Ellex’s Ultra Q Reflex YAG laser is a breakthrough treatment for capsulotomies, peripheral iridotomies, and vitreolysis-based floater treatment. The minimally invasive, low-risk, in-office procedure can potentially delay or obviate the need for vitrectomy.
“The system’s proprietary reflex technology aligns the operator’s vision, the target illumination, and the treatment beam along the same optical path and optical plane,” explains Bill Swaim, president of Ellex, Inc. in Minneapolis, Minnesota. “Consequently, physicians can focus on-axis with more depth and spatial reference when treating floaters in the middle to posterior vitreous. Physicians can use the illumination tower coaxially to enhance the view of the floater by using the fundus red reflex as a contrast comparison; a green aiming beam provides enhanced contrast conditions and more precise focusing.”
The Ultra Q Reflex YAG laser is distinct from traditional YAG lasers, which deliver their illumination from a low, noncoaxial position — making it difficult to clearly visualize the middle and posterior vitreous where the bulk of symptomatic floaters reside. Vitrectomy, another option considered to be highly effective for floater removal, is invasive and carries a significant risk of bleeding, infection, and cataract formation.
A CLOSER LOOK
During a procedure, 3-second nanosecond pulses of YAG laser energy are applied to the floater, which is focused through a specially designed laser lens, Swaim explains. The energy evaporates the vitreous opacities and severs vitreous strands. The collagen and hyaluronin molecules within the targeted floaters convert into a gas form or reduce to a size that no longer impedes vision. The gas bubbles quickly dissolve and reabsorb into the vitreous humor. Depending on the type of floater, patients may need 2 or 3 treatment sessions to achieve a satisfactory result.
Specifically, the instrument is ideal for performing YAG capsulotomy for patients with posterior capsular opacity, YAG peripheral iridotomy for patients with anatomically narrow anterior chambers, and YAG vitreolysis for patients with symptomatic vitreous opacities that are disabling to patient quality of life. “The excellent optics and tightly controlled plasma energy make it easier for the surgeon to perform these procedures,” says Michael Tibbetts, MD, a retina specialist with Tyson Eye in Cape Coral, Florida, who uses the laser at his practice. It can also be used for cases of angle-closure glaucoma.
“The laser provides a platform for the full range of YAG procedures that I perform, and eliminates the need to switch between machines.”
Inder Paul Singh, MD, president of the Eye Centers of Racine and Kenosha, in Wisconsin, says the Ultra Q-Reflex YAG laser’s reflex technology platform offers coaxial (on) and off-axis illumination. The illumination mirror, which briefly moves out of the laser pathway during firing, ensures that the laser beam is coaxial for anterior, mid, and posterior vitreous treatment applications and is never obstructed. “The illumination tower can be used coaxially to enhance the view of the target opacity and allows for a clear visualization of the internal eye from the cornea all the way to the retina, providing the needed spatial context for procedure,” Dr. Singh explains. “The coaxial position allows for a red reflex and maximizes visualization of floaters in the middle and posterior vitreous. Without coaxial illumination, it is not possible to identify many symptomatic floaters and more importantly, provide spatial context with the retina. By allowing the laser to fire at any position of the slit lamp, the system provides the surgeon with the ability to titrate the amount of coaxial illumination by moving the slit lamp of axis to obtain the optimal balance of red reflex and contrast.”
Another key feature is the efficient delivery of energy into the eye. The laser has a narrow Gaussian energy beam profile (sharper rise and fall), which improves the efficiency of energy delivery. “Most standard YAG lasers with typical original equipment manufacturer cavities produce a wider beam profile,” Dr. Singh says. “The new narrow beam profile allows for the 50% air breakdown to be at 1.8 mJ, which is significantly lower than standard YAG lasers.”
In general, Ellex lasers have a unique cooling system that allows surgeons to fire hundreds or thousands of shots in a single sitting without the laser overheating and having to be reset. “That’s important for flow and efficiency, since we are firing hundreds of shots per vitreolysis session,” Dr. Singh says.
The compact instrument has a fully integrated microscope. “The interface is straightforward, with control of the offset and power at the user’s fingertips,” Dr. Tibbetts adds.
Swaim points out that ergonomics and enhanced physician comfort are at the heart of Ellex’s product design. “The Ultra Q Reflex channels the treatment laser through slit lamp optics for improved operational performance, as well as enhanced physician comfort,” he says.
A study showed that the ability to perform YAG laser vitreolysis may improve the outcome of patients with symptomatic vitreous opacities. Ellex’s laser was used in the first randomized controlled trial of YAG laser vitreolysis1 and demonstrated that it could reduce both the subjective symptoms and objective findings of vitreous opacities.
The majority of patients can expect a 60% to 90% improvement in the mass or amount of floaters following treatment with laser vitreolysis. “The Ultra Q Reflex performs such precise capsulotomy treatments that the incidence of floater formation post capsulotomy is greatly reduced,” Swaim says. Laser vitreolysis typically takes between 10 and 20 minutes to perform, depending on the location and type of floater. Most patients experience an almost immediate improvement in visual function and can return to normal daily activities right after the procedure. Reported side effects and complications associated with vitreolysis are rare. Side effects may include cataracts and a spike in intraocular pressure.
“After a short time performing YAG vitreolysis on a few patients, I experienced high patient satisfaction, and appreciated the impact removing floaters can have on a patient’s quality of life,” Dr. Singh concludes. RP
- Shah CP, Heier JS. YAG laser vitreolysis vs sham YAG vitreolysis for symptomatic vitreous floaters: a randomized clinical trial. JAMA Ophthalmol. 2017 Jul 20. [Epub ahead of print]