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NeoSoniX to debut in summer 2001
Hybrid system seeks improved safety and efficiency. No phaco required on soft nuclei; easier lens disassembly on hard nuclei.
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MIAMI — A hybrid low- and ultra-high frequency cataract removal system from Alcon Surgical will become available this summer. The NeoSoniX system combines two complementary methods to perform lens disassembly at lower energy and temperature.
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“NeoSoniX represents a combination. Instead of having sonic or ultrasound only, it uses the two together and uses them synergistically,” said Lisa B. Arbisser, MD, at the American College of Eye Surgeons 15th annual symposium.
It may offer a cutting advantage over standard phaco “in the sense that, for very soft nuclei, phacoemulsification may be avoided altogether. And for very hard nuclei, it will be an extra modality to synergistically help us with those very dense cataracts, using less ultrasonic energy,” said Dr. Arbisser, a surgeon in private practice in Iowa.
The system should be commercially available by August.
Low-heat system
Oscillating, low-frequency energy could make lens disassembly more efficient, she said. Less ultrasound is used, compared with standard phaco.
The concept of non-ultrasonic to sonic energy has already been developed and is commercially available in STAAR Surgical’s Wave system. Alcon’s design effort improves on that concept by providing the combination of sonic oscillation simultaneously with ultrasonic energy.
“Instead of just extrusion, as we find in classic phaco, as well as in the STAAR Wave system, this has oscillation with extrusion,” Dr. Arbisser said. The tip oscillates at 2°, 0.003 inch and 120 Hz.
Another advantage is that no additional heat is created.
“A lot of the energy we use in phacoemulsification is really wasted in heat and does not affect the disassembly or dissolution of the lens. When it’s combined with the fluidics that are already available, it will work even on its own on mild-to-moderate cataracts, and this system may be a very nice addition,” she said.
No changes to surgical technique are required, she added.
Stand-alone or combo
Cataracts to +3 can be effectively disassembled on the low-power setting; lenses of greater density will likely require low-frequency in combination with ultrasound.
“It is a viable modality for removal of cataracts. It’s going to replace ultrasound on the soft and medium nuclei and supplement ultrasound on hard nuclei. It’s going to top out at 2+ or 3. Three or above is going to be a combo,” said Chris Nenon of Alcon.
“At first, we thought it was just going to be a supplement to ultrasound, but our pre-release evaluations showed us it really is a stand-alone product as well; I was with I. Howard Fine, MD, and he did four cases with zero ultrasound and these were all 2, 2+ nuclei that he did strictly with NeoSoniX, he added.
Legacy upgradeable
Advantec, Alcon’s new software and hardware package, will upgrade all current Legacy systems and permit use of NeoSoniX as well.
“It’s a way of adding a sophisticated software and hardware package to what currently exists, rather than an entirely new box,” Dr. Arbisser said. In addition to permitting use of the NeoSoniX feature, occlusion mode, viscoelastic removal mode and linear flow management features will be available as well.
“There will be linear flow, meaning across all of our phaco modes we’ll be able to use position II to change flow,” she continued.
“Visco mode creates a clear space before going to phaco so that the eye is not heated, and this will help to facilitate the case and make that quicker. We will be able to use our foot pedal to change between modes and not have to depend on our scrub people to increment through the case.
“This is a new paradigm shift. Rather than our trying to decide what parameters we want for a given memory setting, we’re going to think of our surgery perhaps more in terms of what we’re doing: Are we chopping? Are we removing epinucleus? Are we sculpting? And instead of remembering memory settings, we’ll be just saying, ‘now it’s time for the epinucleus removal,’ and be able to scroll through those on our own.”
Farther into future: AquaLase
AquaLase, currently under development by Alcon, will use water as the primary cutting tool.
High-energy fluid pulses can dissolve cataractous lenses, according to early results, Dr. Arbisser said.
“We’re talking about using balanced salt solution pulsed in an extremely rapid manner, which actually dissolves the nucleus. … There is a directed fluid that fans out so it disperses its energy throughout the nucleus, and basically you can paint away the nucleus with this water energy as it washes the posterior capsule,” she said.
The fluid is pulsed at 50 to 100 times per second, and possibly this method will not cause capsule tears. In some instances, it may still need to be combined with phaco so that “it still won’t be idiot-proof,” she added. Removal time is commensurate with existing methods, and no incisional heat is generated, she said.
For Your Information:
- Lisa B. Arbisser, MD, can be reached at 1351 West Central Park, Suite 1200, Davenport, IA 52804; (319) 323-8888; fax: (319) 328-3619; e-mail: l-arbisser@usa.net. Dr. Arbisser has no direct financial interest in the products mentioned in this article, nor is she a paid consultant for any companies mentioned.
- Alcon Surgical can be reached at 6201 South Freeway, Fort Worth, TX 76134; (800) 826-5266; fax: (817) 241-0677.