COVER FEATURE  

Tool Time
Unique, advanced technology
that your phaco unit can't offer may warrant a platform change


by Matt Young EyeWorld Staff Writer
 
 

Surgeons disagree on what Сadvanced technology' is, but you can decide for yourself.

view chart

 

Switching phacoemulsifiers is no small matter some believe choosing a platform is essentially marrying it for the foreseeable future but there is one important reason to make a change, surgeons said.

If significant advanced technology becomes available only in a different platform, it may be a good time to swap.
Of course, surgeons don't all agree on what significant advanced technology is, but hopefully, a collection of their comments will allow you to assess whether your phacoemulsifier is ready to retire. Even if it is, purchasing a new platform may not be terribly costly.

СAdvanced' technology

One of the biggest phacoemulsifier changes in recent years has been the ability to upgrade your platform without changing it, said Stephen S. Lane, M.D., clinical professor, University of Minnesota, St. Paul, Minn., and in private practice at Associated Eye Physicians, St. Paul.
But to take advantage of unique, advanced technology such as a different type of pump a machine change for some is a must, surgeons said.
It generally isn't possible to change pump technology without changing the machine,Ф said David F. Chang, M.D., clinical professor of ophthalmology, University of California, San Francisco.
So when people go from the Diplomax (Advanced Medical Optics, Santa Ana, Calif.) to the Sovereign (AMO), or go from the Legacy (Alcon, Fort Worth, Texas) to the Infiniti (Alcon), they are moving up the ladder to a much more responsive and dynamically controlled pump,Ф Chang said.
In addition, another major advance in conventional phacoemulsification technology has been hyperpulse, which only exists in two machines: The Sovereign with WhiteStar technology and the Infiniti,Ф Chang said.
While hyperpulse is beneficial for routine cataracts it is particularly advantageous for the brunescent end of the spectrum,Ф he said.
This technology improves followability and reduces particle turbulence and chatter at the tip, which in turn decreases endothelial cell loss with brunescent cataracts,Ф Chang said. In addition, with hyperpulse, there is a significant lowering in the overall amount of phaco energy delivered into the eye to remove a cataract.Ф
With respect to the future, hyperpulse is what makes the Sovereign WhiteStar and the Infiniti ideally suited for bimanual microincision phacoemulsification, Chang said.
But Lane said that the Infiniti has significant advantages over the Sovereign WhiteStar that also could tempt one into switching.
While hyperpulse is not unique to the Sovereign WhiteStar, AquaLase which uses a water-pulse process to remove cataracts is unique to the Infiniti, Lane said.
Somebody may decide that that is a better way of removing a cataract because there's no ultrasonic energy being expelled within the eye,Ф Lane said. Therefore, they may change platforms based on that kind of technology, which is not available on any of the other instruments.Ф
Lane agreed with Chang that both the Sovereign WhiteStar
and the Infiniti are superior in
performing bimanual microincision phacoemulsification.
You should be able to get up to 15 pulses per second to be safe with bimanual,Ф which can be achieved by all the modern phacoemulsification machines, Lane said. But both the Infiniti and Sovereign can go much higher than that.Ф
Actually, there are really four machines that are in the top tier of performers both for coaxial and bimanual phacoemulsification, said Mark Packer, M.D., clinical assistant professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, and in clinical practice with Drs. Fine, Hoffman & Packer, LLC, Eugene, Ore.
Packer said the Millennium (Bausch & Lomb, Rochester, N.Y.) and the STAAR Sonic Wave (STAAR Surgical, Monrovia, Calif.) provide results on par with the Infiniti and Sovereign with WhiteStar.
Sonic Wave uses sonic frequency, which is actually three orders of magnitude lower than conventional phaco,Ф Packer said. You can hold the vibrating tip in your fingers it doesn't get hot. So for that reason it can be very efficient.Ф
The Millennium works especially well from moderate to very dense nuclei, Packer said.
Consider the package deal,
and better results
Companies are trying to make it more affordable for practitioners to switch to their phacoemulsifiers, Packer said.
They will make the price of the phaco machine quite reasonable if you agree to buy lots of other stuff from them consumables particularly, which need to be purchased over and over again,Ф he said. Examples of these consumables include intraocular lenses, viscoelastics, tubing, drapes and antibiotics.
In fact, when evaluating the cost of switching platforms, it is better to look at the cost of the machine's consumables than the machine's price, Packer said.
When you buy a Legacy or Sovereign, then you have to buy your packs from those companies too, and so that's where your cost is,Ф Packer said.
But for business' sake, be more concerned about the quality of patient outcomes than phacoemulsifier price, Packer said.
What seems to be driving the market in our neck of the woods are the results you get,Ф Packer said. When you have a patient that is 20/20 on the first day or even several hours after their cataract operation, the next thing you know, that patient's children want LASIK, their grandchildren want glasses, and their neighbors want more cataract surgery.Ф
In other words, the results you get with patients are critical to marketing your practice, Packer said.
So it's worth upgrading to one of the currently available machines that provide better outcomes,Ф Packer said.

Editors' note: Chang has is a consultant for AMO and has received educational travel support from Alcon. Lane is a consultant for Alcon. Packer receives honoraria and travel support from STAAR Surgical, AMO, Alcon and Bausch & Lomb.


Contact Information
Chang: 650-948-9123, fax 650-948-0563, dceye@earthlink.net
Lane: 651-222-5666, fax 651-227-9370, sslane@associatedeyecare.com
Packer: 541-687-2110, fax 541-484-3883, mpacker@finemd.com


 




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