The Teleguidance feature for the Navilas Laser System 577s by OD-OS enables retina specialists to remotely log in and pre-plan retinal laser treatments, review treatment plans stored on the device, and observe live treatments performed by novice users. This remote access makes expert knowledge available when resources are limited. Simultaneously, the new software plugin device allows for tele-education opportunities, in which students can observe treatments remotely.

“Teleguidance is the next logical step that builds on Navilas’ digital core functionalities,” says Sarah Wolfe, manager of US clinical applications for OD-OS Inc. “No other retina laser offers the functionalities of a fully digital system with fast, computer-assisted delivery of laser spots.”

Teleguidance can support all types of retinal laser treatments, including diabetic retinopathy, retinal tears, and central serous chorioretinopathy — basically all retinal indications that need threshold or subthreshold laser treatments, Wolfe says.

According to Igor Kozak, MD, PhD, a vitreoretinal surgeon and clinical lead at Moorfields Eye Hospital Abu Dhabi in United Arab Emirates, who helped to define the clinical applications of Teleguidance for Navilas, navigation laser technology has allowed the field to move from diagnostic purposes to “therapeutic” teleophthalmology.

BENEFITS OF PRE-PLANNING

Being able to prepare for a procedure has many advantages. By pre-planning, Jay Kumar Chhablani, MD, associate professor of ophthalmology at University of Pittsburgh School of Medicine, who performed clinical trials for the Navilas, says he can better understand what needs to be done for a procedure. “I can visualize my goal and then perform treatment as needed,” he says.

Likewise, Dr. Kozak says when there’s sufficient time to plan, a physician can prepare for the best treatment approach. This is not possible when pre-planning isn’t done.

Outlining treatments before an actual office team performs them maximizes patient flow and saves time by minimizing delays, Dr. Kozak adds. In order to pre-plan, a fundus image taken by the Navilas needs to be available as a template for pre-planning.

EDUCATIONAL PURPOSES

Because it offers remote learning capabilities, Teleguidance for Navilas is a great educational tool. A professor can use Teleguidance to prepare a treatment strategy so physicians in training can concentrate on performing laser treatments with the additional safety net of an expert’s pre-planning, Dr. Kozak says. Resident ophthalmologists can observe live treatments even when they aren’t at a clinic.

The device helps identify and protect zones such as the optic nerve in which laser energy shouldn’t be applied. This provides an additional level of safety, which is especially important for students who are less experienced, Dr. Kozak says. When students become more familiar with photocoagulation, they can be asked to prepare a treatment approach based on the pathology presented on a retinal image. The professor can then make online changes if needed.

“The live support options can help residents overcome the challenge, and sometimes even the fear, of their first laser treatments by knowing that their supervisor is there to help in the background virtually,” Dr. Kozak says.

When working with younger residents, Dr. Chhablani says pre-planning allows him to work toward standardizing treatment approaches. “We haven’t fully achieved this yet, especially when doing subthreshold treatments,” he says.

Wolfe says that hands-on teaching, including live observation, is difficult with conventional slit lamp lasers. In this scenario, only 1 student can be in the same room to follow a treatment via a teaching scope. Also, during the COVID-19 pandemic, the Navilas was a great tool to have for remote learning, avoiding the need to social distance at a clinic, Wolfe adds.

IMPROVING PATIENT OUTCOMES

The Navilas is the first laser system to provide accurate documentation of laser parameters, including the treated area. “This is particularly important for understanding the treatment effect of subthreshold laser delivery and for performing repeat treatment,” Dr. Chhablani says. “This helps to standardize treatment approaches.”

With more standardization, better outcomes can be expected. Dr. Chhablani has seen this with refractive laser correction. “Results become less variable; when variability is reduced you can learn how to improve treatment,” he says.

“By having a centralized location for laser planning to be done, we can better learn what types of plans work best for which types of patients,” Dr. Chhablani continues. “In the end, we will be able to design optimal strategies to maximize treatment outcomes. This will benefit patients, although only in the long run.”

Being able to better train residents will result in higher quality treatments, Dr. Kozak says. “Patients will have peace of mind knowing that an expert can review residents’ treatment approaches and more often can virtually assist and monitor challenging treatments,” he says. “Moreover, by offering expert consultation and creating treatment plans for patients in regions with fewer retina experts, the quality of treatments can be enhanced in those areas.”

The broader vision is not only networking within a single clinic, but also to bring together individuals involved in retinal care worldwide, Wolfe notes. Clinics in different parts of the world can connect and request external expert consultations for difficult cases.

EASE OF USE

To use Teleguidance for Navilas, users simply connect via a platform called Navigate app, either from an iOS, Android device, or PC browser to a Navilas Laser System. Navilas itself is very intuitive to use, Dr. Chhablani says. It has a large touchscreen to plan and follow treatment.

Camera-based retinal photocoagulation has also been shown to be ergonomic. “Navilas itself is easy to use with the full fundus image overview to prepare future treatments,” Dr. Kozak says. RP