Unique Non Unique Non-OCT Unique Non Unique

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Non-OCT Unique NonVisualization System of Femtosecond Laser Frank A. Bucci, Bucci, Jr.,MD Jr.,MD Bucci Laser Vision Institute Wilkes--Barre, PA Wilkes

Disclosures No relevant financial relationships to disclose. disclose

Non--OCT Visualization System  Femto Non Background Requirements for Optimum Imaging in Femtosecond d Cataract Surgery 1. 1 Precisely P i l identify id tif the th key k anterior t i segment structures  anterior & posterior cornea  anterior & posterior capsules  intracapsular lenticular characteristics  image the full range of cataract opacities

Non--OCT Visualization System  Femto Non Background B k d Imaging Requirements for Optimum Femtosecond Cataract Surgery 2. Image the entire anterior segment in g video frame a single  enhances resolution and accuracy of identification

 area to image ((anter anter.. cornea cornea— —post cap) can be b 8-9 mm (8 (8--9000 μm μm))

Non--OCT Visualization System  Femto Non Background Creation of 3D – CSI Confocal Structured Illumination  LENSAR began with researching the correction of presbyopia with imaging & lasering the lens  all current imaging methods were investigated  none fulfilled the requirements for imaging the entire anterior segment with sufficient resolution and accuracy

Non--OCT Visualization System  Femto Non Background

3D – CSI Confocal Structured Illumination  was specifically designed for the purpose off iimaging i ffrom the h anterior cornea to the posterior lens

Non--OCT Visualization System  Femto Non Introduction

OCT is known for its high i h resolution l i Whyy was it rejected? j

Non--OCT Visualization System  Femto Non Introduction  OCT shows excellent resolution over shallow target depths  Image of cornea over 576 μm

Non--OCT Visualization System  Non

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Introduction  OCT shows excellent resolution over shallow target depths  Retinal OCT images g over approx. pp 500μm μ  Imaging of deeper tissues through increasingly opaque media diminishes image g q qualityy and resolution

Non--OCT Visualization System  Femto Non Introduction

Why was OCT rejected?  the signal signal--to to--noise ratio dramatically decreases limiting the resolution  photo stitching of 2 or more images is required  image processing (dewarping) dewarping) is necessary to improve the image quality

Non--OCT Visualization System  Non

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Introduction d i

Why was OCT rejected?  although lh h processing i OCT images i by b pixel i l interpolation and extrapolation will eliminate noise and improve resolution this is done at the expense of accurately locating key anterior segment structures

Non--OCT Visualization System  Femto Non Why was OCT rejected? Resolution does not equal Accuracy  images must account for the refractive properties or curvature of the surfaces it is trying to identify  otherwise the image will be distorted distorted,, whatever the resol resol..  processing is therefore required to “fix “fix”” the distortion “R ” distorted di d iimage O RDVi “Raw” Optovue RDView

“C lib d” image i O RDVi “Calibrated” - Optovue RDView

Non--OCT Visualization System  Femto Non Introduction d i

Confocal Structured Illumination LENSAR states that 3D – CSI  provides a high quality image with optimal id tifi ti t i segmentt surfaces f identification off anterior without the requirement of post post--processing to “highlight” off k key iinterfaces as “hi hli h ” the h llocation i f seen with OCT

Non--OCT Visualization System  Femto Non Components  3D CSI Imaging

A NON NON--OCT 3-D BIOMETRY SYSTEM  high resolution IR camera - rotating platform  a scanning i ill i ti illumination b beam - confocal f l with ith the treatment laser beam  a “down the pipe” camera - visualize surgery as through a surgical microscope  patent pending calibration software - links the camera,, scanning illumination, and treatment camera beams into a single 3-D system

Non--OCT Visualization System  Femto Non High resolution IR camera on a rotating platform based on Scheimpflug Principle

parallel images from five different positions  one scan of each pair images the center of the lens  second scan provides a 1.5 1.5mm mm parallel offset image

Non--OCT Visualization System  Femto Non Variable Scan Rate  SLD Illumination Low scan rate for highly reflective surfaces

Lower scan rate to avoid excess reflection from iris

Higher scan rate for less reflective surfaces

Highest scan rate for least reflective surfaces

Non--OCT Visualization System  Femto Non Rotating camera images in up to 10 planes

scans limbus to limbus and anterior cornea to post capsule in a single video frame without photo stitching

Non--OCT Visualization System  Femto Non automated surface detection

Superior Image Quality analyzes all grades of cataracts

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Invite the prospective femtosecond cataract surgeon to compare this image quality to what has been produced by the OCT technology of other femto systems

Automated Cataract Analysis LENSAR augmented reality images detailed 3D cataract structure Novel algorithm locates boundaries between p , and cortex endonucleus,, epinucleus endonucleus epinucleus,

Programmable Automated Pattern Selection

Non--OCT Visualization System  Femto Non  these images have high contrast to noise and high signal to noise ratios

Non--OCT Visualization System  Femto Non  analyzed automatically to detect key anterior segment surfaces

Non--OCT Visualization System  Femto Non  analyzed automatically to detect key anterior segment surfaces

Ray Tracing  3D Reconstruction

 The ten single video frame images are selectively combined to produce a 3-dimensional model of the anterior segment  Optical p ray-tracing y g algorithms g resolve visual system y “tilt”,, regardless g of corneal refractive power

Non--OCT Visualization System  Femto Non Ray tracing R t i produces d a 3-D 3 D reconstruction t ti – forms f the th basis of the treatment patterns p  capsulotomy  lens fragmentation  potential LRIs  corneal entry wounds

Non--OCT Visualization System  Femto Non  additional information is provided on the degree of lens tilt

Non--OCT Visualization System  Femto Non  the lens tilt compensation effects the placement and dimension of the treatment patterns

Non--OCT Visualization System  Femto Non  the lens tilt compensation effects the placement and dimension of the treatment patterns

“Localized Scanning” - Optimizes Incision Placement  Ensures optimal placement of each corneal incision  begin following cap/frag  Pulses are sent to center of cornea predicted by original 3-D model  Localized imaging identifies reall center t cornea postt potential movement of eye during cap/frag  Delta identified, displayed, and incorporated into incision placement

Non--OCT Visualization System  Femto Non Why Accurately Mapping the Eye Matters  without precision mapping & 3D reconstruction accuracy of laser pulses decreases

safety f is i compromised i d  larger l ““safety f t zone”” around d ffrag. necessary

effectiveness is compromised

Non--OCT Visualization System  Femto Non Conclusions

 The 3D-CSI imaging g g system y created byy LENSAR represents a significant step forward in anterior segment g biometryy  It captures the entire anterior segment in a single video frame  It precisely identifies key anterior segment landmarks without the need for processing as seen with OCT

Non--OCT Visualization System  Femto Non Conclusions

 this highly accurate 3D reconstruction then becomes the basis b h b i off the h very precise i femtosecond treatments applied to the corneal, capsular, & lenticular elements

Mahalo ! ! !