Upgrades to laser cataract surgery platform streamline treatment process

Take-home:

Upgrades to a laser cataract surgery platform include features such as high-resolution video screening images that improve efficiency. In addition, a new interface with a smaller suction ring diameter expands the number of people who are candidates for laser cataract surgery.

Dr. DonnenfeldBy Nancy Groves; Reviewed by Eric D. Donnenfeld, MD

Long Island, NY-The advent of two new technologies for a laser cataract surgery platform (Catalys Precision Laser System, Abbott Medical Optics [AMO]) may provide greater efficiency for surgeons, while also expanding the number of people eligible for the procedure.

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These technologies include the Cataract Operating System 3 (cOS3) and the Liquid Optics Interface 12, both from AMO. The cOS3 has more than 50 enhancements, many of which were developed in response to user feedback.

“It’s a marked improvement, starting with the integral guidance system and moving right through to the actual treatment,” said Eric D. Donnenfeld, MD, founding partner of Ophthalmic Consultants of Long Island and Connecticut and clinical professor of ophthalmology, New York University Medical Center, New York.

The interface is updated to become more intuitive throughout the procedure. The cOS3’s template-based interface has been redesigned with expanded customization options that streamline planning and result in simpler treatment.

“The platform also has high-resolution streaming optical coherence tomography (OCT) so that you can see the anterior segment structures during the surgery,” Dr. Donnenfeld said.

The stream is refreshed every .5-2 Hz for uninterrupted visualization of the eye throughout treatment.

The enhanced integral guidance system guidance system also calculates dimensions automatically.

“One of my favorite things is an automatic limbus offset,” Dr. Donnenfeld said. “Instead of having four steps that have to be done by the surgeon to use the software, there are only two steps: confirming the ocular anatomy, then confirming all the incisions. You visualize all of the incisions that you’re using during the procedure.”

The cOS3 upgrade and the Catalys system’s Liquid Optics technology work together to improve the docking process.

“It centers the docking and removes all forces from the eye during the treatment, which saves a lot of time,” Dr. Donnenfeld said.

The non-applanating technology helps maintain corneal shape throughout the procedure.

“Another advantage of the Liquid Optics technology is that it increases the number of people eligible for laser cataract surgery by offering two patient interface sizes. You can now dock on some of these more difficult eyes,” Dr. Donnenfeld said. “You have the flexibility to close the optimal interface for each laser cataract surgery patient, even those with smaller interpalpebral fissure widths.”

The system is available with suction rings having 14.1 mm and 12.0 mm inner diameters; the 12.0 mm interface, used to treat patients with smaller eyes, is the smallest patient interface available.

Along with the upgrades, the Catalys system has maintained several advantages, such as no significant rise in IOP due to the non-applanating system. The average IOP increase is 10 mm Hg.

“Also, there are no folds in the cornea; the cornea is pristine so that the delivery to the capsule and the lens is the best I’ve ever seen of any of the treatments I’ve performed with other machines,” Dr. Donnenfeld said. “Every single case I have ever performed has had a free-floating capsulate, and I use no ultrasound energy on the majority of my cataract surgeries.”

In summary, laser cataract surgery with the Catalys system is more of a refractive procedure than ever before, he continued

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“Being able to center the lens optically will improve effective lens position as well as improve higher-order aberrations; incisions are more astigmatically neutral because they are more peripheral and reproducible. There are a lot of things that make the procedure better.”

“The cOS3 software is redesigned to simplify the user interface for a more intuitive procedure. There is very little learning curve involved with it,” he added. “The surgeon is aware of the eye throughout the procedure because of the streaming OCT.

“The guidance system has new algorithms for automatic positioning for IOL placement; you can now center the capsulotomy on the lens, on the visual axis, or on the pupil,” Dr. Donnenfeld concluded. “The new interface allows surgeons to treat eyes that were more difficult to treat before, and it has also sped up the treatment dramatically. The time of the procedure is one-third less than it was before.”

Eric D. Donnenfeld, MD

E: ericdonnenfeld@gmail.com

Dr. Donnenfeld is a consultant for Abbott Medical Optics. Abbott received FDA clearance for the Cataract Operating System 3 (cOS3) and the Liquid Optics Interface 12 in October 2014.