Is there still a place for phaco in the age of the femtosecond laser? Short answer: yes. Femto has done nothing to replace phacoemulsification. In fact, the use of lasers to slice and dice cataracts can make phaco even safer and more efficient, since less ultrasound energy is needed to dissolve the material and, as a result, less heat is created in the eye. About 40% of laser cases don't even use ultrasound, they just irrigate and aspirate the pieces.
Given the continued utility of phaco machines as well as the proven durability of these workhorses, should the introduction of an all-new, next-generation system lead you and your cataract surgeons to consider an upgrade?
With cataract facility reimbursements what they are, no one relishes the idea of shelling out 6 figures for a new phaco machine today. But as you'll see in the product roundup over the next few pages, the features on the new machines make cataract removal significantly safer than ever before. Even though you can't charge more per case for cataract procedures in the wake of a capital expense, the new machines can make the procedure more efficient, saving OR time.
Functionally speaking, will the new system work dramatically better than the technology your surgeons are operating with now? If the machine they use is from 2 generations ago, it's definitely possible that fluidics the manner in which the machine sucks material out as it pours new balanced salt solution in to replace it have seen some innovations and improvements since then.
Function and economics should also drive any potential purchasing decision when, every few years, you invite manufacturers' representatives into your facility and trial the newest add-ons and tweaks to their phaco systems. I don't think you can go wrong with any of them, but make sure all of your surgeons get a chance to use each system and determine whether they meet their needs. Are the fluidics better than their current equipment? Is the ultrasound more efficient? How about the irrigation and aspiration? A surgeon needs to ask, do I feel safe with the equipment I have? A hands-on trial will help to provide an answer.
The reality of equipment purchasing today is, deals are done in bundles. If you're thinking of buying a phaco machine, as with other surgical components, it's economically wise to look at the vendor and its other products. Do your surgeons like their intraocular lenses, viscoelastics and other supplies? In many cases, it is easier to negotiate a more favorable price on that purchase from a manufacturer whose products you use in high volume. If your center bought $250,000 worth of their IOLs last year, be sure to let the vendors' rep know.
It will be interesting to see how the next generation of phaco machines accommodate to the use of femtosecond lasers in cataract surgery. The cost of laser technology and skepticism over its clinical necessity have limited its adoption, but it is an advance we can't ignore, and it may be even more common in 5 or 6 years. However, no manufacturer has yet rebuilt a phaco system to truly dovetail with the femto laser featuring, for example, aspiration and phaco tips that can vacuum up larger pieces. Future phaco advances will have to go hand-in-hand with laser capabilities, and yet also serve the users who haven't implemented laser technology. We'll see.
Abbott Medical Optics
Whitestar Signature System
Pricing: not disclosed
FYI: The Whitestar Signature System combines revolutionary Fusion Fluidics, which automatically adjust with intraocular changes for increased chamber stability, and Whitestar technology's optimized energy delivery to provide the flexibility needed for easy, safe, low-energy removal of hard and soft lenses. A proprietary dual pump allows transitions between true peristaltic and true venturi on the fly for additional versatility. The modular system lets you configure the system to meet your requirements and a wireless control pedal eliminates cable clutter.
Centurion Vision System
Pricing: Lists at $125,000
FYI: Alcon's next-generation phacoemulsification platform innovates the product category to improve surgeon control and patient outcomes. The Centurion Vision System's Active Fluidics automatically maintain a user-designated intraocular pressure range, allowing physicians to focus on the patient, not on the machinery. Balanced Energy software and instrumentation (including a redesigned phaco tip, a customizable foot pedal and software settings) deliver efficient torsional phaco. And its Applied Integration technology ensures that the platform works seamlessly with Alcon's cataract-refractive suite of equipment and is upgradeable with future innovations.
Bausch + Lomb
Stellaris Vision Enhancement System
Pricing: $45,000 to $125,000, depending on model and selected options and accessories
FYI: With a flexible, hybrid approach to fluidics and advanced, ultra-efficient cutting dynamics, the Stellaris Vision Enhancement System enables sub-2mm surgery. The system features customizable preferences for vacuum or flow-based fluidics and supports standard, small-incision coaxial phaco as well as microincisional surgery using coaxial or bimanual modes. A redesigned, ergonomic, ultralight titanium handpiece and 18-inch, high-resolution touchscreen display make setup and use easy. The StellarisPC integrates phaco functionality with vitreoretinal capabilities for a combined system that serves expanding practices.
Dutch Ophthalmic USA
Pricing: not yet determined
FYI: Dutch Ophthalmics' EVA, to be launched in the United States upon FDA approval, is a combined phaco and vitrectomy platform capable of 1.8mm micro-incisional cataract surgery. Its multiple ultrasound power modes allow surgeons to optimize the energy's use to their individual techniques. The Vacuflow VTi (Valve Timing Intelligence) pump enables switching between flow and vacuum fluidics for efficient, controlled removal of lens and visco material. A triple-step flared phaco needle, available in straight and angled design, aids in emulsification of nucleolus material, while a pulse mode speeds removal at lower ultrasound levels. A programmable wireless footswitch offers dual-linear or hybrid-vacuum boost options.
Oertli CataRhex 3
Pricing: starts at $50,000, depending on number of handpieces
FYI: The Swiss-made Oertli CataRhex 3 is a portable cataract and glaucoma surgery system that delivers full-featured performance, says Katalyst Surgical, its U.S. distributor. The compact, 5 kg device easily attaches to an IV pole. A simple user interface, multifunctional pedal and efficient pump system lend themselves to faster procedures. And the stability of the system's fluidics make adjusting the height of the BSS bottle superfluous. The CataRhex offers programmable pre-settings for 20 surgeon users.