they will slide up under the machine and the arm comes right down into position,” he explains of the process. “There is some time savings as far as movement goes. Then, previously, the laser would go through a
30 to 45 second period of calibration but with the 800, it’s almost instantaneous. Finally, when the procedure is complete, previously you would hit the exit button and the bed has to slide down. But with the 800, the arm goes up and patients can sit right up. These incremental time savings add up to a smoother and more efficient process.”

John F. Doane, MD, FACS, a refractive and corneal surgeon with Discover Vision Centers in Kansas City, Mo., has been following the evolution of the VISUMAX 800 since its start. He says that easier dissections lead to easier surgeries — all of which makes everything easier on the surgeon.

“Anytime that you can make a procedure easier, you have the attention of the surgeon,” he says. “The increased laser frequency and faster cut speed leads to an easier dissection and easier tissue removal. At the end of the day, if surgeons are going home less mentally exhausted and less stressed because surgeries went smoother, that can improve their longevity.”

Like Dr. Goel, Dr. Doane says that the sped-up patient experience has been noticeable. 
“It’s not just the laser speed but also the fact that the software runs faster,” he says. “There were times I had to wait for the 500 to be ready but the 800 is ready while I’m still talking to the patient. The faster clock time for the software to do its calculations is a noticeable difference and patients also appreciate how fast it all is — making for a more enjoyable experience.”

The VISUMAX 800 also offers computer-assisted cyclotorsion (OcuLign) and centration (CentraLign) aids, giving more precision and control to procedures, Dr. Wiley points out. 
“The centration aid translates to an overall higher percentage of 20/20 patients while the cyclotorsion assistance helps ensure better placement for astigmatism correction,” he says. “The 800 provides better visual access than its predecessor.”

The learning curve

All the surgeons express that it was an easy transition from the 500 to the 800. Dr. Doane says that one learning curve from the 500 is the heads-up display. Instead of looking down, surgeons are now looking directly at a display. But he notes that it very quickly becomes apparent that this is more comfortable.

Dr. Wiley adds that an easier dissection due to a cleaner incision also translates to a faster learning curve for new surgeons, who might be performing some of their first-ever SMILE procedures.

“Newer surgeons typically tend to struggle with the dissection in SMILE, which is more nuanced than LASIK,” he explains. “However, an easier dissection means less learning curve for those new surgeons.”

Continued improvements = happier patients

Those who were early adopters of femtosecond lasers say that the continued evolution has been beneficial for both surgeons and their patients.

“We’ve been using a femtosecond laser from the beginning and each time it has evolved it has gotten faster,” says Dr. Wiley. “But beyond that, it’s continued to improve in many ways. Now, with the VISUMASX 800, we are seeing an overall improved procedure with faster visual recovery. That definitely translates to happier patients.” OASC