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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


    Johnson & Johnson Vision

    Abbott Medical Optics (AMO) was recently acquired by Johnson & Johnson Vision (J&J Vision). Although AMO has a long history within phaco, J&J Vision had a foray into phaco that actually predated AMO, said Leonard Borrmann, J&J’s vice president of research and development for surgical platforms.

    “The Site Microsurgical System was a tabletop unit launched in the mid-80s by IOLab, a division of J&J, and was our first extension of Dr. Kelman’s original invention,” Borrmann said.

    Fast forward a few years to 1988, and AMO, at that point a division of American Hospital Supply, launched its first phacoemulsification unit called the Four Plus, which had a large handpiece and was an early attempt to better harness fluidics to help manage the anterior chamber.

    Next came the Phaco Plus, which reflected the industry’s focus on increasing vacuum and flow to reduce thermal risk at the cornea from the vibrating handpiece.

    The Prestige system was launched in 1992 and was the first closed-loop phaco unit from AMO. It had improved software to help the surgeon reach higher levels of vacuum and flow.

    Then the Sovereign was introduced in 1997.

    “The Sovereign System was a big-box phaco machine with improved fluidics and outstanding performance,” said Borrmann, noting the company was Allergan Medical Optics by that time.

    The Sovereign Compact was the first small footprint tabletop unit and came along in 2001. It was targeted for emerging markets. It had both disposable single-use fluidics cassettes as well as a reusable cassette.

    In 2002, the WhiteStar handpiece was introduced as an upgrade to the Sovereign System. It was the first micropulsed ultrasonic handpiece and was built on the idea of a more elegant handpiece about the size of a MontBlanc pen (it was even named for the white star that appears on the tip of a MontBlanc, Borrmann said). The WhiteStar system allowed surgeons to control the delivery of energy at the tip.

    The WhiteStar Signature phaco unit soon followed in 2007 and the unit was the first phaco system to have both peristaltic and venturi pump options for surgeons, according to Borrmann.

    Two new handpieces were introduced around 2010, the ELLIPS and the ELLIPS-FX, which combined both longitudinal and elliptical motion into a single handpiece to improve the efficiency of ultrasonic energy delivery.

    In 2015, the company launched the Compact Intuitive System as a replacement for the Sovereign Compact, as well as the WhiteStar Signature Pro, which was an improvement on the WhiteStar Signature unit.

    Borrmann believes in the future the phaco unit will function as the workstation of the operating room, and will have the ability to work seamlessly with the femtosecond laser technology geared toward cataract surgery.

    “It wouldn’t surprise me if one day there is a replacement for ultrasound, but given phacoemulsification is still a preferred practice 50 years later, it wouldn’t surprise me if it endures another 50 years,” he said.

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