Article Date: 11/1/2012

The Benefits of a Multi-wavelength PatternScanLaser

The Benefits of a Multi-wavelength PatternScanLaser

Features that enhance versatility and efficiency also improve the patient’s experience.

BY VIRGINIA PICKLES, CONTRIBUTING EDITOR

At Vitreous-Retina-Macula-Consultants of New York, conducting clinical research, evaluating new devices and maintaining a position at the forefront of retina care is critical to the practice. “We have always been involved with new technology,” says K. Bailey Freund, MD. “Lawrence Yannuzzi, MD, a partner in the practice, is one of the pioneers of retinal photocoagulation with lasers and was involved in the development of krypton red. We’ve also been instrumental in the development and refinement of imaging technology, such as indocyanine green angiography, fundus auto-fluorescence imaging and enhanced-depth imaging optical coherence tomography (EDI-OCT). We’ve always pursued and tried to bring in new technology.”

When it became apparent the time had come to replace the laser photocoagulator in the main office of this forward-thinking practice, you might have expected there would be a long list of must-have features, as well as a target return-on-investment figure. Although these are important factors, Dr. Freund notes, there was an overarching consideration. “When thinking about return on investment, you don’t necessarily think in terms of dollars and cents,” he says. “There’s value in being able to provide the best care you can, to make the patient’s experience the best it can be.”

That sentiment was echoed by Kamal Kishore, MD, who practices at Illinois Retina Institute, and Lloyd M. Wilcox Jr., MD, who practices at The Eye Center of Concord, New Hampshire. Both physicians were instrumental in the decision to purchase a laser photocoagulator for their practices, and both agreed that the litmus test for adding, replacing or upgrading technology is always one question: Will this improve patient care?

All three practices chose the MC-500 Vixi Multicolor Scan Laser Photocoagulator (Nidek Co. Ltd.). “We purchased this laser primarily to provide better care to our patients,” Dr. Kishore says. Dr. Wilcox notes, “We did not buy this laser based on cost. We were interested in the quality of the work it could perform.” In assessing laser photo-coagulators, these physicians zeroed in on several key features they felt would enhance patient care.

Versatility

The ability to choose from among three wavelengths – 532 nm green, 577 nm yellow and 647 nm red – or combinations of any two of the three, allows surgeons to treat numerous retinal pathologies using a single machine. “With the various wavelengths, there’s very little pathology you cannot work through,” Dr. Wilcox says. “The red wavelength, for example, facilitates treating through blood and can be used for deep choroidal pathology. The yellow wavelength penetrates cataract and other dense media. I use it primarily to treat discretely in the macula of patients with good vision but who have macular edema. With it, I can selectively treat microaneurysms with far less energy. The green wavelength is most commonly used for panretinal photocoagulation (PRP).”

According to Dr. Wilcox, The Eye Center of Concord has had a Nidek multicolor laser for about 2 years and recently added the pattern component, which expands the laser’s utility. “There is a general tendency today toward doing lighter PRP treatments,” he notes. “With the patterns, it is easy to do that. In fact, they were designed for that purpose. The physicians in our practice lobbied to add the pattern component for the benefit of our patients.”

As Dr. Kishore further explains, the Vixi laser is capable of multifunctional scan deliveries. “The single mode is used in conventional laser emission and is useful for sealing a retinal tear, because a relatively longer duration is beneficial for creating a strong chorioretinal adhesion,” he says. “The auto manipulation mode is used for repeated laser emission with variable interval times and conventional coagulation setting in a selectable scan pattern. The scan mode is for repeated laser emission with a fixed interval time, high power and instantaneous speed. By delivering patterns in a triple arc (21 spots instantly), the procedure is more efficient.”

The Vixi laser includes eight preprogrammed scan patterns with a memory function for up to 14 patterns. The spacing between spots for each pattern can be changed, and the pattern can be rotated in 15-degree increments using the LCD touch screen.

Dr. Freund says the retina specialists in his practice have had opportunities to try various lasers, including pattern photocoagulators. “I liked being able to use the patterns, particularly for PRP,” he says, “but the laser we tried had only one wavelength. A feature of the Vixi laser that I find especially desirable is the ability to use patterns with the three different wavelengths. I tend to use the 577 nm yellow laser frequently because it is well absorbed by oxygenated hemoglobin and minimally absorbed by the yellow xanthophyll pigments in the macula. Another physician in our practice found performing iridotomies easier with the Vixi laser than one of the alternative commercially available pattern photocoagulators. The multicolor pattern laser gives us needed versatility.”

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Dr. Wilcox also appreciates that the Vixi laser is easily adaptable. “With this laser, I can treat single microaneurysms with a 100-, 80- or even 50-micron spot size, and then, a few moments later, I can change it to a pattern and do PRP.”

Patient Comfort and Practice Efficiency

According to Dr. Wilcox, photocoagulation with the pattern laser is a particularly good treatment choice for patients who are sensitive to the discomfort caused by spot laser treatment in the peripheral retina. “Applying spot after spot after spot takes longer and is more painful for patients than a pattern treatment, which lays down anywhere from 4 to 25 spots almost instantaneously,” he says.

The duration of each pulse with the Vixi laser is only 20 milliseconds compared with 100 to 200 milliseconds for traditional PRP. “Rather than applying one laser spot at a time, we can deliver numerous spots in a preselected pattern with a single press of the foot pedal,” Dr. Kishore says. “This results in less discomfort for the patient and less risk of damage to adjacent retinal tissue. In our practice, we rarely need retrobulbar or peribulbar anesthetic injection for PRP in pattern mode.”

Banking on Reliability

Another factor that weighs heavily in any assessment of new equipment is the practice’s prior experience with a specific manufacturer. Both Drs. Wilcox and Freund describe the Nidek lasers they replaced as “workhorses.”

“I had one of the first Nidek lasers used in this country,” Dr. Wilcox says. “It was cutting edge at the time, and it lasted more than 10 years without any major problems. Then we purchased a second one, which also performed reliably; the Vixi is our third Nidek laser. I have had very good experiences with Nidek’s products and service,” Dr. Wilcox says.

Dr. Freund’s experience was with a multiwavelength Nidek laser in a satellite office of his practice. “I have always been pleased with the quality and reliability of that laser,” he says. “When we needed to acquire a new laser for our main office, I knew I wanted to take a look at what Nidek had to offer.”

Dr. Freund agrees that pattern laser treatment is a better experience for patients than spot laser because exposure times are shorter, and the procedure is completed more quickly with less discomfort. In addition to improving the patient’s overall experience and comfort with laser photocoagulation, shortened treatment times also improve efficiency in the practice. As Dr. Freund notes, PRPs are completed more quickly with the pattern laser, which in turn, minimizes wait times for the laser.

“In private practice, time is money,” Dr. Kishore says. “We see about 40 patients a day. We like to perform all diagnostic tests and treatments on the same day because many patients travel great distances to see us and we want to accomplish as much as possible during their visit to minimize their travel.” To enhance practice efficiency and deliver state-of-the-art care, Dr. Kishore notes his practice has embraced new technology, such as digital angiography, electronic health records, spectral domain OCT and the MC-500 Vixi Multicolor Scan Laser Photocoagulator. “Patients, their relatives and referring providers appreciate our philosophy,” he says.

Additional Upgrades

For Dr. Freund and Dr. Wilcox, the transition to the Vixi laser was a transition from a tube laser to a solid-state laser, with the inherent advantages of such an upgrade. “Solid state is the state of the art in engineering,” Dr. Wilcox says. “One advantage is that the laser is more precise in the amount of energy it delivers, while power consumption has been reduced. In addition, solid-state lasers are more compact, so they are easier to move, and they tend not to generate as much heat as tube lasers. Of course, the Vixi laser has the indirect ophthalmoscope as did previous models.”

Dr. Kishore notes, “The split-prism optics of the Vixi laser provide superior visualization of the retina by reducing annoying reflections from the lens. We can visualize retinal details with great clarity, which enables us to deliver laser spots more accurately. In addition, the flickering aiming pattern causes less obstruction in visualization of retinal blood vessels compared to a fixed pattern.”

As Dr. Freund concludes, “The Vixi laser is easy to use. It has good design, good optics, good ergonomics, nice touchpad control, and it is the only laser photocoagulator I know of that does patterns in all three wavelengths.”

Improving the Patient’s Experience

As these physicians emphasized, the impetus behind adopting new technology is not merely to have the latest and greatest equipment. It is more about being able to practice medicine at the most advanced level and improving the patient’s experience whenever possible. “We have always invested fairly heavily in technology, so that we can offer patients many more treatment options,” Dr. Wilcox says. “I think patients appreciate that. In the case of a pattern laser, for example, we can now offer them PRP that will be faster and more comfortable.”

As Dr. Freund notes, “I enjoy being able to offer patients the best state-of-the-art care, and having a laser like the Vixi helps ensure that.”

Adds Dr. Kishore: “From our inception, our practice’s philosophy has been to provide state-of-the art care to our patients. Bringing new technologies to our community has been a very satisfying experience.” ●



Retinal Physician, Issue: November 2012, page(s): 13 14 15