BLOG: An evolution in laser vision correction
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Key takeaways:
- The Teneo excimer laser offers advancements in safety, efficacy, efficiency and usability.
- The laser is the result of collaborative effort between industry and clinicians.
From the early days of excimer lasers to recent breakthroughs, each innovation has enhanced our ability to provide safe, effective and efficient solutions for patients.
This year marks a new era in the field of refractive surgery with the first FDA approval of an excimer laser in 17 years. The Teneo excimer laser platform (Bausch + Lomb), approved for myopia and myopic astigmatism up to –10 D with sphere between –1 D and –10 D and cylinder between 0 D and –3 D, is now the smallest and fastest flying spot excimer laser in the U.S., operating at 500 Hz.
Advancements in safety, efficacy, efficiency and usability
Over the past decade, refractive surgeons have seen few advancements in excimer laser technology. Notable innovations have included higher repetition rate lasers, topography guidance and high-definition wavefront-guided ablation profiles. While these improvements have enhanced our precision and leveraged innovative diagnostic capabilities, the core technology powering excimer lasers remained largely unchanged. For many surgeons, myself included, the arrival of the Teneo laser has created a resurgence of excitement for the accuracy and efficiency we can achieve with modern laser vision correction procedures. It also enhances usability due to specific features that aid in both surgeon and patient comfort.
Safety and efficacy. As an investigator in the FDA clinical trial for the Teneo and having performed the first U.S. commercial surgeries, I can speak firsthand to the laser’s safety and efficacy across a broad range of myopic correction. Notably, the laser demonstrated exceptional performance, with 97.8% of patients achieving 20/25 or better uncorrected distance vision, and more than 50% were 20/16 or better. Additionally, more than 33% of eyes gained one or more lines of best corrected visual acuity compared with preoperatively, and no patient lost two lines or more of vision. The mean manifest refractive spherical equivalent at 9 months was –0.04 D, which is some of the best data that we've seen published. Patients also experienced a statistically significant improvement in contrast sensitivity with glare and subjective satisfaction. Patients reported that, for activities such as driving at night and in difficult conditions and sports or other outdoor activities, they performed better postoperatively than they did preoperatively.
These results showed that the Teneo system not only performed exceptionally well in visual acuity results but that patients were very happy with their outcomes.
Efficiency. Beyond clinical performance, Teneo offers a host of efficiencies that streamline preoperative planning and postoperative care. First and foremost, the software does not require an external nomogram. This reduces the potential for transcription errors, streamlines surgical planning and eliminates several steps before surgery. Now, only three steps are required: selecting a patient, choosing and confirming treatment, and treatment. We are simply treating off the manifest refraction down to 0.01 D.
The advanced eye tracker operates at more than three times the speed of the laser repetition (1,740 Hz), which is important with high-repetition rate excimer lasers, ensuring the most accurate placement of ablation pattern possible with very fast treatments averaging seconds. In addition to tracking in the x and y axes, it also tracks in the z axis. Further, Teneo uses a radial ablation profile that accounts for spherical aberration and minimizes spherical aberration induction to create a more natural ablation profile, using a truncated gaussian beam profile. The laser has the fastest ablation time (1.2 seconds per diopter) of all excimer lasers in the U.S., which enables rapid treatments. Fast ablation time has also been associated with reduced stromal dehydration and optimized flap architecture.
The user interface is customizable, allowing surgeons to access their preferred patient data without flipping through multiple screens. This seemingly small efficiency can save valuable seconds on every case.
Usability. In addition to the time-saving advantages, Teneo’s small footprint (6.8 ft2) frees up limited space in the OR, enhancing staff, surgeon and patient flow. The 360° swiveling microscope can be adapted to surgeon height and posture, and the treatment bed comfortably accommodates all patient sizes. It swings out for easier access and can be manipulated for optimal patient head positioning and positioned for a second treatment device, eliminating the need for patients to get up and move between treatment steps.
Why it matters
Surgical efficiency is an important metric for the busy refractive surgical practice. In addition to achieving safe and effective surgery, incorporating new technologies and advances can improve your productivity, reduce procedural steps and valuable time from your surgery schedule, and optimize workflow.
We are, however, already extremely efficient. Putting available resources to their best use and learning how to integrate new technologies seamlessly into your existing workflow are key for success. The use of a new technology in my routine should be a potential enhancement. In my clinical experience to date, Teneo has proven to be just that.
Conclusion
It is essential to recognize the collaborative effort between industry and clinicians required to produce meaningful innovation. The introduction of the Teneo excimer laser is just one example of how our feedback and insights can refine the design and functionality of a technology, ensuring it meets the evolving needs of both surgeons and patients. The safety, efficacy, efficiency and usability of the Teneo are opening new ways for us to approach refractive surgery.
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