The Great Femtosecond Face-off: Carl Zeiss Meditec VisuMax
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Transcript of The Great Femtosecond Face-off: Carl Zeiss Meditec VisuMax
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
Dan Z Reinstein MD MA(Cantab) FRCSC FRCOphth1,2,3,4
1. London Vision Clinic, London, UK2. St. Thomas’ Hospital - Kings College, London, UK 3. Weill Medical College of Cornell University, New York,4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche) , Paris, France
©DZ Reinstein [email protected]
Financial Disclosure
The author (DZ Reinstein) acknowledges a
financial interest in Artemis™ VHF digital
ultrasound (ArcScan Inc, Morrison, CO)
The author (DZ Reinstein) is a consultant for
Carl Zeiss Meditec AG (Jena, Germany)
©DZ Reinstein [email protected]
• The Bermuda triangle of treatment parameters– Short procedure time– Easy flap lift / tissue separation– Excellent cut quality– No adverse effects (DLK, TLS)– Accurate focusing
• Flaps• FLEX
Pulse Rate
Precise FocusingSpot Energy
VisuMax Femtosecond System
0.1 µJ
500 kHz
~1 µm
©DZ Reinstein [email protected]
• Zeiss high performance optics key for optimum cut
▼low Numerical aperture high ▲▼large Spot diameter small ▲▼low Depth accuracy high ▲▼high Single pulse energy small ▲
VisuMax Femtosecond System
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
©DZ Reinstein [email protected]
Assessment of VisuMax Flap Thickness
• 24 eyes treated with intended flap thickness of 110 µm• Central flap thickness measured by Artemis
J Refract Surg. Online Pre Release.
©DZ Reinstein [email protected]
Artemis very high-frequency digital ultrasound arc-scanner
• Digital signal processing significantly reduces noise and enhances signal-to-noise ratio compared to analog signal processing
• doubles resolution• increase measurement precision by a factor of 3
• Thickness measurements made by computer-analysis of peaks on the I-scan trace – each peak provides a surface localization of 0.87 µm
• 3D layered pachymetry precision• Epithelium – 0.61 µm• Cornea – 0.74 µm• Flap – 1.14 µm
Surface localization:0.87 µm
ArcScan Inc Evergreen, Colorado
©DZ Reinstein [email protected]
Flap Thickness Measurement
• 3D VHF digital ultrasound flap thickness measurement before and 3 months after treatment with Artemis I
+Pre-op
Post-op3 months
Epithelial thickness
Stromal Flap thickness
• Central flap thickness =
Thickness of the stromal component of the flap
measured 3 months after surgery
+ Preoperative epithelial thickness
©DZ Reinstein [email protected]
Artemis B-Scan: 6 Months Post LASIK
Artemis B-Scan (above) of VisuMax Flap 6 months post LASIK. Edge detection by I-scan digital signal processing (red outline, below) based on raw scan data
©DZ Reinstein [email protected]
RESULTS: Central Flap Thickness
Intended flap thickness = 110.00 µm
Average flap thickness = 112.31 µm
Accuracy = +2.31 µm
Precision (SD) = 7.89 µm
Minimum flap thickness = 102.61 µm
Maximum flap thickness = 132.94 µm
Range = 30.34 µm
©DZ Reinstein [email protected]
RESULTS: Central Flap Thickness
• 25% of eyes within 2 µm of the intended flap thickness
• 54.2% of eyes within 5 µm of the intended flap thickness
• 87.5% of eyes within 10 µm of the intended flap thickness
©DZ Reinstein [email protected]
Flap Thickness Reproducibility: PublishedAuthor Microkeratome Accuracy (µm) SD (µm) Pachymetry Method Pachymetry InstrumentStahl 2007 IntraLase FS60 +12.0 5.0 1 Mo Post-op OCT VisantePietila 2009 Femto LDV -20.0 5.0 Intra-op US SP-3000Alio 2008 IntraLase FS30 +6.0 6.2 1 Mo Post-op VHFU Artemis-2Hu 2007 IntraLase FS30 +13.9 7.1 3 Mo Post-op CMTF NRReinstein 2009 VisuMax +2.3 7.9 Pre and 3 Mo Post-op VHFU Artemis-1Li 2007 IntraLase (Pulsion) +35.0 9.0 1 Wk Post-op OCT CAS-OCTHolzer 2006 Femtec -0.4 9.1 Micrometer DigimaticSutton 2008 IntraLase FS30 -1.0 9.8 Intra-op US Corneo-Gage PlusBinder 2006 IntraLase FS10 +35.8 10.1 Intra-op US Cornea Scan II 50 MHzBinder 2006 IntraLase FS15 +21.1 10.2 Intra-op US Cornea Scan II 50 MHzHolzer 2006 Femtec +3.7 10.7 Micrometer DigimaticBinder 2006 IntraLase FS15 +25.8 10.8 Intra-op US Cornea Scan II 50 MHzSutton 2008 IntraLase FS15 +11.8 10.8 Intra-op US Corneo-Gage PlusLi 2007 IntraLase (Pulsion) +30.0 11.0 Intra-op US Corneo-Gage 2 50 MHzLi 2007 IntraLase (Pulsion) +36.0 11.0 1 Wk Post-op OCT CAS-OCT (Visante prototype)Holzer 2006 Femtec -7.9 11.1 Micrometer DigimaticHu 2007 IntraLase FS15 +16.8 11.1 3 Mo Post-op CMTF NRBinder 2006 IntraLase FS15 +20.1 11.8 Intra-op US Cornea Scan II 50 MHzBinder 2004 IntraLase FS +2.4 11.9 Intra-op US NRBinder 2004 IntraLase FS +15.0 12.0 Intra-op US NRTalamo 2006 IntraLase FS +9.0 12.0 Intra-op US Pachette IIBinder 2006 IntraLase FS10 +29.2 12.4 Intra-op US Cornea Scan II 50 MHzKim 2008 IntraLase FS60 +8.9 13.6 3 Mo Post-op OCT VisantePfaeffl 2008 IntraLase FS30 +0.4 13.6 Intra-op OCP Online OCPKezirian 2004 IntraLase FS -16.0 14.0 Intra-op US Pachette 50/60 KHz pachymeterBinder 2006 IntraLase FS10 +29.7 14.3 Intra-op US Cornea Scan II 50 MHzNeuhann 2008 IntraLase FS30 +11.7 14.7 Intra-op OCP Online OCPBinder 2006 IntraLase FS10 +17.4 15.2 Intra-op US Cornea Scan II 50 MHzBinder 2004 IntraLase FS -1.3 16.6 Intra-op US NRBinder 2006 IntraLase FS10 -0.4 17.1 Intra-op US Cornea Scan II 50 MHzKim 2008 IntraLase FS60 +4.8 17.6 3 Mo Post-op OCT VisanteBinder 2004 IntraLase FS -7.5 18.5 Intra-op US NRBinder 2006 IntraLase FS10 -9.4 19.0 Intra-op US Cornea Scan II 50 MHzLi 2007 IntraLase (Pulsion) +40.0 19.0 Intra-op US Corneo-Gage 2 50 MHzBinder 2006 IntraLase FS10 +13.4 22.1 Intra-op US Cornea Scan II 50 MHz
Two studies done with Artemis
©DZ Reinstein [email protected]
Measurement Precision
Data Reproducibility
Validity of Measurement Instrument
©DZ Reinstein [email protected]
90 95 100 105 110 115 120 125 130
Measured Flap Thickness
95% values within 2 standard deviations
90 95 100 105 110 115 120 125 130
Measured Flap Thickness
Validity of Measurement Instrument
©DZ Reinstein [email protected]
90 95 100 105 110 115 120 125 130
Measured Flap Thickness
95% values within 2 standard deviations
90 95 100 105 110 115 120 125 130
Measured Flap Thickness
Precision: 1 µm
95% within: 108-112 µm
Validity of Measurement Instrument
©DZ Reinstein [email protected]
90 95 100 105 110 115 120 125 130
Measured Flap Thickness
95% values within 2 standard deviations
90 95 100 105 110 115 120 125 130
Measured Flap Thickness
Precision: 10 µm
95% within: 90-130 µm
Validity of Measurement Instrument
©DZ Reinstein [email protected]
95 104 105 106 114 115 116 125
Instrument 1
Value 1 Value 2
Instrument 2
Valid
Invalid
Validity of Measurement Instrument
©DZ Reinstein [email protected]
Data Reproducibility
Measurement Precision
Required Precision: 2.5 µm
Reproducibility: 5 µm
Validity of Measurement Instrument
©DZ Reinstein [email protected]
Measurement Precision
Data Reproducibility
Ideal Precision: 1.66 µm
Reproducibility: 5 µm
Validity of Measurement Instrument
©DZ Reinstein [email protected]
Artemis Flap Thickness Repeatability: 1.14 µm
Therefore, the Artemis is capable of measuring a flap thickness reproducibility of 7.89 µm as found in this study
Validity of Measurement Instrument
©DZ Reinstein [email protected]
Artemis Flap Thickness Repeatability: 1.14 µm
The Artemis is capable of measuring a flap thickness reproducibility as small as 3.42 µm
Validity of Measurement Instrument
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
©DZ Reinstein [email protected]
VisuMax Femtosecond System: Patient Comfort
Cross section of the contact glass• Spherical contact interface to cornea• Low corneal suction
– Minimal applanation– Minimal IOP increase– No vision loss during suction (data on file)
• “Out-to-in” femtosecond ablation– Fixation throughout flap creation
©DZ Reinstein [email protected]
Comparison of typical curves plotted on the same scale
0
50
100
150
200
250
300
350
0 20 40 60 80 100
time (sec)
IOP
(m
mH
g)
IntraLase
VisuMax
IOP Comparison: VisuMax vs IntraLase
Ref: Grabner G. Femtosecond to fully replace microkeratome. Ophthalmology Times, 2008
©DZ Reinstein [email protected]
0
50
100
150
200
250
300
350
0 20 40 60 80 100
time (sec)
IOP
(m
mH
g)
IntraLase
VisuMax Fast
VisuMax flap creation time VisuMax flap creation time reduced to reduced to ~20 seconds~20 seconds with software v 2.4.0with software v 2.4.0
IOP Comparison: VisuMax vs IntraLase
Comparison of typical curves plotted on the same scale
Ref: Grabner G. Femtosecond to fully replace microkeratome. Ophthalmology Times, 2008
Questionnaire: Patient Experience
VisuMax vs Hansatome
©DZ Reinstein [email protected]
Questionnaire: Claustrophobia
Did you feel a sense of claustrophobia when the machine was maneuvered onto your eye?
58.3%
25.0%
16.7%15.4%
46.2%
30.8%
7.7%
0.0%0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Perc
en
tag
e P
ati
en
ts
VisuMax [12] 58.3% 25.0% 16.7% 0.0%
Hansatome [13] 15.4% 46.2% 30.8% 7.7%
none at all not really a little a lot
©DZ Reinstein [email protected]
Questionnaire: Discomfort from Pressure
What level of discomfort did you experience while the pressure was applied to the eye and the laser was used to create the flap (green light became
obscured)?
16.7%
41.7%
33.3%
0.0%
7.7%
30.8%
46.2%
7.7%
0.0%
8.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
Perc
en
tag
e P
ati
en
ts
VisuMax [12] 16.7% 41.7% 33.3% 8.3% 0.0%
Hansatome [13] 7.7% 30.8% 46.2% 7.7% 0.0%
very comfortable
comfortable uncomfortablevery
uncomfortablepainful
©DZ Reinstein [email protected]
Questionnaire: Length of Time With Pressure
How did you feel about the length of time that pressure was applied on the eye?
50.0%
41.7%
8.3%
15.4%
76.9%
7.7%
0.0%0.0%0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Perc
en
tag
e P
ati
en
ts
VisuMax [12] 50.0% 41.7% 8.3% 0.0%
Hansatome [13] 15.4% 76.9% 7.7% 0.0%
quick not too long too long far too long
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
©DZ Reinstein [email protected]
• Internal fixation target for patient – refraction corrected• Patient compliance• Auto centration on docking to contact glass – corneal vertex• Patient visualisation of the target throughout the procedure
VisuMax Femtosecond System: Centration
©DZ Reinstein [email protected]
Flap Centration on Corneal Vertex
©DZ Reinstein [email protected]
Flap Centration on Corneal Vertex
Corneal vertex
Flap edgeDye pooling in ablation zone
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
©DZ Reinstein [email protected]
Ultra Thin Flap LASIK: No Need For PRK
• PRK Corneal Thickness Limit: 350 µm
• Alternative: Ultra Thin Flap LASIK– VisuMax Flap Thickness: 80 µm– Corneal Thickness: 350 µm– LASIK RST = 350 – 80 = 270 µm (>250 µm)
Flap thickness: 84 µm
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
©DZ Reinstein [email protected]
Flap Creation with Previous PRK
Thick epithelium after hyperopic PRK
Flap underneath epithelium
Epithelium Post PRK for +3.00 D
©DZ Reinstein [email protected]
Recutting Flaps: Measure Twice, Cut Once!
Incomplete Flap: Hansatome zero compression microkeratome
©DZ Reinstein [email protected]
Recutting Flaps: Measure Twice, Cut Once!
Second flap created under the half flap using the VisuMax femtosecond laser
©DZ Reinstein [email protected]
Recutting Flaps: Measure Twice, Cut Once!
• Original flap created in 1999• Measure Once: Artemis scan to measure flap thickness
Flap Thickness Profile
©DZ Reinstein [email protected]
Recutting Flaps: Measure Twice, Cut Once!
• Micro-bubble layer created with the VisuMax• Measure Twice: Artemis scan repeated before lifting the flap• Confirmed that the VisuMax flap was below original flap
VisuMax Micro-Bubble Layer Creation
©DZ Reinstein [email protected]
Recutting Flaps: Measure Twice, Cut Once!
• Flap lifted and ablation performed• Artemis scan 1 month post-op confirmed VisuMax flap below
original flap
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
©DZ Reinstein [email protected]
VisuMax when Hansatome not Possible
Hansatome VisuMax
Forced to switch to PRK
Retreatment as VisuMax
©DZ Reinstein [email protected]
VisuMax Flap in RK Patient
©DZ Reinstein [email protected]
VisuMax Flap in Deep Lamellar Keratoplasty
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
©DZ Reinstein [email protected]
VisuMax Population
• 232 eyes of 131 patients• Age
– median 38 years– range 21 to 68 years
• Spherical equivalent– mean -4.00 ± 1.86 D– range -0.13 to -8.63 D
• Cylinder– mean -0.72 ± 0.54 D– range 0.00 to -2.50 D
• BSCVA– 100% 20/20– 59% 20/16
©DZ Reinstein [email protected]
Attempted vs Achieved: 6 MonthsAttempted vs. Achieved Spherical Equivalent
y = 0.9201x - 0.1442
R2 = 0.952
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
-9-8-7-6-5-4-3-2-10
Attempted Spherical Equivalent (Diopters)
Ach
ieve
d S
ph
eri
cal E
qu
iva
len
t (D
iop
ters
)
©DZ Reinstein [email protected]
Accuracy 6 Months: Within Range of Intended
Accuracy: Within Range of Intended
0% 1%
15%
26%
13%
4%1% 0%
41%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Accuracy of Spherical Equivalent
Perc
en
tag
e E
yes
VisuMax [232] 0% 1% 15% 41% 26% 13% 4% 1% 0%
-2.00 To -1.51
-1.50 To -1.01
-1.00 To -0.51
-0.50 To -0.14
-0.13 To
0.13
0.14 To
+0.50
+0.51 To
+1.00
+1.01 To
+1.50
+1.51 To
+2.00
©DZ Reinstein [email protected]
Efficacy 6 Months: Binocular Vision
Efficacy: Binocular UCVA
36%
75%
96%100% 100% 100%98%
0%
20%
40%
60%
80%
100%
Binocular UCVA
Perc
en
tag
e E
yes
Efficacy 36% 75% 96% 98% 100% 100% 100%
20/12.5 20/16 20/20 20/25 20/32 20/40 20/63
©DZ Reinstein [email protected]
Efficacy 6 Months: Monocular Vision
Efficacy: Monocular UCVA
9%
59%
100% 100%
16%
62%
96%99% 100% 100%99%
0%
20%
40%
60%
80%
100%
Monocular UCVA
Perc
en
tag
e E
yes
Pre BSCVA 9% 59% 100% 100%
Efficacy 16% 62% 96% 99% 99% 100% 100%
20/12.5 20/16 20/20 20/25 20/32 20/40 20/63
©DZ Reinstein [email protected]
Safety 6 Months: Lines Change BSCVA
Safety: Lines Change BSCVA
0.0% 0.0%3%
40%
2%
55%
0%
20%
40%
60%
Lines Change BSCVA
Perc
en
tag
e E
yes
Safety 0.0% 0.0% 3% 55% 40% 2%
Loss 3 or More
Loss 2 Loss 1 No Change Gain 1Gain 2 or
More
©DZ Reinstein [email protected]
Stability: Change in Spherical Equivalent
Pre Op 1 Day 1 Month 3 Months 6 Months
Avg SEQ -4.06 +0.37 -0.08 -0.15 -0.17
SD SEQ 1.85 0.36 0.43 0.42 0.41
# eyes 232 228 223 203 222
Stability: Change in Spherical Equivalent
-7.00
-6.00
-5.00
-4.00
-3.00
-2.00
-1.00
0.00
1.00
2.00
Pre op 1 day 1 month 3 months 6 months
Time Point
Sp
heri
cal
Eq
uiv
ale
nt
(D)
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
1. High Flap Thickness Reproducibility
2. Low Corneal Suction
3. Centration on the Corneal Vertex
4. Ultra Thin Flap
5. Flaps "Made to Measure"
6. Flaps in “Difficult” Eyes
7. Visual Outcomes
8. Future Potential: All-in-One
©DZ Reinstein [email protected]
VisuMax Unsurpassed Future Potential
• The new horizon of femtosecond technology in ophthalmology
• VisuMax is designed to become the corneal surgery workstation for a large spectrum of procedure options
• Unprecedented accuracy in corneal incisions– eg Femtosecond lenticule extraction (FLEx)
The Great Femtosecond Face-off:
Carl Zeiss Meditec VisuMax
Dan Z Reinstein MD MA(Cantab) FRCSC FRCOphth1,2,3,4
1. London Vision Clinic, London, UK2. St. Thomas’ Hospital - Kings College, London, UK 3. Weill Medical College of Cornell University, New York,4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche) , Paris, France
Thank You
Comparison with IntraLase
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• Reinstein et al– Accuracy and Reproducibility of Central
Flap Thickness and Visual Outcomes of LASIK with the VisuMax Femtosecond Laser System and the MEL80 Excimer Laser
– JRS [Online]
• Blum et al– LASIK for Myopia Using the Zeiss
VisuMax Femtosecond Laser and MEL 80 Excimer Laser
– JRS [Online]
• Sekundo et al– First efficacy and safety study of
femtosecond lenticule extraction for the correction of myopia Six-month results
– JRS Sept 2008
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• Dan Reinstein• So what? It’s just newer!
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• Instability and crashes have been ironed out since the prototype
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• Curved glass is auto-calibrated for each lens
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• IOP has been shown to be lower for VisuMax than IntraLase (Grabner)– VisuMax: 84 mmHg– IntraLase: 180 mmHg
• IOP raised for shorter duration– VisuMax: ~30 seconds– IntraLase: ~80 seconds
• Patient can see during procedure
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• Reinstein data showed achieved flap diameter 0.50 mm greater than displayed
• Recentration with IntraLase reduces flap diameter
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• Not required as VisuMax auto-centrates on the corneal vertex
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• Why do you need an oval flap?• Induce astigmatism?
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster? • ICRS settings in the pipeline
along with graft, AK etc
©DZ Reinstein [email protected]
IntraLase Claims vs VisuMax
• Lack of clinical data• Few “champion” users• Instability• Curved glass can't work properly• IOP• Flap diameter• No recentration software• Can't do oval flap• Can't do ICRS• Faster?
• Total time for IntraLase is longer– Ring segment placement– Docking of lens– Ablation