Q&A: Surgeon reports positive early experience with Veritas system for cataract surgery
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As the demand for cataract surgery continues to increase, the technology has evolved to meet the goals of both patients and surgeons.
In this interview with Healio/OSN, Kevin L. Waltz, MD, OD, speaks about his firsthand experience with the Veritas vision system (Johnson & Johnson Vision), a new dual-mode phacoemulsification system that aims to make cataract surgery safer, more predictable and more ergonomically comfortable for the surgeon.
In the midst of the pandemic, in rather challenging conditions, a study was successfully carried out to evaluate the clinical outcomes of the system, as well as the degree of satisfaction and comfort of the surgeons involved.
Healio/OSN: What innovative features have been introduced in the Veritas vision system to improve efficiency and safety of cataract surgery?
Waltz: The Veritas changed the fluidics and the power application for cataract surgery. Our goal as surgeons is to provide lots of power at the tip of the phaco needle and, at the same time, not repel the fragments. The Veritas improves on that process through more efficient energy delivery in the phaco needle and improved fluidics. The system is engineered to have better fluidics with physics as well as software. The inflow tubing is larger in diameter than the outflow tubing to provide the optimal balance. The outflow tubing is stiffer to avoid building up potential energy in the outflow tubing with the vacuum. The fluidic properties of this dual-durometer tubing were designed to reduce surge and make the chamber more stable.
Healio/OSN: How do these features affect your surgical experience?
Waltz: When you put the phaco handpiece in the eye, you can apply power, and you do not get movement inside the eye. The anterior chamber is stable. So, you develop confidence that you can apply power to the lens without collapsing the cornea or harming the posterior capsule. Those are the things that happen in the background, and the combination of them results in a stable chamber right from the start of the procedure.
Healio/OSN: Musculoskeletal disorders are common among ophthalmic surgeons. How does the Veritas improve ergonomics in the OR?
Waltz: The handpiece is light and short and allows up to 220° of rotation. It is easy and comfortable to handle and maneuver, and it gives surgeons great control over the phaco needle. Imagine you have a stick that is 2 feet long and you are moving it; you have a tail that you have to be careful of. The shorter you can get with the phaco handpiece, the more helpful that is. Posterior segment surgeons have small vitrectomy handpieces for that reason. Decreasing the length of the phaco handpiece is a step in the right direction also in cataract surgery. In addition, the foot pedal has a metal foot loop for ease of equipment repositioning, and the 19-inch monitor has 15° of tilt and 80° of side-to-side rotation for ease of viewing.
Healio/OSN: Tell us something about the first-in-human study with the Veritas. How many patients were treated, and where?
Waltz: The study included 115 eyes of 79 patients, of which 36 had bilateral surgeries and 43 had unilateral surgeries. There were two sites, one in El Salvador and one in California. In El Salvador, we did the first patients late in 2020, and due to COVID restrictions, the technicians from J&J could not travel. Normally when you start with a new phaco system, you have a phaco representative there to help with the settings, so this was an entirely new situation. We were also concerned because the machine had been shipped from California, and a lot of things could happen on that journey. However, the machine was intact and ready to go. It was so stable that it allowed us to proceed without any technical help. We just turned it on, and it worked beautifully from the first case. That is unusual — it was not just that it worked well, but it worked out of the box.
Healio/OSN: What about your results?
Waltz: We had amazingly good results, taking into account that in this environment, the typical patient has quite dense cataract and vision of 20/200 or worse. Eye after eye, we were treating these rather hard cataracts with a new machine, without a phaco rep present, and we were getting consistent, very nice results. In the first 60 cases, we had one vitrectomy in a difficult cataract with prior trauma, and the machine performed beautifully. All the other patients recovered quickly.
Healio/OSN: How would you compare this experience with your early experience with other phaco machines?
Waltz: I have worked with the early release of phaco machines for many years, and in general, I do not like doing it because there are oftentimes surprises. It takes a period of months to understand the machine and fine-tune it. So, I was concerned in this case because we were going to use a brand-new phaco machine, and we were alone. Once I turned it on and got it in the eye, it was immediately comfortable. The chamber was stable — more stable than with other phaco systems — the cutting quality of the phaco tip was as good as anything I have ever tried, there were no surprises in terms of the software settings, and with each case I found the settings were fine for my particular style of surgery. I also liked the large screen to display the various options, and it was a pleasant surprise overall. I went from being cautious to confident in less than 10 cases.
Healio/OSN: Were these impressions shared by the other surgeons involved in the study?
Waltz: Each surgeon completed a questionnaire regarding their clinical experience with the new machine. Satisfaction with anterior chamber stability, post-occlusion surge, followability, holdability, cutting efficiency and usability was favorable in 99% of cases or more. Enhanced ergonomics improved the surgical experience in 97% of cases or more. Results at day 1 were satisfactory in 94% of cases or more regardless of cataract grade. Of note, there were multiple surgeons participating in the study, with different levels of experience ranging from relatively inexperienced to very experienced, and we were all happy, satisfied and comfortable with the machine.
Reference:
- Quesada G, et al. Clin Ophthalmol. 2022;doi:10.2147/OPTH.S363061.
For more information:
Kevin L. Waltz, MD, OD, can be reached at email: kwaltz56@gmail.com.
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