Pattern Scan Laser System
PASCAL Delivers Laser Treatments with Less Pain in Less Time.
LESLIE GOLDBERG, ASSISTANT
Corporation (Santa Clara, Calif) has developed the pattern scan laser (PASCAL) for
use in standard photocoagulation procedures. The laser's primary applications are
panretinal photocoagulation for treatment of proliferative diabetic retinopathy
(PRP) and macular grid treatment for diabetic macular edema.
PASCAL photocoagulator is based on the use of a proprietary, semi-automated pattern
generation method using short 532-nm laser pulses. These laser pulses are delivered
in a rapid predetermined sequence resulting in improved precision, safety, patient
comfort, and significant reduction in treatment time compared with conventional
photocoagulation, according to David Mordaunt, CEO at OptiMedica.
"This laser allows you to preselect a pattern of grid laser for
varying degrees of macular edema. It also allows application of a very uniform pattern
of PRP treatment, says Harry W. Flynn, Jr., MD, professor of ophthalmology at the
Bascom Palmer Eye Institute in Miami. Dr. Flynn also listed other potential advantages
to the PASCAL laser for PRP:
► Multiple spot placement
► Short duration burns
► Improved efficiency
► Less pain
► Less patient fatigue
► Potential for one session to complete
PATTERN SCANNING TECHNOLOGY
"The idea behind pattern scanning is that
it allows the surgeon to deliver a more precise photocoagulation with more standardized
energy in a quicker manner," says George Williams, MD, chairman, Department of Ophthalmology
and director of the Beaumont Eye Institute at Beaumont Hospital in Royal Oak, Mich.
"The net effect is that when performing a panretinal photocoagulation, each time
the surgeon steps on the foot pedal, instead of delivering 1 spot he can deliver
up to 25 spots. And each of those spots is going to be the same, so it allows for
more precision in the actual distribution of the spots, the actual pattern."
The pattern array options include single spot, square arrays,
octants, quadrants, macular grid, and arcs (Figure 1). As many as 25 spots may be
delivered in 0.5 seconds. The PASCAL software allows surgeons to adjust the pattern
as they see fit.
different sections of the eye, you may want a tighter or more dispersed pattern,"
explains Dr. Williams. "For example, one pattern presents a 5x5 array. Each of those
spot distributions can be controlled by adjusting how close one spot is to another.
They can be within a 1�4
spot of each other and up to 3 spot sizes apart. We can manually space our burns
a certain distance apart."
1. The PASCAL's touchscreen user interface.
Dr. Williams explains that for a standard panretinal photocoagulation,
most surgeons deliver somewhere around 1000 spots per treatment. "With a conventional
laser, a surgeon would have to hit the foot pedal 1000 times. With this type of
technology, if you are using the 5x5 square array, you can get there with 40 hits,"
LESS PAIN EXPERIENCED BY
Dr. Williams says that because the burns
are delivered in a shorter time duration, his practice's clinical experience to
date is that patients find that this type of treatment is much more comfortable.
"In addition to the time savings, each depression of the pedal is less uncomfortable,"
says Dr. Williams. "My personal experience is that patients are more likely to come
back for additional treatments when they haven't had a painful experience with the
PASCAL USE FOR MACULAR DISEASE
The PASCAL has features that allow placement
of a very precise grid pattern for macular disease. Again, it is possible to adjust
spacing as well as number of spots for macular treatment. "One of the nice features
of PASCAL," says Dr. Williams, "is that the energy delivery is so quick that patients
do not have the time to change their fixation. We are always worried that when we
are photocoagulating the macula, the patient will change their fixation and get
a foveal burn. With this type of technology, this becomes less likely."
Figure 2. The PASCAL delivers a pattern-generated
laser burn [at top left], while the conventional laser burn [at bottom left] delivers
a more random result.
CONVENTIONAL VS. PASCAL PHOTOCOAGULATION
Retinal disease is expected to grow by more
than 70% by 2020 based on increasing life expectancies and the prevalence of diabetes,
according to the Archives of Ophthalmology. There has been little change
in photocoagulation delivery throughout the past 3 decades. While laser treatment
is the standard of care, it is time consuming, reimbursement occurs only once per
course of treatment (regardless of the number of sessions needed), and treatment
is painful. "With the PASCAL method of photocoagulation," says Dr. Mordaunt, "less
heat is transferred to the choroid, there is improved patient tolerance, and there
may be potential clinical benefits due to less collateral damage, less inflammatory
response, and preservation of retinal nerve fiber." (Figure 2)
FEATURES OF THE PASCAL
The PASCAL has an intuitive touchscreen
interface, pattern scanner technology, an advanced-optics slit lamp, micromanipulator,
and it is LIO compatible. It also has ergonomic features that benefit both the patient
and the physician.
"The design of the laser table allows wheelchair access so that
they can put their feet directly under the slit lamp," says Dr. Flynn.
For more information visit OptiMedica's Web site at
Dr. Flynn and Dr. Williams serve on OptiMedica's medical advisory board.
Retinal Physician, Issue: September 2006