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Supra Scan Laser Offers Comfort and Speed
Samantha Stahl, Assistant Editor
In anxiety-inducing laser photocoagulation procedures, patient comfort must be a top priority for the treatment to be a success. Physical distress induces movement, lengthening procedure time and possibly jeopardizing the accuracy of energy delivery. The new Supra Scan multispot laser photocoagulator from Quantel Medical seeks to make the process quicker and more comfortable for both patients and surgeons.
EASING THE PAIN
While patients are bound to experience uneasiness during any procedure, Thomas Aaberg Jr., MD, of Grand Rapids, MI, says the Supra Scan has been instrumental in reducing treatment time and increasing patient comfort. Approximately half of his cases produce no “discomfort cringe” at all; for those that do, the cringe is not as great as with other lasers.
“Patients who have had traditional laser followed by the Quantel uniformly preferred the Quantel,” he reports. One needle-phobic patient refused to have a retrobulbar block and couldn't tolerate the discomfort of another laser. Dr. Aaberg eventually used the Supra Scan. “She was one of the first patients I treated, and ultimately the reason I bought the machine.”
The secret to the system's success: quick exposure time. The micropulse duration ranges from 0.01s to a continuous exposure for all wavelengths, so it gives surgeons better visibility of previously treated areas.
The laser offers five preset scan patterns (squares, triple arcs, circles, macular grid and a single spot) and the option of customizing a pattern. The spot size is also adjustable, with a range of 100 µm to 500 µm in pattern mode and 50 µm to 500 µm in classic mode. Dr. Aaberg says he does not use the pattern function within 1500 µm of the fovea due to potential patient eye movement.
Dr. Aaberg uses Supra Scan for nearly every retinal procedure, including focal macular photocoag ulation, PRP and laser retinopexy. He typically uses the cube patterns, varying the distance between and size of the spots to meet the needs of the pathology. Occasionally, he notes, he will use other patterns to “fit” an area of macular ischemia.
“It has the power and flexibility to use anywhere in the eye,” he says. “The Supra Scan has such short pulse duration times that one can place relatively mild burns with a very nice pattern in the more peripheral—and typically more ischemic—areas of the macula.”
Dr. Aaberg found that the learning curve for the device was slight, but does offer this advice to colleagues: “Be very aware of the power settings as you move toward the periphery. If you maintain the same spot size and/or power used near the posterior pole, you will have periodic ruptures of Bruch's membrane and subretinal hemorrhages.” He increases the spot size gradually as he moves toward the periphery and lowers the power when necessary. He also advises to closely note areas with variable pigmentation, which affect laser uptake.
“If you're treating a relatively blond fundus and approach an area of greater pigmentation, turn down the power or increase the spot size and titrate the power or spot size accordingly.”
Other benefits of the Supra Scan include portability—convenient for surgeons who need to transport it to different exam rooms or practice locations—and programmable settings for practices with multiple users who have different preferences. The scanner easily attaches to many Haag-Streit style slit lamps and the mount can stay in place, reducing the time spent attaching and detaching the device.
Based on five to six months of follow-up, Dr. Aaberg has found the laser spots have stayed relatively the same size, likely due to the short burn times. While greater laser spread further decreases VEGF load produced by ischemic and necrotic tissue, he says Supra Scan offers the potential to “more accurately treat ischemic regions of the retina and still spare some functional peripheral retinal real estate, and consequently, peripheral vision.” RP
Visit quantel-medical.com for more information.
Supra Scan attaches easily to many Haag-Streit style slit lamps.