LENSAR’s ALLY is smaller, faster, smarter.
The first second-generation femtosecond laser cataract surgery (FLACS) platform has come to market in the form of LENSAR’s ALLY Adaptive Cataract Treatment System, the company says. The device offers advanced imaging technology with a dual-pulse laser. And, thanks to its small footprint, the ALLY’s design gives surgeons the option of performing laser cataract surgery side by side with a phaco machine or independently in a separate laser suite.
OBSTACLES TO OVERCOME
LENSAR’s CEO Nick Curtis notes that despite first-generation FLACS systems being introduced to much fanfare more than a decade ago, some surgeons felt the technology fell short of its promise.
“As part of the design and build process with ALLY, we sought to find out why surgeons were not broadly adopting it into their practices. We learned that the shortcomings included having to do the procedure in a separate room, slowing down the overall flow of surgery, and staffing considerations when it comes to moving patients between phases of the procedure.”
Combining those inefficiencies with cost was a barrier to implementation, and surgeons did not easily adapt.
“We developed ALLY to overcome those challenges, mindful of practice efficiency becoming even more important as surgeons catch up with post-COVID cataract surgery demand, growth in patient population, and are faced with shrinking reimbursement,” Mr. Curtis says.
A LOOK AT THE ADVANCES
“With ALLY’s dual pulse laser technology, one laser pulse width is optimized for corneal tissue and the other for the capsulotomy and the fragmentation inside the eye,” explains Robert J. Weinstock, MD. This allows for a more efficient laser treatment, reducing overall energy delivered to the eye compared to previous iterations of the laser.
Dr. Weinstock, director of cataract and refractive surgery at the Eye Institute of West Florida in Largo and assistant clinical professor of the Department of Ophthalmology at the University of South Florida, worked closely with LENSAR on the technology’s development and performed the first procedures using the platform.
ALLY’s six-camera imaging system quickly and automatically categorizes cataract density while identifying the lens layers and the nucleus, and then customizes the treatment to those tissues with fragmentation patterns according to the surgeon’s preferences. The imaging and laser speed improve the experience for patients, surgeons and staff, further increasing efficiency and decreasing procedure time, notes Dr. Weinstock.
With ALLY, “the entire procedure has taken between one and 2 minutes, resulting in a much-improved patient experience compared to the traditional 8- to 10-minute procedure,” says Jack M. Chapman, Jr, MD, of North Georgia Eye Associates, Gainesville, Ga., and EyeSouth Physician Advisory Board co-chair.
The “feeder model,” where the patient is first taken to the femtosecond laser room and then moved into an OR suite, requires the surgeon be in the laser room for anywhere from 2 to 3 minutes — acquiring the images, planning the treatment and applying the laser. With the ALLY, the laser treatment takes about 15 seconds, Dr. Chapman says. “A minute or two [time savings] might not seem like a lot, but with 20 or 30 cases, it adds up.”
As a pioneer in laser cataract surgery, LENSAR continues to prove its value in astigmatism management, Dr. Weinstock says.
“One of the issues plaguing the cataract world is surgeons ignoring astigmatism during surgery, neglecting to identify and treat it in all patients,” he notes. Even though it’s a non-covered service by insurance, it is in the patient’s interest to offer the opportunity to correct the astigmatism to achieve their best vision. “No matter the amount of astigmatism, the laser and ALLY specifically is a critical tool in its management.”
Using proprietary iris registration, the platform’s imaging system finds and marks the true axis of intended astigmatism correction accounting for cyclorotation.
“If the patient has astigmatism over 1.00 or 1.50 D and a toric lens has been selected, ALLY will create a capsulotomy and mark it at the steep axis as a reference to guide lens implantation,” Dr. Weinstock says. “This eliminates the need for ink marking or intraoperative aberrometry and is more accurate and efficient for ensuring the lens is placed at the correct axis.”
EASE OF INTEGRATION
ALLY wirelessly integrates preoperative data from numerous diagnostic devices. “Surgeons can automatically get information from the Cassini, Pentacam (Oculus) or IOLMaster 700 (Zeiss), for example, regarding the magnitude and axis of astigmatism, and the software chooses an arcuate to correct that amount based on built-in surgeon tables and nomograms,” Dr. Weinstock says.
Surgeons also have the option of choosing their own amount of astigmatism to be corrected and their choice of axis as several machines can give slightly different measurements. (USB integration with Nidek OPD-Scan III and Topcon Aladdin is also available.
In his practice, Kerry Solomon, MD, found incorporating the platform easy and intuitive. “We paired it with our Zeiss Veracity software, and all devices communicate with essentially no extra steps. Although there were a few changes — for example, the docking is a little different from our previous system — the learning curve was short.” Dr. Solomon is partner, Carolina Eyecare Physicians, Charleston, S.C., and adjunct professor, Medical University of South Carolina, Charleston.
Also, his time in the laser room is a fraction of what it was. “I’m a pretty efficient surgeon, but I’ve never seen anything as quick as this,” says Dr. Solomon. “My entire procedure time is roughly 40 seconds from start to finish, and my time in the room is maybe a minute.”
Additionally, the LENSAR training team made it straightforward for his staff, he says.
BETTER FOR ALL
Overall, Dr. Solomon has been satisfied with ALLY — he says the capsulotomies are great, lens disassembly is very effective, and it speeds up his OR time during phaco. “All in all, I’ve been very pleased with the unit. Multiple surgeons in our facility have adopted ALLY, and they all feel that it’s a worthwhile transition, better for the patient and better for them.” OM
Drs. Weinstock and Solomon are consultants to LENSAR and Zeiss.