Mohsen Farvardin M.D.

• Improved patient comfort
•
Better ergonomic handling
• Faster procedures
Fast swiveling motion & variable swiveling angles (30 ° or 45 ° )
Adjustable headrest (height)
Left/right eye detection, automated movement from OD  OS and central position
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®

Reproducibility (standard deviation microkeratome >20µm)
Single use patient interface
Very homogeneous flap thickness minimal deviation in geometries (diameter, hinge, etc.)
Even stromal bed
Wide adjustment range of geometries and parameters
Non-mechanical Keratoplasty and intrastromal Rings
Bladeless
Better results (no astigmatism & abberation induction)
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Flap creation using Femto-Laser
• Cutting geometries are designed on the computer and created with LASER precision
– Flap diameter very accurate
– Large applanation area
– Large effective ablation area for the Excimer
– Hinge and orientation not depending to the suction ring and its application
– Lamellar cut through out the flap (homogeneous thickness)
– Surgeon can design and control (computer aided) side cut angle, flap thickness, diameter and centration
– Visibility to the stroma through out the cutting procedure
– Flap is after femto-LASER application not separated from the stroma
– Custom Flap design
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-Flaps
-Standard Flaps (round)
-Custom Flaps (oval)
-Rings
-Keratoplasty
-Penetrating Keratoplasty
- Anterior Lamellar Keratoplasty
-Posterior Lamellar Keratoplasty
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New Features
• Build in online pachymeter (OLCR- Optical Low-Coherence Reflectometry)
– Static and dynamic (during ablation) measurement of corneal thickness
– Can be saved by soft button
– Needs proper apex adjustment (distanced diodes) Traffic light system
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New Features
• Build in N
2 generator
– Continuously purged beam-path; enhancing energy stability
– simplifying logistics and operation, reducing running cost and space requirements
– Just one gas bottle  ArF
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New Features
Enhanced beam-path and laser head design
• The combination of a short beam-path and continuously (while switched on) N
2 purged optics (starting at the Laser head to the scanner output) grants for stability and efficient use of energy, while keeping the optics free of dust and ozone formation.
• New Laser head design multiplying expected life time
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New Features
Advanced motorized Zoom
Microscope
• Stepless zoom
• Programmable magnifications for:
• Treatment
• Start
• Prepare
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•To move illumination ring to treatment /prepare position
•Switches between / combines:
•Microscope - field Illumination
•OP – field Illumination
•Plume evacuator
•Starts before Laser treatment
•Increased working distance  250 mm
•Infrared light illumination
•NOTE: Energy sensor moves automatically (not visible) into the beam path for Energy Check
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- the solid Base
Wavelight EX500 uses the well known
Wavefront Optimized profiles
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- the solid Base
WaveLight:
Wavefront Optimized TM optical zone
Non-wavefront optimized optical zone
Wavefront Optimized TM treatments result in a large true aspheric optical zone and a functional transition zone . This results in better mesopic and scotopic vision.
Non-wavefront optimized treatments create relatively narrow optical zone a wide transition zone. These profiles may cause night vision issues caused by induced higher order aberrations.
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– Visual Outcomes
Effectiveness: UCVA (Uncorrected visual acuity)
100%
80%
64%
93%
99%
100%
76%
93%
99%
100%
60%
40%
20%
0%
25%
22% wavefront-guided Wavefront Optimized TM
>= 20/12.5
>= 20/16
>= 20/20
>= 20/40
>= 20/200
Both groups demonstrated similar performance for visual acuity. In both groups 93% of patients achieved UCVA 20/20 or better after treatment.
Source: US Clinical Trials 200 Hz ALLEGRETTO WAVE
®
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Active Cyclotorsion Control :
 Never change a running system!
•
The advanced NeuroTrack feature ensures active opto-kinetic eye-tracking to control cyclotorsion .
• NeuroTrack forces the eye to stabilize the retinal image to achieve perfect vertical and horizontal orientation.
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• Results from two international sites of 141 high astigmatism corrections.
The post-operative plot diagram shows the high accuracy of treatment results.
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Video-based eye-tracker guarantees fast multidimensional active eye-tracking for better results and outmost patient care.
• High speed tracking 1050 Hz
• Ultra fast - 2.5 ms latency
• Multi-dimensional eye-tracking
• Requires no dilation; allows streamlined workflow
• Works in infra-red light
• Three independent angulated lightsources for redundant lightning
• Compensation option for angle kappa
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When patient is looking up and down the head isn ’ t moving, but the eye is rolling!
Available at NEXT revision of Wavelight EX500
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Displacement calculated by conventional
Eye-Tracker
+ x
Centre of ablation using rotational compensation for X and Y rotation
Detected centre of pupil horizontal displacements vertical displacements rotational centre of the eye
~13 mm below the cornea
Available at NEXT revision of Wavelight EX500
1 st dimension:
2 nd dimension:
3 rd dimension:
4 th dimension: horizontal displacements vertical displacements horizontal rotation vertical rotation
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Roots of Rotation errors:
Patient check up is carried out in sitting position, but treatment in supine arrangement
Patient might sit in a angled head-position to the examination tool
Rotation caused by patient “ squeezing ” against the speculum during ablation or flap creation vertical displacements
Static cyclotorsion compensation for errors resulting from sitting to supine position or head position
Practicable for T-CAT with Topolyzer Vario horizontal displacements
Dynamic cyclotorsion compensation resulting from torsion movements during the treatment
Available at NEXT revision of Wavelight EX500
1 st dimension:
2 nd dimension:
3 rd dimension:
4 th dimension: horizontal displacements vertical displacements horizontal rotation vertical rotation
5 th dimension: cyclotorsion
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vertical displacements horizontal displacements passive tracking for large displacement in Z axis
(laser stops triggering) and visual control (distance diodes)
Available at NEXT revision of Wavelight EX500
1 st dimension:
2 nd dimension:
3 rd dimension:
4 th dimension: horizontal displacements vertical displacements horizontal rotation vertical rotation
5 th dimension: cyclotorsion
6 th dimension: Z displacement
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Pupil centroid shift caused by natural shift of pupil centre at a different pupil diameter
(example: wavefront measured at scotopic pupil, while treatment is performed in mesopic to photopic condition)
Pupil centroid change during ablation, caused by change of illumination or accommodation.
Mesopic
1 st dimension:
2 nd dimension:
3 rd dimension:
4 th dimension: horizontal displacements vertical displacements horizontal rotation vertical rotation
5 th dimension: cyclotorsion
6 th dimention: Z displacment
7 th dimension Centroid shift
Scotopic
Static and dynamic centroid shift compensation for all errors resulting from pupil size changes
Practicable with T-CAT and Topolyzer Vario
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• Corneal vertex centering
– Obligatory for Topography Guided
– Pre-selectable for WFO and Custom Q
• Pupil Centre centering for different lighting conditions (photopic, mesopic or scotopic)
– Pre-selectable for WFO and Custom Q
• Line of sight centering
– Obligatory for Wavefront Guided ablation
– Pre-selectable for WFO and Custom Q
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Surgeon view:
Laser and eye tracker
Compensated OPMI 300µm
OPMI = Surgeons view superior inferior
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Eye-tracker
Energy stability
Energy calibration
Eye alignment
Cyclotorsion
Pulse control
Thermal impact
1050 Hz, 2.5 ms and multidimensional active video based eye-tracker  tracks pupils from 1.0 up to 8.0 mm
Steady and reliable energy stability throughout the treatment due to the closed loop energy control and the enhanced sealed beam path
 WaveLight ® EX500 now includes N
2 purging of laser head optics!
Automatic energy calibration before every patient
Convenient fluence test on PMMA once a day
Integrated and advanced Eye Tracker alignment & cross line projector with the WaveLight
®
EX500 passive cyclotorsional alignment
Every laser pulse is controlled from its source till the point where it is applied to the cornea
 no uncontrolled ablation possible with
Minimized thermal impact because by thermo neutral pulse distribution
 Every 5th pulse is allowed to overlap
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