EyeWorld India March 2013 Issue

52 EWAP DEVICES March 2013 New - from page 50 Not - from page 51 advantage, particularly, since this would not require reformulation of the existing drugs, including those with higher viscosity.” Looking to the future Dr. Ianchulev said he thinks the future looks positive for this sort of technology. He said it’s important for physicians to be certain that patients are getting the medication prescribed to them. Dr. Packer agreed that this could not only benefit the administration of drops to the eye but also the ability for physicians to track compliance in patients. “Because this device is electronic and it’s built like a microprocessor, it can gather and communicate information,” he said. “So it would be possible to track patients’ utilization of their medications.” Another advantage of the new technology, Dr. Ianchulev said, would be that it seems to be fairly independent of the type of drug being administered. So far, over 90 drugs have been tested and worked with it. “You don’t have to reformulate the drugs,” he said. And this would be advantageous for the pharmaceutical companies. Dr. Packer added that the most likely form for the technology would be a cartridge-type system, which would allow patients to buy one system and use different medications in it. “The main thing is ease of use,” Dr. Packer said. It has to be easy to use, it has to be comfortable, and it has to be sterile, he said. EWAP Editors’ note: Dr. Packer has financial interests with Corinthian Ophthalmic. Dr. Ianchulev has financial interests with Corinthian Ophthalmic. Dr. Robin has no financial interests related to this article. Contact information Ianchulev: tianchul@yahoo.com Packer: mark@markpackerconsulting.com Robin: arobin@glaucomaexpert.com Index to Advertisers AMO – TECHNIS Family of IOLs Page: 20 , 21 www.AbottMedicalOptics.com Carl Zeiss Meditec AG Page: 35 www.meditec.zeiss.com/ReLEx Moria Page: 24 , 46 Phone: +33 (0) 146744674 Email: moria@moria-int.com www.moria-surgical.com Oculus Optikgerate GmbH Page: 11 Phone: +852-2987-1050 E-mail: info@oculus.hk www.oculus.de Synergetics Inc Page : 2 Phone: +636.939.5100 Fax: +636.939.6885 Email: customerservice@synergeticsusa.com www.synergeticsusa.com Technolas Perfect Vision GmbH- A Bausch + Lomb Company Page: 14 Phone: +65-6592-0792 www.technolas.com – www.bausch.com Topcon Singapore Medical Pte Ltd Page: 39 Phone: +65-68720606 Email: medical_sales@topcon.com.sg www.topcon.com.sg Ziemer Ophthalmic Systems Page: 60 www.ziemergroup.com ASCRS Page 48 , 59 www.ascrs.org APACRS Page 5, 7, 27 , 31 , 42 www.2013apacrs.org World Ophthalmology Congress (WOC 2014) Page: 57 www.woc2014.org Dr. Safran prefers metal blades for lamellar work. He feels it is easier to stay on plan with a metal blade that is beveled on one side. “If the blade is too sharp, it won’t stay on the plane but will cut across it,” Dr. Safran said. “It’s like using a knife for the lasagna instead of a spatula.” Pros and cons The positives to choosing a metal, disposable blade are cost and tactile feedback, according to Dr. Devgan. “They’re not nearly as sharp as a diamond blade, and you don’t get as clean an incision as with diamonds. For experienced surgeons, using a diamond blade is like a hot knife through butter— there’s no tactile feedback,” he said. Diamonds don’t require routine resharpening, but they are expensive (running a few thousand dollars per blade) and are “as fragile as a potato chip because they’re so incredibly thin,” Dr. Devgan said. If surgeons want to change their preferred incision size from 2.8 mm to 2.2 mm, the diamond blade can be rehoned, but if the surgeon opts to go back to the larger size, a new blade is necessary, which adds to the cost as well. Sapphire blades fall somewhere between steel and diamonds, Dr. Devgan said. They’re reusable and cost more than steel blades, and while they are less expensive than diamond blades, they may not last as long (somewhere in the tens or hundreds of uses). “Gem-quality diamond blades can be used ad infinitum unless they’re damaged,” Dr. Devgan said. The femtosecond lasers offer an additional type of incision and while they can create any architecture design that a surgeon can fathom, “the floor and the roof of the incision aren’t quite as smooth as you get with a diamond blade,” Dr. Devgan said. Number of users Newer surgeons should probably do their first couple hundred incisions with a metal blade before trying a diamond. “Part of any learning experience is to try all the different blades,” Dr. Naseri said. “Each surgeon is going to make his or her own decisions based on what he or she likes. I provide my residents with a rationale about why I prefer metal blades, but in the end it’s their decision.” Dr. Naseri said if he’s the only user at a surgery center, “I’d consider the diamond blade, but only ones without side-cutting elements. At an institution with multiple users and trapezoidal blades, there is just too much inconsistency.” Dr. Devgan said he literally has residents’ hands in his own during their first few uses of a diamond blade since the feedback is reduced. “Whatever blade you use will ultimately depend on what you are most comfortable having in your hands and whether the surgery center can process it without breaking or damaging it,” Dr. Safran said. EWAP Editors’ note: Dr. Ambrosio has financial interests with Oculus (Lynnwood, Wash., USA). Dr. Fontes has no financial interests related to his comments. Contact information Devgan : 800-337-1969, devgan@gmail.com Naseri : 415-221-4810, ext. 4707, ayman.naseri@va.gov Safran : 215-962 5177, safran12@comcast.net