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