3Swiveling bed Improved patient comfort Better ergonomic handling Faster proceduresFast swiveling motion & variable swiveling angles (30° or 45°)Adjustable headrest (height)Left/right eye detection, automated movement from OD OS and central position
5Why femtosecond LASER? Safety Precision Versatility Patient benefit Reproducibility (standard deviation microkeratome >20µm)Single use patient interfacePrecisionVery homogeneous flap thicknessminimal deviation in geometries (diameter, hinge, etc.)Even stromal bedVersatilityWide adjustment range of geometries and parametersNon-mechanical Keratoplasty and intrastromal RingsPatient benefitBladelessBetter results (no astigmatism & abberation induction)
6Advantages Femto vs. mechanical microkeratome Flap creation using Femto-LaserCutting geometries are designed on the computer and created with LASER precisionFlap diameter very accurateLarge applanation areaLarge effective ablation area for the ExcimerHinge and orientation not depending to the suction ring and its applicationLamellar cut through out the flap (homogeneous thickness)Surgeon can design and control (computer aided) side cut angle, flap thickness, diameter and centrationVisibility to the stroma through out the cutting procedureFlap is after femto-LASER application not separated from the stromaCustom Flap design
19New FeaturesBuild in online pachymeter (OLCR- Optical Low-Coherence Reflectometry)Static and dynamic (during ablation) measurement of corneal thicknessCan be saved by soft buttonNeeds proper apex adjustment (distanced diodes) Traffic light systemTraffic light System like OB820 speed of measurementApexDistance- Std best <1
20New Features Build in N2 generator Continuously purged beam-path; enhancing energy stabilitysimplifying logistics and operation, reducing running cost and space requirementsJust one gas bottle ArF
21New 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 timeLife time Laserhead 3-4 times more than Allegretto expectedOptics higher life time expected
23Illumination RingTo move illumination ring to treatment /prepare positionSwitches between / combines:Microscope - field IlluminationOP – field IlluminationPlume evacuatorStarts before Laser treatmentIncreased working distance 250 mmInfrared light illuminationNOTE: Energy sensor moves automatically (not visible) into the beam path for Energy Check
25Wavefront Optimized - the solid Base Wavelight EX500 uses the well knownWavefront Optimized profiles
26Wavefront Optimized - the solid Base WaveLight:Wavefront OptimizedTM optical zoneNon-wavefront optimized optical zoneWavefront 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 treatmentscreate relatively narrow optical zone a wide transition zone. These profiles may cause night vision issues caused by induced higher order aberrations.
27Effectiveness: UCVA (Uncorrected visual acuity) Wavefront Optimized – Visual OutcomesEffectiveness: UCVA (Uncorrected visual acuity)25%64%93%99%100%22%76%0%20%40%60%80%wavefront-guidedWavefront OptimizedTM>= 20/12.5>= 20/16>= 20/20>= 20/40>= 20/200Both 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®
28NeuroTrack - 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.
29NeuroTrack - 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.
30All encompassing eye-tracking Video-based eye-tracker guarantees fast multidimensional active eye-tracking for better results and outmost patient care.High speed tracking 1050 HzUltra fast ms latencyMulti-dimensional eye-trackingRequires no dilation; allows streamlined workflowWorks in infra-red lightThree independent angulated light-sources for redundant lightningCompensation option for angle kappa
31Why 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
32vertical displacements horizontal displacements Compensating for H and V rotationDisplacement calculated by conventional Eye-TrackerCentre of ablation using rotational compensation for X and Y rotation+xvertical displacementshorizontal displacementsDetected centre of pupilrotational centre of the eye~13 mm below the cornea1st dimension: horizontal displacements2nd dimension: vertical displacements3rd dimension: horizontal rotation4th dimension: vertical rotationAvailable at NEXT revision of Wavelight EX500
33vertical displacements horizontal displacements Cyclotorsion the 5th dimensionRoots of Rotation errors:Patient check up is carried out in sitting position, but treatment in supine arrangementPatient might sit in a angled head-position to the examination toolRotation caused by patient “squeezing” against the speculum during ablation or flap creationvertical displacementsStatic cyclotorsion compensation for errors resulting from sitting to supine position or head positionhorizontal displacementsPracticable for T-CAT with Topolyzer VarioDynamic cyclotorsion compensation resulting from torsion movements during the treatment1st dimension: horizontal displacements2nd dimension: vertical displacements3rd dimension: horizontal rotation4th dimension: vertical rotation5th dimension: cyclotorsionAvailable at NEXT revision of Wavelight EX500
34vertical displacements horizontal displacements Z displacement the 6th dimensionvertical displacementshorizontal displacements1st dimension: horizontal displacements2nd dimension: vertical displacements3rd dimension: horizontal rotation4th dimension: vertical rotation5th dimension: cyclotorsion6th dimension: Z displacementpassive tracking for large displacement in Z axis (laser stops triggering)and visual control (distance diodes)Available at NEXT revision of Wavelight EX500
35Practicable with T-CAT and Topolyzer Vario Pupil centroid shiftPupil 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 displacements2nd dimension: vertical displacements3rd dimension: horizontal rotation4th dimension: vertical rotation5th dimension: cyclotorsion6th dimention: Z displacment7th dimension Centroid shiftMesopicScotopicStatic and dynamic centroid shift compensation for all errors resulting from pupil size changesPracticable with T-CAT and Topolyzer Vario
36Automated Centering Automated, surgeon and predefined centering option Corneal vertex centeringObligatory for Topography GuidedPre-selectable for WFO and Custom QPupil Centre centering for different lighting conditions (photopic, mesopic or scotopic)Line of sight centeringObligatory for Wavefront Guided ablation
39SafetyEye-tracker1050 Hz, 2.5 ms and multidimensional active video based eye-tracker tracks pupils from 1.0 up to 8.0 mmEnergy stabilitySteady 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 patientEnergy calibrationConvenient fluence test on PMMA once a dayEye alignmentIntegrated and advanced Eye Tracker alignment & cross line projector with the WaveLight® EX500Cyclotorsionpassive cyclotorsional alignmentPulse controlEvery laser pulse is controlled from its source till the point where it is applied to the cornea no uncontrolled ablation possible withThermal impactMinimized thermal impact because by thermo neutral pulse distribution Every 5th pulse is allowed to overlap