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