1. Effective Sales Demos and Evaluations

2. 3 “Skills” to Learn for ECP
“Watching Video Monitor
Controlling endoscope movement
While observing 2 dimensional screen.

3. 3 “Skills” to Learn for ECP
Inflating Ciliary Sulcus Well
Instilling Cohesive Viscoelastic below Iris for 180°
Insure clear view of entire Ciliary Process “Head”

4. 3 “Skills” to Learn for ECP
Controlling Laser – Rate of Ablation/Distance to Target
Operating with Laser in Continuous Wave mode. Foot pedal controls On/Off of laser energy.
Control intensity of laser energy varying distance to target tissue,
Demonstrate “over treatment” by lasering too close to tissue or using t0o high a power setting setting.
First practice making spots on retina, (may have to turn power up to 600 mw) as there is very little pigmentation.
Practice turning brown ciliary epithelium “white”using laser set at 250 mw. Start with “spots” then “painting”

5. Microendoscopy in Ophthalmology
Conducting Effective Wet Labs
 Have the Following Supplies Available
At least 1 Eye per physician. Order extra in case some are bad.
2.5 mm or larger keratome disposable knife.
Gauze 4 x 4 Pads, Merocel or other PVA Instrument Wipes
Styrofoam head, suction cup or other device to secure Pig Eye
Alcohol or Alcohol Wipes to clean tip of endoscope (often!)
E2 & Monitor, E4 & Monitor & Laser, and all Accessories needed.
Viscoelastic/Sodium Hyaluronate (Never Methylcellulous)
Powder-Free Exam Gloves

6. Microendoscopy in Ophthalmology
Conducting Effective Wet Labs
 Start with Pars Plana Incision in Eye
- Insure Incision is Generous
- Make Incision about near Globe Equator (Due to Large Lens)
 Adjust Laser Parameters on Console
- Set Laser 250mw
- Set Laser Continuous
 Set Laser Aiming Beam Relatively Low
 Set Illumination Relatively High

7. Microendoscopy in Ophthalmology
Conducting Effective Wet Labs
 Before Introducing Endoscope into Eye…
- Adjust Orientation of Image
- Optimize Focus of Image
- Adjust Illumination to View Wound Site
 Introduce Endoscope Pointing Posterior Slowly
- View Optic Nerve/Disc & Other Anatomy
- Adjust Illumination as needed

8. Microendoscopy in Ophthalmology
Conducting Effective Wet Labs
NOTE: If surgeon has difficulty inserting endoscope due to loose conjunctiva the endoscope tip make capture debris, making the image cloudy. It should be removed and cleaned with an alcohol wipe or Merocel surgical sponge soaked in BSS.
NOTE: It is important to clean the endoscope tip each time the endoscope is removed from the eye. Be sure to reorient image every time before re-entering the eye.

9. Microendoscopy in Ophthalmology
Conducting Effective Wet Labs
 Demonstrate Controllable Laser Ablation
- Adjust Laser Power to 600 mW for Retina
- Laser Retinal Veins and view developing burn
- Increase/Decrease Distance & Observe Ablation Rate
 Incline Endoscope Anteriorly to View Ciliary Body
- Adjust Laser Power to 250nm
- Adjust Laser Aiming Beam
- Take Care to Avoid Touching Posterior Lens Capsule
- Laser Ciliary Processes and Observe Developing burn
- Increase/Decrease Distance & Ablation Rate

10. Microendoscopy in Ophthalmology
Conducting Effective Wet Labs
 Demonstrate Limbal/Corneal Endoscope Insertion
- Carefully Clean Endoscope Tip w/Instrument Wipe
- Create Generous Limbal Incision mm
- Create Wound near equator to reduce forward pressure on Lens
- Inject Viscoelastic Under Iris, Above Lens Capsule - Do not touch Iris!
- Check Image Orientation and Focus before insertion
- Do not view Monitor until the Endoscope is near Iris Edge.
- View Image on Monitor, and Proceed under Endoscopic View
- Insert Endoscope Horizontal/Posterior to Iris Plane
- Place Tip Under Iris to Bring Processes into view

11. Microendoscopy in Ophthalmology
Conducting Effective Wet Labs
 Demonstrate Controllable Ciliary Process Ablation
- Adjust Laser Power to 250nm
- Have 6 to 8 Ciliary Processes in View to start in Pig Eye*
- Adjust Laser Aiming Beam
- Laser Processes Observing both Whitening & Shrinking
- Move Tip closer/further to Demonstrate Distance vs Laser Power
- Intentionally Overtreat to Observe “Popping” of Ciliary Process
- Practice “Painting” Technique with Continuous Laser Energy.
Note: In Human Eyes keep 4 to 6 Processes in view

12. Microendoscopy in Ophthalmology
Conducting Effective Clinical Evaluations
 Arrive Early to Allow Time for Staff Training & Set Up
- Obtain Biomedical Engineering Review & Authorization
- Review Set Up & Operation with Surgeon & Staff
- Orientate System for Optimal Proximity to Surgeon
- Turn on System and Check all Scope Connections
- Evaluate Images Quality of Endoscopes
- Sterilize Endoscopes to be used in Surgery
- Insure Proper Visco, Wipes, Anesthesia & Meds are on hand
- Preset Laser Parameters - 250mw & Continuous

13. Microendoscopy in Ophthalmology
Conducting Effective Clinical Evaluations
 Patient Selection is Critical to Success in Early Cases
- Medically Controlled Moderate POAG, IOP <26 mm/Hg
- Taking 2 or more Glaucoma Medications
- No Previous Failed Surgery (For Early Patients Only)
- No Other Pathology (For Early Patients Only)
 Review ECP Treatment Plan with Surgeon
- Reiterate Importance of Creating a Generous Iris Bombe
- Encourage at least a 270 Degree Treatment
- Encourage Slow and thorough Laser Treatment
- Be certain that an appropriate Viscoelastic is used!!!
- Reiterate Importance of thorough Visco Evacuation!!!

14. Microendoscopy in Ophthalmology
Conducting Effective Clinical Evaluations
 Be Prepared to Coach and Support During Surgery
- Insure Incision Site(s) are > 1.8 mm to Prevent Corneal Torque
- Insure that Sulcus is Adequately Inflated with Healon
- Check Image Orientation & Focus Prior to Insertion
- Have Surgeon Visualize Target Tissue Before Lasering
- Assist in Controlling Illumination, Orientation and Aiming Beam
- Reiterate importance of careful complete removal of viscoelastic
- Suggest dexamethazone intracmerally or IV post op*
* Note: Reduces risk of transient post operative inflammation

15. Microendoscopy in Ophthalmology
Conducting Effective Clinical Evaluations
 Be Prepared to Coach and Support During Surgery
- Have Minimum 4 to 6 Processes in View Whenever Possible
- Clean Endoscope Tip Regularly
- Encourage Slow and complete 270°+ Degree Treatment
- Oversee Complete Aspiration of Viscoelastic
- Recommend Intracameral Dexamethasone before closing eye
- Recommend Continuing Glaucoma Meds until follow up
- Follow Up on Patient Outcomes at 6 to 8 Weeks
- Direct Questions/Concerns to Endo Optiks!

16. Endo Optiks Support Staff

17. Endo Optiks Staff Support Contacts
Rich Camarra
Director Intl Sales & Marketing Tel:
Jim Perry
Clinical Training Director Tel:
Don Watson
Technical Manager Tel:
Paula Ender
Chief Operations Officer Tel: