When S.K. Steven Houston III, MD, a vitreoretinal surgeon at Florida Retina Institute in Orlando, Florida, had the opportunity to see and test Norlase’s LION — a laser indirect ophthalmoscope (LIO) and green laser photocoagulator in one device — he immediately saw value in the new model. “Having the compact laser housed in a headset and eliminating the fiber was a key advantage,” he says. Additionally, the LION uses the Keeler LED indirect, which he believes has the best optics and visualization available. After the laser’s FDA approval in October 2020, Dr. Houston became an early adopter.

Creating an innovative laser was indeed a motivator for Norlase in designing the LION. “The traditional laser indirect ophthalmoscope hasn’t undergone any meaningful changes or innovations in more than 30 years, despite advances in technology,” says Oliver Hvidt, CEO and president of Norlase. “Doctors have literally been tethered to their lasers, with cumbersome fiber-optic cables and carts that limit mobility and practice efficiency. In fact, fiber-optic cables are a leading cause for breakdowns and costly repairs.” Given the shortcomings of existing technologies, Norlase saw an opportunity to integrate the entire laser into the indirect ophthalmoscope.

PRODUCT SPECIFICATIONS

The LION performs laser treatment in the same manner as other LIOs on the market, with one significant difference: There’s no need for an external laser console, because the laser source is housed seamlessly in the LIO headset. LION is powered by a rechargeable battery located in the footswitch, and it can be used for multiple days with a single charge. As with typical LIO procedures, a physician uses the LIO with an indirect lens.

According to Hvidt, the LION provides physicians with an all-in-one treatment solution for retinal disorders. The integrated and untethered design eliminates the need for an external laser console and provides a new level of functionality and flexibility, allowing physicians to move freely. “In short, LION lets doctors treat anytime, anywhere,” he says. By not requiring a dedicated laser treatment room, the device enables practices to free up valuable space.

In addition, ultraclear laser optics and visualization enhance physicians’ experiences and allow for diagnosis and treatment from the same device, improving the patient experience and practice efficiency, Hvidt says.

LION’s parameter settings are fully operable through an intuitive user interface on a wireless tablet. “The tablet allows for touchscreen control of laser parameters, including voice control of treatment parameters, making it easy for surgeons to use without a technician,” Dr. Houston says. “The voice recognition feature also enables physicians to better maintain their focus on the patient.”

By having the laser incorporated into the headset and without an external fiber, Dr. Houston says that costs, including maintenance, are lower than those for typical lasers. “In my experience, the fiber sustains damage over the course of regular use, often requiring it to be replaced annually at a significant cost,” he says. Incorporation of the laser into the headset makes the device highly portable, as well as lightweight.

In his opinion, by using a Keeler LED indirect to house and connect the LION laser, Dr. Houston says Norlase chose one of the best LIO headsets to pair with its technology. “The visualization and optics for performing LIOs have improved over prior devices,” he says. In addition, Norlase’s technology increases the depth of focus, which makes it easier to use than other LIOs, especially in the retina’s periphery. “With these enhancements, I have better visualization during procedures, including when there are media opacities such as cataract and capsular opacities.”

ADVANTAGES ABOUND

Simply put, LION exceeds the limitation of current laser technology, Hvidt says. The specially designed semiconductor laser at the heart of the device is 10 times smaller and 10 times more power efficient than lasers used in current laser consoles, Hvidt says. It provides a full 1 watt to tissue and is rated for over 100 million pulses, which is more than any other ophthalmic laser.

The learning curve is minimal. “Norlase representatives spent 20 to 30 minutes reviewing the LION’s setup, use, and control at my practice,” Dr. Houston says. “This was ample time for me and my staff to be confident in using it. After more than a month of use, my staff raves about the ease of setup and use.”

Another benefit is that laser treatment with an LIO allows physicians to treat patients in the supine position. “This can be more comfortable for patients and also adds distance between the doctor and patient compared with a slit lamp, which is safer during the COVID-19 pandemic,” Hvidt says. “The superior optics allow doctors to clearly visualize, diagnose, and treat, which streamlines treatment for patients.”

“Overall, the technology stack offered by Norlase results in the most technologically advanced LIO on the market,” Dr. Houston concludes. “I can perform retinal laser treatments much faster, which my patients appreciate. The LION will be a game changer for my practice now and well into the future.” RP