New Phaco TechnologyNew Phaco TechnologyMark Packer, MD, FACS

Clinical Associate Professor of OphthalmologyOregon Health & Sciences University

Drs. Fine, Hoffman & Packer, Eugene, Oregon

ASCRS 2009

Mark Packer, MD

Financial Disclosure

Consultant

Abbot Medical Optics, Inc.

Advanced Vision Science, Inc.

Bausch & Lomb, Inc.

Candeo Clinical/Science Communications, LLC

Carl Zeiss Surgical GmbH

General Electric Company

Gerson Lehman Group, Inc.

Ista Pharmaceuticals, Inc.

i-Therapeutix, Inc.

Johnson & Johnson Vision Care, Inc.

Leerink Swann & Company

Sirion Therapeutics, Inc.

Transcend Medical, Inc.

TrueVision Systems, Inc.

Visiogen, Inc.

VisionCare, Inc.

WaveTec Vision Systems

Travel & Honoraria

Endo Optiks, Inc.Synermed Communications

March 19, 2009

FCataract Surgery

Est. 1862

Refractive Lens Refractive Lens ExchangeExchange

DA

B-MICS

Kurz S, Krummenauer F, Gabriel P, Pfeiffer N, Dick HB. Biaxial microincision versus coaxial small-incision clear cornea cataract surgery. Ophthalmology. 2006 Oct;113(10):1818-26.

AMO Signature

WHITESTAR™ ICE Technology

ICE Pulse“Increase Control and Efficiency”

WHITESTAR™ ICE Technology

ICE Pulse

AMO Signature ellips

Longitudinal and transversal motion

Punch separates tip from material

Micro void forms

BSS flows in and accelerates cavitation

Signature - chop

Signature - segment

B & L Stellaris

Stellaris – EfficiencyStellaris – EfficiencyUnique Dual-Linear TechnologyUnique Dual-Linear Technology

• On-demand independent linear control of aspiration and phaco power

• Pre-programmable foot pedal settings customizable to surgeon technique

• Surgeon control of total phaco time for added safety and efficiencythroughout procedure

• Wireless connectivity for OR convenience

Stellaris Handpiece

• Six-crystal configuration

• 28.5 kHz for optimized cavitation, and rapid emulsification with minimal thermal loading

• SureLockTM Locking irrigation connectors

• C-MICS and B-MICS capable

Conventional power modulation

Advanced power modulation with CCS

Traditional pulse: 20 pps Hyperpulse: up to 120 pps-more effective cutting with

less heat

Traditional burst: minimum of 80 ms

Hyper burst: minimum of 4 ms- less energy w/ nuclear removal- less heat build-up- less total energy

Extended range of programmability vs. conventional pulse and burst modes

Custom Control Software (B&L)Custom Control Software (B&L)

Conventional Advanced power modulation

with CCS

Fixed duty cycle Variable duty cycle (10 – 100%)-To prevent continuous phaco energy even w/ maximum pedal depression

Fixed rise time Variable rise time (waveform pulse)

Unique to Millennium technology- less energy during nuclear removal- less heat build-up; less total energy

Variable Duty Cycle, Rise TimeVariable Duty Cycle, Rise Time

Stellaris Handpiece –Stellaris Handpiece –Cutting Dynamics Cutting Dynamics

• Increased stroke length for efficient cutting of the nucleus

• Tighter, more focused and consistent delivery of stroke

• CustomControl Software II for customizable, programmable wavefront power modulations for all techniques

Alcon Infiniti

Torsional Phacoemulsification

• New energy delivery modality on the INFINITI® Vision System designed to– Reduce repulsion and turbulence– Improve thermal safety profile

• Oscillatory motion at the hub of the phaco tip similar to NeoSoniX® with lower frequency than traditional ultrasound– NeoSoniX® oscillations 100 Hz– Torsional phaco 32,000Hz – Traditional Longitudinal phaco 40,000Hz

Ozil Reverse Kelman Tip

Power Modulations

• Provide millisecond level control of US

• Reduce repulsion, improve followability (with transversal or torsional motion delivery)

• Minimize thermal energy, free radical production

• Facilitate B-MICS

Parameters

• Found at The Expert View

– http://www.finemd.com/theexpertview/

• Or by email

– mpacker@finemd.com

Thank You

Thank You