80 Thinking of Buying … Retina Surgery Platforms Look for speed, control and the best deal. Lou Sheffler, MPS

For high-volume ophthalmic centers with skilled, efficient surgeons, the time may be right to add retina. Reimbursement rates are up in commonly performed procedures. Plus, the latest vitrectomy machines, 5 of which we'll review on the pages that follow, enable fast and safe operations. Here's a quick overview of this cornerstone equipment.

What matters most to surgeons
Most surgeons will judge a retina surgery platform based on 2 features: the speed of its vitrectomy cutter, and the efficiency and control of its fluidics.

• Faster is better. The vitrectomy cutter handpiece incorporates a 20-, 23- or 25-gauge needle (with a hole in the side for suction) that chops pieces of the vitreous. Its speed is measured in cuts-per-minute (abbreviated "cpm"). The earliest 18-gauge vitrectors were slow: In the 1970s they delivered 1 cut per press of the foot-pedal, and retina surgery could take hours. Now, though, they're able to make thousands of cuts per minute, and surgeries can clock in at 35 to 40 minutes. In expert hands, faster cutting is not only more efficient, but more accurate.

• Balance is critical. The removal of vitreous tissue requires replacement with fluid to support the ocular structure. Otherwise the underinflated eye will collapse, risking retina and blood vessel tears. That's why precisely controllable fluidics — irrigation into and aspiration from the eye — is an important feature. In older models, fluidics relied on an IV-pole-mounted bottle of balanced salt solution and gravity. However, compressed gases and pressurized tubing offer greater control.

There are 2 types of fluidics pumps: venturi and peristaltic. Retina surgery employs venturi, while cataract surgery uses both. Some manufacturers have built both types into their vitrectomy machines, effectively letting them (after a few adjustments) pull double duty as phaco machines. If you're looking to upgrade your cataract services while also adding retina, a dual anterior-posterior platform could save money and OR space.

Business arrangements
In large part, the selection of a vitrectomy platform comes down to surgeon preference. Which one have they used primarily in hospital ORs? Which are they most comfortable with?

As an administrator, though, you're looking to make the best deal you can in the purchase. Fortunately, surgeon preference can play a part here. Find out if your physicians are using any of the manufacturers' supplies or equipment in your cataract case load, and see if you can parlay that into a bundled arrangement.

Even if your surgeons have their hearts set on 1 particular manufacturer's model, be sure to evaluate the others to create competition. Don't leave pricing in 1 company's hands: If you show them some competition, they might show you a better price.

Also, find out what they can do for you. Retina sales reps more than likely know which docs in the area are doing their cases at which local hospitals. It may be that their business can help your business by bringing in more cases, and why wouldn't that cooperation earn them your sale?

Retina procedures can be expensive. They reimburse well, but the disposable supplies can be costly. Should your purchasing decision focus more on those continuing costs than the equipment itself? Should the capital expense take a back seat to the vitrectomy packs? Yes, perhaps, but not necessarily from day one. You can always change the contents of the pack. It might be most advisable to supply the retina surgeons you recruit with their hospital pack, then work on cost containment, modifying the disposables to your center's specific needs.

Alcon Surgical
Constellation Vision System
www.alconretina.com
(800) 862-5266
List price: not disclosed FYI: Alcon's Constellation Vision System is a full-function vitreoretinal platform with both posterior and anterior segment capabilities. Its Ultravit 7,500-cuts-per-minute (cpm) probe enables high-speed cutting and duty-cycle modification for flow control independent of vacuum and cut rates. The long-lasting, high-brightness Xenon Illuminator incorporates radiofrequency identification technology to automatically adjust light intensity according to the probe size, and the 532-nanometer Purepoint laser is controlled from the Constellation's screen. The company's V-Locity efficiency components include automated features designed to speed set-up times, increase OR productivity and assist administrative oversight.

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Bausch & Lomb
Stellaris PC Vision Enhancement System
tinyurl.com/by7rs89
(800) 338-2020
List price: $130,000 FYI: The Stellaris PC combines Bausch & Lomb's vitreoretinal innovation with its phacoemulsification technology, allowing surgeons to perform both cataract and retina surgeries on a single, versatile platform. Its lightweight, 5,000-cpm vitrectomy probes are designed to reduce traction and turbulence for efficient cutting. Its optimized duty cycle provides stable fluidics and flow efficiency. Dual, independent light sources (xenon and mercury) and surgeon-controlled color filters help to optimize visualization. It is compatible with 25-, 23- and 20-gauge vitrectomy packs as well as 1.8mm micro-incisional cataract surgery.

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Dutch Ophthalmic USA
Associate 6000 Ophthalmic System
www.dorc.nl
(800) 753-8824
Price range: $65,000 to $90,000 FYI: The dual peristaltic and venturi pump on Dutch Ophthalmic USA's Associate 6000 lets the system offer both posterior segment procedures (with 20-, 23-, 25- or 27-gauge instruments) and anterior segment cases (including micro-incisional cataract surgery). The vacuum-controlled vitrectomy probe is capable of making 6,000 cuts per minute with minimal traction. An LED light source with a lens focusing system delivers up to 40 lumens of illumination. A programmable dual linear footswitch aids in operative efficiency.

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Insight Instruments
Intrector Portable Vitrectomy System
www.insightinstruments.com
(800) 255-8354
List price: $6,000, $208 each for disposable probe tips FYI: A lightweight, portable, guillotine-style vitreous cutting system, Insight's Intrector uses manually controlled aspiration and infusion to remove and substitute vitreous matter. Its single-entry, variable-speed probes (with ergonomically designed handpieces) are capable of 1,200 cuts per minute for reduced turbulence. The Intrector dual-chamber probe contains aspiration and irrigation syringes, while the Retrector Retractable Sharp-Tip probe has an aspiration syringe only. The Intrector system can be powered by AC current or rechargeable batteries.

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Synergetics
VersaVIT Vitrectomy Platform
www.synergeticsusa.com
(800) 600-0565
List price: $29,500, $200 to $375 each for packs FYI: A small vitrectomy machine with a big purpose, Synergetics's VersaVIT was designed to respond to the changing needs of the retinal surgery community, namely to provide a portable, versatile, space-saving and cost-efficient platform. The vitrector operates at 2,500 cuts per minute. A dual LED light source delivers bright, long-lasting light. The unit can be powered by compressed air, nitrogen or CO2, run by batteries or electrical current, and mounted on a cart or stand.

Mr. Sheffler ([email protected]) is the chief operating officer of Somerset, N.J.-based American Surgisite Centers, an ASC consulting firm that manages 12 ophthalmic centers in 5 states.