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    Phaco technology evolves over time

    Manufacturers of cataract surgery platforms mark five decades of innovation, with a look to the future

    Manufacturers of ophthalmic surgical equipment have responded to surgeons’ needs and provided tools to make cataract surgery easier ever since Charles Kelman, MD, introduced phacoemulsification (phaco) 50 years ago. Here’s how three of the biggest players in the field—Alcon Laboratories, Bausch + Lomb, and Johnson & Johnson Vision—have updated their phaco offerings through time.

    Alcon Laboratories

    Alcon’s lineage goes back to Dr. Kelman’s Cavitron, the first commercial phacoemulsification unit, said Mikhail Boukhny, PhD, vice president and head of surgical instrumentation for Alcon.

    “It was absolutely breakthrough for its time,” Dr. Boukhny said.

    A total of 50 units were made, and one of the industrial-grade stainless steel units is on display at the company’s research and development site in Lake Forest, CA.

    “Unlike today’s standards, there was no proportional control of fluidics or phaco power,” he explained. “It was pretty much on and off.”

    Of course, phaco surgery at that time was more complicated as well, often lasting hours and using much more fluid.

    The manufacturer had several phaco units through the years, but the Alcon 10,000 Master unit was introduced at the beginning of phaco’s growth period, Dr. Boukhny said.

    “It still required skill, but surgeons got outcomes that were significantly better than what they would get with extracapsular cataract extraction in those days,” he said.

    The ability to go in through smaller incisions made a big difference surgically. The Legacy Series 20,000 coincided with the broad availability of high-quality foldable IOLs, enabling smaller incisions for the entire surgery. With this approach, outcomes improved further, there was greater and more rapid patient satisfaction, and the once exotic phaco approach became standard, Dr. Boukhny said.

    The Infiniti phaco unit was introduced in 2003, followed by the introduction of torsional ultrasound (OZil) in 2006.

    “This significantly reduced repulsion and heat associated with longitudinal phaco,” Dr. Boukhny said. “There was less turbulence, better consistent outcomes, and it made surgery easier for beginning surgeons.”

    The Centurion Vision System was introduced in 2013. Two major innovations—active fluidics and balanced tip—further improved chamber stability and reduced amount of heat generated. Even in more challenging cases—including comorbidities, such as pseudoexfoliation, patients taking tamsulosin (Flomax, Boehringer Ingelheim Pharmaceuticals), and hard cataracts--outcomes are often consistently good, thanks to the latest phaco technology, Dr. Boukhny said.

    The future of phaco will be more automated, Dr. Boukhny predicted.

    “I believe incision sizes will continue to get smaller,” he said. “Phaco will keep up with and stay ahead of innovations in IOLs. The surgery will benefit from laser-assisted modalities, where it will combine with phaco what the laser is good at—creating a capsulorhexis and fragmenting the lens.”

    Phacoemulsification itself will play a smaller role in future surgery, which will largely be controlled by fluidics, he noted.

    Bausch + Lomb

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