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New femtolasik Refractive suite

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Presentation on theme: "New femtolasik Refractive suite"— Presentation transcript:

1 New femtolasik Refractive suite
IN THE NAME OF GOD New femtolasik Refractive suite Mohsen Farvardin M.D.


3 Swiveling bed Improved patient comfort Better ergonomic handling
Faster procedures Fast swiveling motion & variable swiveling angles (30° or 45°) Adjustable headrest (height) Left/right eye detection, automated movement from OD  OS and central position

4 WaveLight® FS200

5 Why femtosecond LASER? Safety Precision Versatility Patient benefit
Reproducibility (standard deviation microkeratome >20µm) Single use patient interface Precision Very homogeneous flap thickness minimal deviation in geometries (diameter, hinge, etc.) Even stromal bed Versatility Wide adjustment range of geometries and parameters Non-mechanical Keratoplasty and intrastromal Rings Patient benefit Bladeless Better results (no astigmatism & abberation induction)

6 Advantages Femto vs. mechanical microkeratome
Flap creation using Femto-Laser Cutting geometries are designed on the computer and created with LASER precision Flap diameter very accurate Large applanation area Large effective ablation area for the Excimer Hinge and orientation not depending to the suction ring and its application Lamellar cut through out the flap (homogeneous thickness) Surgeon can design and control (computer aided) side cut angle, flap thickness, diameter and centration Visibility to the stroma through out the cutting procedure Flap is after femto-LASER application not separated from the stroma Custom Flap design

7 Lamellar flap created by the FS200

8 Versatility Flaps Standard Flaps (round) Custom Flaps (oval) Rings
Keratoplasty Penetrating Keratoplasty Anterior Lamellar Keratoplasty Posterior Lamellar Keratoplasty




12 Wavelight EX500







19 New Features Build in online pachymeter (OLCR- Optical Low-Coherence Reflectometry) Static and dynamic (during ablation) measurement of corneal thickness Can be saved by soft button Needs proper apex adjustment (distanced diodes) Traffic light system Traffic light System like OB820  speed of measurement Apex Distance- Std best <1

20 New Features Build in N2 generator
Continuously purged beam-path; enhancing energy stability simplifying logistics and operation, reducing running cost and space requirements Just one gas bottle  ArF

21 New Features Enhanced beam-path and laser head design
The combination of a short beam-path and continuously (while switched on) N2 purged optics (starting at the Laser head to the scanner output) grants for stability and efficient use of energy, while keeping the optics free of dust and ozone formation. New Laser head design multiplying expected life time Life time Laserhead 3-4 times more than Allegretto expected Optics higher life time expected

22 New Features Advanced motorized Zoom Microscope Stepless zoom
Programmable magnifications for: Treatment Start Prepare

23 Illumination Ring To move illumination ring to treatment /prepare position Switches between / combines: Microscope - field Illumination OP – field Illumination Plume evacuator Starts before Laser treatment Increased working distance 250 mm Infrared light illumination NOTE: Energy sensor moves automatically (not visible) into the beam path for Energy Check

24 Allegretto’s proven features

25 Wavefront Optimized - the solid Base
Wavelight EX500 uses the well known Wavefront Optimized profiles

26 Wavefront Optimized - the solid Base
WaveLight: Wavefront OptimizedTM optical zone Non-wavefront optimized optical zone Wavefront OptimizedTM treatments result in a large true aspheric optical zone and a functional transition zone. This results in better mesopic and scotopic vision. Non-wavefront optimized treatments create relatively narrow optical zone a wide transition zone. These profiles may cause night vision issues caused by induced higher order aberrations.

27 Effectiveness: UCVA (Uncorrected visual acuity)
Wavefront Optimized – Visual Outcomes Effectiveness: UCVA (Uncorrected visual acuity) 25% 64% 93% 99% 100% 22% 76% 0% 20% 40% 60% 80% wavefront-guided Wavefront OptimizedTM >= 20/12.5 >= 20/16 >= 20/20 >= 20/40 >= 20/200 Both groups demonstrated similar performance for visual acuity. In both groups 93% of patients achieved UCVA 20/20 or better after treatment. Source: US Clinical Trials 200 Hz ALLEGRETTO WAVE®

28 NeuroTrack - preventing torsion
Active Cyclotorsion Control:  Never change a running system! The advanced NeuroTrack feature ensures active opto-kinetic eye-tracking to control cyclotorsion. NeuroTrack forces the eye to stabilize the retinal image to achieve perfect vertical and horizontal orientation.

29 NeuroTrack - Cross Line Projector
Results from two international sites of 141 high astigmatism corrections. The post-operative plot diagram shows the high accuracy of treatment results.

30 All encompassing eye-tracking
Video-based eye-tracker guarantees fast multidimensional active eye-tracking for better results and outmost patient care. High speed tracking 1050 Hz Ultra fast ms latency Multi-dimensional eye-tracking Requires no dilation; allows streamlined workflow Works in infra-red light Three independent angulated light-sources for redundant lightning Compensation option for angle kappa

31 Why multidimensional ET?
When patient is looking up and down the head isn’t moving, but the eye is rolling! Available at NEXT revision of Wavelight EX500

32 vertical displacements horizontal displacements
Compensating for H and V rotation Displacement calculated by conventional Eye-Tracker Centre of ablation using rotational compensation for X and Y rotation + x vertical displacements horizontal displacements Detected centre of pupil rotational centre of the eye ~13 mm below the cornea 1st dimension: horizontal displacements 2nd dimension: vertical displacements 3rd dimension: horizontal rotation 4th dimension: vertical rotation Available at NEXT revision of Wavelight EX500

33 vertical displacements horizontal displacements
Cyclotorsion the 5th dimension Roots of Rotation errors: Patient check up is carried out in sitting position, but treatment in supine arrangement Patient might sit in a angled head-position to the examination tool Rotation caused by patient “squeezing” against the speculum during ablation or flap creation vertical displacements Static cyclotorsion compensation for errors resulting from sitting to supine position or head position horizontal displacements Practicable for T-CAT with Topolyzer Vario Dynamic cyclotorsion compensation resulting from torsion movements during the treatment 1st dimension: horizontal displacements 2nd dimension: vertical displacements 3rd dimension: horizontal rotation 4th dimension: vertical rotation 5th dimension: cyclotorsion Available at NEXT revision of Wavelight EX500

34 vertical displacements horizontal displacements
Z displacement the 6th dimension vertical displacements horizontal displacements 1st dimension: horizontal displacements 2nd dimension: vertical displacements 3rd dimension: horizontal rotation 4th dimension: vertical rotation 5th dimension: cyclotorsion 6th dimension: Z displacement passive tracking for large displacement in Z axis (laser stops triggering) and visual control (distance diodes) Available at NEXT revision of Wavelight EX500

35 Practicable with T-CAT and Topolyzer Vario
Pupil centroid shift Pupil centroid shift caused by natural shift of pupil centre at a different pupil diameter (example: wavefront measured at scotopic pupil, while treatment is performed in mesopic to photopic condition) Pupil centroid change during ablation, caused by change of illumination or accommodation. 1st dimension: horizontal displacements 2nd dimension: vertical displacements 3rd dimension: horizontal rotation 4th dimension: vertical rotation 5th dimension: cyclotorsion 6th dimention: Z displacment 7th dimension Centroid shift Mesopic Scotopic Static and dynamic centroid shift compensation for all errors resulting from pupil size changes Practicable with T-CAT and Topolyzer Vario

36 Automated Centering Automated, surgeon and predefined centering option
Corneal vertex centering Obligatory for Topography Guided Pre-selectable for WFO and Custom Q Pupil Centre centering for different lighting conditions (photopic, mesopic or scotopic) Line of sight centering Obligatory for Wavefront Guided ablation

37 Parallax Compensation
Surgeon view: Compensated OPMI 300µm Laser and eye tracker OPMI = Surgeons view superior inferior

38 Card Concept

39 Safety Eye-tracker 1050 Hz, 2.5 ms and multidimensional active video based eye-tracker  tracks pupils from 1.0 up to 8.0 mm Energy stability Steady and reliable energy stability throughout the treatment due to the closed loop energy control and the enhanced sealed beam path  WaveLight® EX500 now includes N2 purging of laser head optics! Automatic energy calibration before every patient Energy calibration Convenient fluence test on PMMA once a day Eye alignment Integrated and advanced Eye Tracker alignment & cross line projector with the WaveLight® EX500 Cyclotorsion passive cyclotorsional alignment Pulse control Every laser pulse is controlled from its source till the point where it is applied to the cornea  no uncontrolled ablation possible with Thermal impact Minimized thermal impact because by thermo neutral pulse distribution  Every 5th pulse is allowed to overlap


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