New Phaco Technology Mark Packer, MD, FACS Clinical Associate Professor of Ophthalmology Oregon Health & Sciences University Drs. Fine, Hoffman & Packer, Eugene, Oregon ASCRS 2009

Mark Packer, MD Financial Disclosure Consultant Abbot Medical Optics, Inc. Advanced Vision Science, Inc. Bausch & Lomb, Inc. Candeo Clinical/Science Communications, LLC Carl Zeiss Surgical GmbH General Electric Company Gerson Lehman Group, Inc. Ista Pharmaceuticals, Inc. i-Therapeutix, Inc. Johnson & Johnson Vision Care, Inc. Leerink Swann & Company Sirion Therapeutics, Inc. Transcend Medical, Inc. TrueVision Systems, Inc. Visiogen, Inc. VisionCare, Inc. WaveTec Vision Systems Travel & Honoraria Endo Optiks, Inc. Synermed Communications March 19, 2009

F Cataract Surgery Est Refractive Lens Exchange D A

B-MICS Kurz S, Krummenauer F, Gabriel P, Pfeiffer N, Dick HB. Biaxial microincision versus coaxial small-incision clear cornea cataract surgery. Ophthalmology Oct;113(10):

AMO Signature

WHITESTAR ™ ICE Technology ICE Pulse “Increase Control and Efficiency”

WHITESTAR ™ ICE Technology ICE Pulse

AMO Signature ellips Longitudinal and transversal motion Punch separates tip from material Micro void forms BSS flows in and accelerates cavitation

Signature - chop

Signature - segment

B & L Stellaris

Stellaris – Efficiency Unique Dual-Linear Technology On-demand independent linear control of aspiration and phaco power Pre-programmable foot pedal settings customizable to surgeon technique Surgeon control of total phaco time for added safety and efficiency throughout procedure Wireless connectivity for OR convenience

Stellaris Handpiece Six-crystal configuration 28.5 kHz for optimized cavitation, and rapid emulsification with minimal thermal loading SureLock TM Locking irrigation connectors C-MICS and B-MICS capable

Conventional power modulation Advanced power modulation with CCS Traditional pulse: 20 pps Hyperpulse: up to 120 pps -more effective cutting with less heat Traditional burst: minimum of 80 ms Hyper burst: minimum of 4 ms - less energy w/ nuclear removal - less heat build-up - less total energy Extended range of programmability vs. conventional pulse and burst modes Custom Control Software (B&L)

ConventionalAdvanced power modulation with CCS Fixed duty cycle Variable duty cycle (10 – 100%) -To prevent continuous phaco energy even w/ maximum pedal depression Fixed rise time Variable rise time (waveform pulse) Unique to Millennium technology - less energy during nuclear removal - less heat build-up; less total energy Variable Duty Cycle, Rise Time

Stellaris Handpiece – Cutting Dynamics Increased stroke length for efficient cutting of the nucleus Tighter, more focused and consistent delivery of stroke CustomControl Software II for customizable, programmable wavefront power modulations for all techniques

Alcon Infiniti

Torsional Phacoemulsification New energy delivery modality on the INFINITI® Vision System designed to –Reduce repulsion and turbulence –Improve thermal safety profile Oscillatory motion at the hub of the phaco tip similar to NeoSoniX® with lower frequency than traditional ultrasound –NeoSoniX® oscillations100 Hz –Torsional phaco32,000Hz –Traditional Longitudinal phaco40,000Hz

Ozil Reverse Kelman Tip

Power Modulations Provide millisecond level control of US Reduce repulsion, improve followability (with transversal or torsional motion delivery) Minimize thermal energy, free radical production Facilitate B-MICS

Parameters Found at The Expert View – Or by

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