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New femtolasik Refractive suite IN THE NAME OF GOD Mohsen Farvardin M.D. Slide 2 Slide 3 Improved patient comfort Better ergonomic handling Faster procedures 3 Swiveling bed Fast swiveling motion & variable swiveling angles (30 or 45) Adjustable headrest (height) Left/right eye detection, automated movement from OD OS and central position Slide 4 WaveLight FS200 Slide 5 Why femtosecond LASER? 5 Safety Reproducibility (standard deviation microkeratome >20m) 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) Slide 6 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 Slide 7 7 Lamellar flap created by the FS200 Slide 8 Versatility 8 -Flaps -Standard Flaps (round) -Custom Flaps (oval) -Rings -Keratoplasty -Penetrating Keratoplasty - Anterior Lamellar Keratoplasty -Posterior Lamellar Keratoplasty Slide 9 Slide 10 Slide 11 Slide 12 Wavelight EX500 12 Slide 13 Slide 14 Slide 15 Slide 16 Slide 17 Slide 18 Slide 19 19 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 New Features Slide 20 20 Build in N 2 generator Continuously purged beam-path; enhancing energy stability simplifying logistics and operation, reducing running cost and space requirements Just one gas bottle ArF New Features Slide 21 21 Enhanced beam-path and laser head design The combination of a short beam-path and continuously (while switched on) N 2 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 New Features Slide 22 22 Advanced motorized Zoom Microscope Stepless zoom Programmable magnifications for: Treatment Start Prepare New Features Slide 23 Illumination Ring 23 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 Slide 24 Allegrettos proven features 24 Slide 25 Wavefront Optimized - the solid Base 25 Wavelight EX500 uses the well known Wavefront Optimized profiles Slide 26 WaveLight: Wavefront Optimized TM optical zone Non-wavefront optimized optical zone Wavefront Optimized TM 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. Wavefront Optimized - the solid Base 26 Slide 27 Effectiveness: UCVA (Uncorrected visual acuity) 25% 64% 93% 99% 100% 22% 76% 93% 99% 100% 0% 20% 40% 60% 80% 100% wavefront-guidedWavefront Optimized TM >= 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 Wavefront Optimized Visual Outcomes 27 Slide 28 NeuroTrack - preventing torsion 28 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. Slide 29 NeuroTrack - Cross Line Projector 29 Results from two international sites of 141 high astigmatism corrections. The post-operative plot diagram shows the high accuracy of treatment results. Slide 30 All encompassing eye-tracking 30 High speed tracking 1050 Hz Ultra fast - 2.5 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 Video-based eye-tracker guarantees fast multidimensional active eye-tracking for better results and outmost patient care. Slide 31 31 When patient is looking up and down the head isnt moving, but the eye is rolling! Why multidimensional ET? Available at NEXT revision of Wavelight EX500 Slide 32 32 rotational centre of the eye ~13 mm below the cornea Detected centre of pupil Displacement calculated by conventional Eye-Tracker Centre of ablation using rotational compensation for X and Y rotation + x Compensating for H and V rotation horizontal displacements vertical displacements 1 st dimension:horizontal displacements 2 nd dimension:vertical displacements 3 rd dimension:horizontal rotation 4 th dimension:vertical rotation Available at NEXT revision of Wavelight EX500 Slide 33 33 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 Static cyclotorsion compensation for errors resulting from sitting to supine position or head position Dynamic cyclotorsion compensation resulting from torsion movements during the treatment horizontal displacements vertical displacements 1 st dimension:horizontal displacements 2 nd dimension:vertical displacements 3 rd dimension:horizontal rotation 4 th dimension:vertical rotation 5 th dimension: cyclotorsion Available at NEXT revision of Wavelight EX500 Practicable for T-CAT with Topolyzer Vario Slide 34 34 Z displacement the 6th dimension horizontal displacements vertical displacements 1 st dimension:horizontal displacements 2 nd dimension:vertical displacements 3 rd dimension:horizontal rotation 4 th dimension:vertical rotation 5 th dimension: cyclotorsion 6 th 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 Slide 35 35 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. Scotopic Mesopic 1 st dimension:horizontal displacements 2 nd dimension:vertical displacements 3 rd dimension:horizontal rotation 4 th dimension:vertical rotation 5 th dimension: cyclotorsion 6 th dimention: Z displacment 7 th dimension Centroid shift Static and dynamic centroid shift compensation for all errors resulting from pupil size changes Practicable with T-CAT and Topolyzer Vario Slide 36 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) Pre-selectable for WFO and Custom Q Line of sight centering Obligatory for Wavefront Guided ablation Pre-selectable for WFO and Custom Q Slide 37 Parallax Compensation 37 Laser and eye tracker OPMI = Surgeons view superior inferior Compensated OPMI 300m Surgeon view: Slide 38 Card Concept 38 Slide 39 Safety Eye-tracker1050 Hz, 2.5 ms and multidimensional active video based eye-tracker tracks pupils from 1.0 up to 8.0 mm Energy 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 N 2 purging of laser head optics! Automatic energy calibration before every patient Energy calibrationConvenient fluence test on PMMA once a day Eye alignmentIntegrated and advanced Eye Tracker alignment & cross line projector with the WaveLight EX500 Cyclotorsionpassive cyclotorsional alignment Pulse controlEvery laser pulse is controlled from its source till the point where it is applied to the cornea no uncontrolled ablation possible with Thermal impactMinimized thermal impact because by thermo neutral pulse distribution Every 5th pulse is allowed to overlap 39 Slide 40