Astigmatism Management with TrueGuideeefa52590bad1a1c5cb4-86539ecacf0c8ca0ab5bc5e39829e729.r57.… · WaveTec Vision Systems, Inc. Abbott Medical Optics Financial Disclosure. TrueGuide

Astigmatism Management with TrueGuide

Mark Packer, MD, FACS, CPI Clinical Associate Professor

Department of Ophthalmology Oregon Health & Science University

Bowie Vision Institute for Ophthalmic Research

Bowie, Maryland

Mark Packer MD FACS CPI Financial Disclosure

Consultant Equity

Abbott Medical Optics, Inc. Corinthian Ophthalmic, Inc.

Advanced Vision Science, Inc. mTuitive, Inc.

Bausch & Lomb Surgical, Inc. Angle, LLC

LensAR, Inc. Surgiview LLC

Oculeve, Inc. Transcend Medical, Inc.

Rayner Intraocular Lenses, Ltd. TrueVision Systems, Inc.

Refocus Group, Inc. WaveTec Vision Systems, Inc.

Transcend Medical, Inc.

TrueVision Systems, Inc. Research Funds

VisionCare Ophthalmic Technologies, Inc. Abbott Medical Optics

WaveTec Vision Systems, Inc. Abbott Medical Optics

Financial Disclosure

TrueGuide • TrueGuide provides digital guidance during cataract and cornea surgery using

state-of-the-art diagnostics and intelligent software applications. • Preoperative patient data and images are processed by TrueGuide™ software,

which compensates for cyclotorsion and accounts for individual surgeon SIA. • Dynamic optimization of incision location and LRI or IOL placement.

FDA Class 1 Registration - Surgical Visualization 510(k) Clearance -RC Toolset Surgical Guidance

CE Mark 3

Integration with Any Surgical Microscope

4 Example – integration with Leica platform

TrueGuide with Cassini • i-Optics Cassini enables accurate data and image generation for surgical

planning using TrueGuide intelligent software applications. • Novel Color LED corneal imaging for topography and astigmatism analysis. • Obtains keratometry, white-to-white and eye image for auto-registration. • Instant acquisition and seamless data flow to the TrueVision surgical system.

i-Optics Cassini corneal diagnostic 5

ata flow to the TrueVision surgica

i-Optics Cassini Corneal Diagnostic

• Color LED True Corneal Shape Analysis • Axis of Astigmatism: error <4.7°

– Scheimpflug > 30°; Placido >15°

• Magnitude of Astigmatism: error <2% – Scheimpflug 0 ; Placido >5

• Instantaneous Capture: 0 seconds – Scheimpflug 1-2 seconds; Placido 0 seconds

• Submicron Accuracy Elevation Mapping: error <0.8 μm – Scheimpflug <1 μm; Placido > 2 μm

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References: McAlinden. IOVS 2011 Karabatsas. BJO 1998 Pentacam Brochure Specs Tripoli, et al. American Journal of Ophthalmology 1996 Tang, et al. Optometry and Vision Science, 2000

New features:Green Arrow showing primary incision locationYellow Shaded Area showing surgeon primary incision zone

TrueCapture Preoperative Planning

Surgical Plan

Angle Kappa

Incision Optimized

New Features:Incision Optimized buttonAngle Kappa valueSurgical Plan button to further customized plan

TrueCapture Preoperative Planning

Auto-Registration of Preop Image to Surgical View

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Preop image is superimposed and auto-registered onto the live surgical view. Surgeon can make final adjustments as needed.

Dynamic optimization of primary incision with astigmatism correction. Real-time calculation of predicted residual astigmatism.

Dynamic Incision and IOL Guidance

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The toric lens axis is precisely aligned to the guidance line.

Toric IOL Guidance

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Th t i l i i i l li d t th id li

Toric IOL Guidance Outcomes Analysis

• Initial 14 eyes using Alcon/AMO/B&L toric IOLs

• Cassini Topography and Baylor Nomogram Adjustment

• TrueGuide surgical guidance algorithm

• Mean Preop Keratometric Astigmatism

– 1.65 +/-0.96 D – Range 0.54 to 3.34 D

• Mean Absolute Value Postop Refractive Cylinder

– 0.39 +/-0.35 D

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• TrueGuide Mean Absolute Value Predicted Error – 0.37 +/-0.28 D

• Mean Axis Identification Error – 3.29 +/-0.94 degrees compared to reference image

• Mean Toric IOL Axis Alignment Error – 2.5+/-0.60 degrees compared to intended axis – 50% better than published benchmark error (Visser JCRS 2011)

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LRI Guidance

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Live eye tracking maintains the placement of the templates. Incisions are made along the digital guidelines. Surgeon can adjust

the angle, diameter and length of the arcs.

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