LenSx Lasers, Inc. 3/3/2012. 1. Mi h l C K chael C. Knorz. Medical Faculty
Mannheim, University of Heidelberg. Mannheim, Germany. History of Cataract
Surgery.
LenSx Lasers, Inc.
3/3/2012
Michael Mi h l C. C Knorz K Medical Faculty Mannheim, University of Heidelberg Mannheim, Germany
History of Cataract Surgery Sushruta performed couching 800 BC S S ( ु ुतसंिं हता)) • Sushruta Samhita (स
Jaques Daviel invented ECCE 1747 Sir Harold Ridley implanted first posterior chamber IOL 1950 Charles Kelman introduced phacoemulsification in 1967
3/3/2012
1
LenSx Lasers, Inc.
3/3/2012
Charles Kelman, 1967
3/3/2012
Charles Kelman, 1967
3/3/2012
2
LenSx Lasers, Inc.
3/3/2012
Phaco 1967 - What is next ? Laser Refractive Cataract Surgery i a femtosecond f t d laser l using ! • 2008: first surgery performed in Budapest by Zoltan Nagy using Alcon LenSx laser • 2009: Alcon LenSx first laser to receive FDA approval for cataract surgery
3/3/2012
My Personal Experience Alcon LenSx laser Surgery performed in Budapest, Hungary Alcon LenS LenSx laser in Mannheim since 7-2011
3
LenSx Lasers, Inc.
3/3/2012
OR Setup, Mannheim, Germany
3/3/2012
OR Setup, Mannheim, Germany
3/3/2012
4
LenSx Lasers, Inc.
3/3/2012
LenSx Laser – User Interface
3/3/2012
Why Laser Refractive Cataract Surgery ? Capsulorhexis Lens fragmentation / liquefaction Corneal incisions Astigmatism correction
3/3/2012
5
LenSx Lasers, Inc.
3/3/2012
CAPSULORHEXIS
Ideal Capsulorhexis Reproducible size and shape, well t d centered Current Manual Capsulorhexis Too large No capsule-IOL p overlap IOL tilt
Too small
Irregular shape
Off center
Phimosis
IOL tilt
IOL decentration
Difficult phaco maneuver
IOL decentration
Edge catches visual axis
3/3/2012
6
LenSx Lasers, Inc.
3/3/2012
Laser Capsulorhexis
3/3/2012
LenSx Laser Capsulorhexis Capsulotomy Diameter Accuracy (Absolute difference between Attempted and Acheived) 100 90
Percent of Sample (%)
80
Laser (n=60)
70 60
Manual (n=60)
50 40 30 20 10 0 0
0.05
horizontal
-0.01±0.16
0.02±0.14
>0.05
Significantly Smaller
Internal Tilt
Internal Coma
Ocular Tilt
Ocular Coma
LENS FRAGMENTATION / LIQUEFACTION
13
LenSx Lasers, Inc.
3/3/2012
Liquefy and Chop Pattern
Liquefy • Used for softer lenses (to Grade 2) • Number of cylinders customizable
Chop • Generally used for harder lenses (grade 3, 4+) • Number of cuts customizable 3/3/2012
Hybrid Technique
3/3/2012
14
LenSx Lasers, Inc.
3/3/2012
Hybrid Pattern • Combination of liquefaction and chop patterns • Efficient for all cataract grades • Rapid lens removal with minimal phaco required • Preferred pattern for surgeons going forward
Hybrid Pattern • Used for all Cataract Grades • # Cuts/Cylinders Customizable
3/3/2012
Phaco vs LenSx Laser
43% reduction
51% reduction
3/3/2012
15
LenSx Lasers, Inc.
3/3/2012
Phaco vs LenSx Laser 28% lower endothelial cell loss in Laser group compared to Phaco group (one month postop)
3/3/2012
CORNEAL INCISIONS
16
LenSx Lasers, Inc.
3/3/2012
LenSx Laser Corneal Incision
PostOp OCT image of LenSx 2-plane corneal incision
3/3/2012
Laser Incisions Laser incisions are more hit t ll reproducible d ibl and d have h architecturally greater self-sealing properties
3/3/2012
17
LenSx Lasers, Inc.
3/3/2012
ASTIGMATISM CORRECTION
Treatment of Pre-Existing Astigmatism
“Cataract and refractive surgeons report that between 5 and 30% of their patients require LASIK, LRI or some other secondary enhancement procedure in order to improve their visual outcomes.” 2011 Market Scope Global IOL report.
12
18
LenSx Lasers, Inc.
3/3/2012
Manual Arcuate Incision Traditional, handheld Diamond Knife Manually executed by “tracing” corneal marks Inconsistent depth control Poorly predictable
3/3/2012
LenSx Laser Arcuate Incisions Image-guided with 3D visualization • Fully Customizable and adjustable • Refractive incisions are no longer
an art form. They are a science. • Place Desired Incisions: • EXACT Size • EXACT Pl Place • EXACT Depth • Every Time
3/3/2012
19
LenSx Lasers, Inc.
3/3/2012
Courtesy Dr. Eric Donnenfeld 3/3/2012
39
LenSx® Laser Arcuate Incision
• Square edge • Uniform depth (no ripples) • Precise, reproducible – Arc A shape h – Arc length – Diameter Steinert RF, Application of the Femtosecond Laser in Cataract Surgery for the Creation of Multi-Planar, Self-Sealing Incisions, ASCRS 2010, Boston
21
20
LenSx Lasers, Inc.
3/3/2012
Double-Angle Plot
Pre OP (n=14) • Keratometric Centroid: +0.08D @ 17° ± 0.59D, ρ = 1.82
Post OP (n=14) • Refractive Centroid: +0.26D x 178° ± 0.23D, ρ = 0.45 3/3/2012
MARKET POTENTIAL
21
LenSx Lasers, Inc.
3/3/2012
Issues to Consider Can the market support another premium technology ? Do we need a laser to improve our clinical performance ? Will our patients understand and embrace the technology ?
3/3/2012
Refractive Cataract Surgery Global Cataract Market Global Cataract Surgery Forecast
547
762
940 9 0
1,171
1,443
1,777
2,183
2,629
Data: Market Scope 2009 Report
22
LenSx Lasers, Inc.
3/3/2012
How we market LRCS
3/3/2012
Welcome to the Future !
Laser Refractive Cataract Surgery A combination of premium technologies A premium opportunity for surgeons and patients
3/3/2012
23
LenSx Lasers, Inc.
3/3/2012
Conclusions Laser Refractive Cataract Surgery increases safety and efficacy of cataract removal Laser fragmentation requires less phaco power and preserves endothelial cells Laser CCC improves IOL centration Laser-created incisions correct astigmatism 3/3/2012
24
