Offering surgeons choice

Bausch + Lomb’s entry into the femtosecond cataract surgery arena will offer surgeons the choice of doing corneal refractive surgery or cataracts with a single laser system.

Based on the existing TECHNOLAS femtosecond workstation, the new VICTUS™ system can do LASIK flaps, intrastromal refractive procedures, and corneal surgery – as well as corneal incisions, including corneal arcuate incisions, anterior capsulotomy and nuclear softening for cataracts. Following clinical trials involving more than 450 cataract procedures, VICTUS earned the CE mark for both cataract and corneal refractive procedures, said Robert Grant, CEO of Bausch + Lomb's surgical division.

Mr Grant believes the dual-purpose VICTUS is an economical alternative for surgeons who do both refractive and cataract work. “It allows leveraging the cost across both kinds of procedures. I think that is a significant advantage,†he said.

Beyond initial purchase savings, replacing two lasers with one will also save about €40,000 annually in maintenance, he said. There is a plan to offer an upgrade path to existing TECHNOLAS femtosecond workstation customers, making it even more attractive to surgeons who want to offer premium refractive cataract procedures.

Most important is performance. VICTUS provides the perfectly centred and sized capsulotomies and reduced phaco benefits of femtosecond laser-assisted cataract surgery. The system also includes safety features such as real-time OCT for procedural planning and monitoring to guide the laser as it operates much deeper in the eye with larger amounts of energy for cataract procedures, a solution TECHNOLAS Perfect Vision (TPV) engineers believe is superior to snapshots offered by a competing system. The user interface is designed to make it intuitive and quick to use in surgery. Rather than installing the OCT module and modified laser on existing workstations, new lasers will be swapped out for surgeons who upgrade, Mr Grant said.

VICTUS uses a disposable curved laser interface in combination with an intelligent pressure sensor system to gently dock the eye to the laser. The approach avoids applanating the cornea, which both eliminates wrinkles that can produce laser “skips†in capsulotomies and reduces the suction required to dock the laser. To date, during the clinical study conducted at Hyderabad, all patients have maintained vision throughout all cataract procedures performed, further indicating safe operations, Mr Grant said.

The VICTUS system can be configured on a pivoting bed for laser corneal surgery or paired with a surgical microscope and Stellaris phaco system for cataract surgery, said Mr Grant, or it can be set up in its own space to serve both refractive and cataract patients, potentially feeding multiple operating suites. “How workflow will develop depends on how surgeons use the system,†he said.

Bausch + Lomb is so confident in the potential of VICTUS to revolutionise cataract and refractive procedures that it has also entered into a definitive agreement providing it with an option to purchase all outstanding TPV shares for up to €450m. TPV was formed in 2009 when Bausch + Lomb spun off its TECHNOLAS division and merged it with 20/10 Perfect Vision. Grant said that Bausch + Lomb intends to retain the technical experts at TPV, and integrate laser platform development with other products, including new intraocular lens designs. “We are looking at a holistic product line that will be femto-optimised,†said Mr Grant.

While premium surgery is the initial market, Mr Grant believes femtosecond technology will soon become the norm. “We strongly believe that this technology will fundamentally change how all cataract surgery is done, not just cataract refractive surgery. Our goal is 20/20 uncorrected vision by 2020.â€

Glistening-free hydrophobic lens During 25 years as a cataract surgeon, Calvin W Roberts MD, Bausch + Lomb’s chief medical officer, said he was often frustrated by IOL manufacturers pushing their preferred lens regardless of patient need or surgeon preference. “If they made a hydrophobic acrylic IOL, that was the only lens you’d get. If they made a hydrophilic acrylic, that was the answer for everything.â€

Bausch + Lomb is taking a different tack, offering both hydrophobic and hydrophilic lenses, as well as innovative new designs such as the glistening-free enVista hydrophobic lens introduced at the XXIX Congress of the ESCRS in Vienna. This makes it possible to take advantage of the superior resistance to PCO of hydrophobic materials without having to worry about light scatter and potential degradation of vision due to infiltration of water into microvacuoles seen in many earlier hydrophobic acrylic lenses, Dr Roberts said. He also noted that enVista can be inserted through a 2.2mm incision with a wound-assisted insertion technique.

“This gives surgeons an opportunity to use a hydrophobic acrylic lens with a smaller incision.â€

For those wanting even smaller incisions, Bausch + Lomb offers the hydrophilic Akreos microincision cataract surgery lens designed for implanting through a 1.8mm incision. The lens features a 360-degree sharp edge and a design that holds the lens against the posterior capsule to prevent cell growth. The MICS system also includes handpieces and fluidics controls for the Stellaris phaco machine as well as specialised instruments and viscoelastics. Dr Roberts believes that the MICS system combined with the refractive capabilities of the VICTUS laser will elevate refractive cataract surgery to a new level. “It allows surgeons to use everything they have learned from refractive surgery to improve vision in cataract patients. Our goal is 20/20 uncorrected.â€

Demand for the new cataract and refractive products, as well as Bausch + Lomb’s broad range of pharmaceutical and eye care products, is strong, said Charl van Zyl, corporate vice-president and commercial leader for Europe, Middle East and Africa. Bausch + Lomb is pursuing a two-pronged strategy of expanding into emerging markets in Russia, eastern Europe and the Middle East and Africa, while deepening its advanced technology product lines in more established markets.

Bausch + Lomb is adding support specialists in pharmaceutical and devices to better serve surgeons, Mr van Zyl said. “We offer a broad portfolio of surgical, pharmaceutical and vision care that allows surgeons to choose solutions that meet their needs. We want to make Bausch + Lomb the preferred partner for surgeons for the future.â€