Modern ophthalmology is inextricably intertwined with and reliant on technology. As an ophthalmologist today, it’s nearly impossible to imagine a day at work without utilizing any number of the technology-driven systems that are integral across the spectrum of patient care, from diagnostics to post-op.
I consider myself and my colleagues to be “technology hounds” – we are passionate about using the latest clinically-proven technology to gather as much information and data as possible in order to deliver the best outcomes possible for our patients.
Now more than ever before, the acceleration of technological advances has shifted treatment paradigms, due in part to the availability of additional diagnostic, planning and analytic systems for preoperative patient evaluations. While such technology provides critically important input and guidance that can directly impact and improve outcomes, these tools aren’t extraneous – rather, they can be invaluable.
Topography-Guided LASIK Technology Planning Software
The introduction of topography-guided technology revolutionized LASIK surgery, providing an approach defined by an unprecedented level of detail and measurements. Among other differentiators, it completely changed and refined the assessment of pre-surgical corneal irregularities, indicating exactly where in the cornea to treat.
As an example, in my practice I have used Alcon’s personalized topography-guided LASIK technology, CONTOURA® Vision, since it became available. From the outset, this offered a distinctly new means of correcting topographical irregularities on the corneal surface and made LASIK an option for more patients who previously may not have been eligible. In accordance with initial product usage guidelines, treatments were calculated based on a patient’s manifest refraction. However, while CONTOURA® Vision indeed facilitated better outcomes, due to several previous technological limitations there was still room to reduce or eliminate the operator guesswork involved in the complexities and nuances of determining the best astigmatic axis and magnitude for each patient, and improve on visual acuity results.
This led to the recent development of the PHORCIDES* Analytic Engine diagnostic software, which was designed to apply logic, math, and optical physics to analyze individualized topographic treatment in CONTOURA® Vision. It integrates data from the anterior and posterior corneal astigmatism as taken by a Scheimpflug topographer, and utilizes advanced algorithms, vector analysis and differential geometry to calculate the ideal sphere and cylinder treatment for CONTOURA® Vision. The output can then be built into the patient’s treatment plan.
Patient Benefits
Advanced patient assessment and treatment planning technologies support the best possible results for patients in part by making other surgical tools or systems more efficient and effective. These rigorously-tested technologies are typically designed to be careful and conservative, ultimately helping surgeons make even more well-informed decisions – in turn increasing the likelihood of getting the treatment right the first time for each patient. For topography-guided LASIK procedures, this means enhanced accuracy and individualization – delivering the best possible refractive outcomes.
When used correctly, trusted tools including software can also mitigate the need for more arbitrary determinations on the part of surgeons during patient evaluations and treatment planning. This is true of the PHORCIDES Analytic Engine, as it is designed specifically to help calculate CONTOURA® Vision treatments. Together, these technologies offer greater precision, capturing the most enhanced profile of a cornea and optimizing visual results.
As powerful a system as CONTOURA® Vision is on its own, the PHORCIDES Analytic Engine helps execute its full potential, supporting peace of mind for surgeons in the accuracy of procedure-related calculations so patients can see better. I use this software as another means of synthesizing and computing the many factors that influence treatment with CONTOURA® Vision, to determine exactly how much to treat a given patient. Without such technology, one might not fully achieve the results seen in the FDA cohort study. This can trigger additional cost, time and other resources associated with redoing a procedure – as well as patient dissatisfaction or discomfort – all of which can quickly surpass the investment involved in utilizing additional functional approaches to patient evaluations and treatment planning.
Practice Considerations
Integrating any new system or software into a clinic comes with a learning curve, and associated trainings take time. While related education is critical for technical staff, we as surgeons must also become experts in learning how these technologies work as part of our dedication to providing the absolute best care for patients. It’s also important to remember that as trustworthy as these technologies are, they often function as a complementary practice enhancement that’s best used in combination with skilled human input and the professional knowledge that comes from education and extensive experience.
In addition, incorporating more assessment and treatment planning tools into patient exams and procedures can mean allocating more time into each appointment. Using other layers of preoperative systems like the PHORCIDES Analytic Engine might take an extra 15 minutes or so with each patient, which can add up over time – but it comes with great value, driving more successful surgeries and may reduce the likelihood that corrective follow-ups will be necessary. This ultimately leads to more streamlined treatment processes overall.
The availability of different LASIK options and approaches means quality vision may be achievable for a broader spectrum of patients. However, as is the case for any surgical method or treatment, usage must be evaluated on a case-by-case basis to determine individual eligibility.
The Art and Science of Ophthalmic Treatment Decisions
Our work is of course based in science, but there is also an art to how we develop treatment plans for patients. This “art” is not abstract – it is meticulous and measured – and input from cutting-edge technologies add a new level of proven, sound science into the art of our decision-making.
As evidenced with the PHORCIDES Analytic Engine and CONTOURA® Vision, additional preoperative assessment and analytical software can help maximize outcomes while minimizing challenges previously encountered with topography-guided LASIK. The specificity of measurements and calculations required for LASIK and other delicate eye care procedures necessitates the highest level of both precision and customization, and technology today has transformed the ability for surgeons to confirm and validate treatment decisions, supporting more consistent and optimized results. Accordingly, in my practice I use the PHORCIDES Analytic Engine every time I use CONTOURA® Vision, as the information it provides helps shape a treatment framework that has shown time and time again to be successful, underscoring the value of investing in such technology.
In both the near- and long-term, implementing additional layers of new technologies into our patient care processes can be a functional and beneficial way to further deliver on our foundational commitment to excellence and improving outcomes for patients.
*PHORCIDES is a trademark of Phorcides, LLC
Parag A. Majmudar, M.D., is a fellowship-trained corneal and refractive surgery specialist with Chicago Cornea Consultants, with private practices in Hoffman Estates, Chicago, and Highland Park, Illinois. He is a paid consultant for Alcon.