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Pattern Laser Offers Homogenous Success

Samantha Stahl, Assistant Editor

Paul Tornambe, MD, of La Jolla, CA, was a long-time pattern laser cynic. “I thought the pattern delivery idea was a gimmick. I was completely skeptical,” he says. He admits that when he was consulted during the creation of a laser system years ago, he said the feature wasn't worthwhile. However, when someone suggested that he give Nidek's new multicolor pattern scan laser, the MC-500 Vixi, a try, he was shocked by the results.

A PATTERN SCAN CONVERT

“It's a wild experience,” Dr. Tornambe says of the system. “It brings a smile to your face. The single-spot lasers have a lot of stress involved with the application. This pattern laser gets the job done — without the stress.”

The system includes eight preprogrammed scan patterns, with 14 available in total.

The problem with non–pattern scan lasers, says Dr. Tornambe, is that each individual spot doesn't get the same burn intensity. Some are hotter, some are colder—you can't achieve the same homogeneous intensity that is possible with patterns. When multiple spots are burned at the same time, they can be delivered quickly and at a low power without the patient moving. “There is a greater margin of safety with patterns,” he says. “You can get a fair number of spots near the fovea and every one will be precisely spaced, without any overlap.”

Nidek's new multicolor pattern scan laser is customizable in one, two or three color wavelengths — green (532 nm), yellow (577 nm) or red (647 nm) — and includes eight preset scan patterns.

He believes the elimination of overlapping burns could result in a lower incidence of decreased night and peripheral vision when the laser is used for PRP. “The scatter pattern is beautiful for doing PRP — especially targeted PRP — and the patients are definitely more comfortable,” he says. He also uses the system for treating proliferative diabetic retinopathy, DME, branch retinal vein occlusion and retinal tears.

With no prior pattern experience be fore using the Nidek system, Dr. Tornambe said the learning curve was “very short” and that the system is intuitive. He insists that someone new to the laser will quickly feel comfortable with the control box used to set power readings, spot size and pattern settings. “If you tend to do something that the laser doesn't want to do, you'll get feedback from the system that says, for example, the power is too low.”

Ergonomically, he has found the laser comfortable to use and says the heads-up device is user-friendly. While he finds that the red-free slit-lamp filter is too blue (“I prefer a greener filter”), he says that the slit lamp “has excellent optics.” The system itself has a small footprint and can fit into smaller exam rooms.

PATIENT COMFORT

Each MC-500 Vixi is customizable in one, two or three color wavelengths — green (532 nm), yellow (577 nm) or red (647 nm). Dr. Tornambe, like many surgeons these days, favors the yellow wavelength due to its increased safety profile. “Pure yellow is best for the macula and working very close to the fovea because the light isn't picked up by the yellow xanthophyll.”

He also finds that the yellow wave length is more comfortable for patients than green. “The patients tolerate the light better, and because the laser spots are smaller they elicit less pain. I don't have to use peribulbar anesthesia for PRP as I do with the indirect ophthalmoscope delivery system.”

A patient with tributary vein occlusion and persistent macular edema came into Dr. Tornambe's office after being treated with a non-pattern laser to no avail. Using the pattern laser, he could be more aggressive with the treatment and work closer to the fovea. “She responded so dramatically. Within a month, she dried up,” he says.

“The pattern component of this system completely changes the way you apply laser near the macula. It almost makes PRP fun for the surgeon,” he says. “I've been in practice for many years and have used lasers from many different manufacturers. This is the best one yet.” RP

For more information, visit www.usa.nidek.com.