2011 Feb 26History Of Femtosecond Lasers In Ophthalmology Flores

History of AlHokama Scientific Day
Femtosecond Lasers Arnold D. Flores III
in Ophthalmology Vice President, Sales & Marketing
Medicals International

History of Femosecond Laser
Evolution and continued advancements have improved patient’s lives

Patients lives have improved with
advancements in technology in
Ophthalmology

History of Femtosecond Laser

PKP CATARACT

How do we help the patients function
ALK RK
with vision correction?

100 + Years PRK LASIK
How do we examine the patients?
Questions How do we help the patients function
with Vision Correction Technology?


1950 Microkeratome Jose Barraquer
1905 Eduard Zirm 1970’s Svyatoslav Fyodorov 1968 Mani Lal Bhaumik Northrop
1912 Vladimir Filatov 1980’s Antonio Mendez 1980 RangaswamySrinivasan IBM
1936 Castroviejo 1983 Steven Trokel
1980/90 Charles Casbeer
1987 PRK Theo Seiler
1989 PRK Dr. Marguerite Mcdonald
1748 Jacques Daviel Extract Cataract 1989 LASIK Dr. Ioannis Pallikaris
1940 Harold Ridley IOL 1996 LASEK Dimitri Azar
1967 Charles Kelman Phacoemulsification 1996 Femtosecond Laser
Dr’s Tibor Juhasz, Xinbing Liu,
Ron Kurtz, Victor Elner.

• 1990 University of Michigan Kellogg School of Medicine established Center
for Ultrafast Optical Science CUOS with$14.3 million in funding from the
National Science Foundation and the state of Michigan
• Tibor Juhasz, Xinbing Liu, and Ron Kurtz design the first prototype in the
new Femtosecond Medical Research Laboratory at the CUOS
• Dr. Ron Kurtz and Dr. Victor Elner will evaluate the laser
• Technology evolves in the 1990s, patents are acquired, and first patients
are treated in LASIK and ICRS (INTACS)

Innovation Genius and Funding
This is the nature of genius, to be able to grasp the knowable even
when noone else recognizes that it is present.

Deepak Chopra

"Ultrashort pulsed lasers produce very localized
ablations, which should be especially useful in eye
surgery where delicate structures can be easily
damaged," Kurtz says. "Another important feature is the
ability to focus the laser light through the clear cornea
onto structures within the eye without the need for a
surgical incision.“ 1996

Innovation Genius and Funding

Even though the new laser system will be more
complex than anything currently available, Liu
says it also must be compact, reliable and
inexpensive, since it eventually will be used by
surgeons in an office setting.
1996

• Ron M. Kurtz, assistant professor of ophthalmology, examines a patient at
the W.K. Kellogg Eye Center. Researchers at the Center for Ultrafast Optical
Science (CUOS) are working with Kurtz to develop new 'ultrashort pulse
lasers' for use in eye surgery and other medical applications.
The University Record, May 7, 1996

Dr. Ron Kurtz
1996 University of Michigan

Innovation and Persistence
I have not failed. I've just found 10,000 ways that won't work.

Thomas Alva Edison
born Aguascalientes, Mexico

• The Femtosecond Group believed Femtosecond Lasers would evolve and
be utilized to treat:
• Glaucoma
• Refractive Eye Surgery
• Cataracts
• Neurology
• Dentistry, vascular surgery or dermatology


• In 2000 First LASIK procedures performed Dr.’s David Schanzlin, Ron Kurtz,
Imola Ratkay-Traub (Budapest)
• In 2000 First ICRS (INTACS) procedures performed Dr.’s David Schanzlin,
Ron Kurtz, Imola Ratkay-Traub (Budapest)

1903 Wright Brothers 1st Flight

2000 ICRS INTACS with Femtosecond Laser

2003 March/April Journal of Refractive Surgery

46 Eyes Femto LASIK
Up to -14.00

16 Eyes Femto ICRS (INTACS)

5 Eyes Femtosecond Laser
Keratomileusis (FLK)

13 Myopic/Hyperopic Eyes
Intrastromal Ablation (ISPRK)

2003 March/April Journal of Refractive Surgery

• “Increase stability of flap”
• Corneal Transplanation
In summary: • Anterior or Posterior Transplantation
• Surgical Manipulation of Sclera (Glaucoma)
• Cataract Surgery
• Presbyopia Surgery

What is driving the innovation?
Why Femtosecond innovations?


 Key Opinion Leaders
 Ease of use
 Faster
 Safer
 Precision

• Laser Eye Surgery
• Fast Recovery
• Quick Procedure
• Low Downtime
• Accurate
• Reproducible
• Premium Industry
Surgeon
Patient

Refractive Surgery $1 billion Market


Surgeons
Differentiate
Drive market


Those surgeons who use laser-made flaps in LASIK cite studies that
show patients have fewer flap complications, need fewer retreatments
and have a greater likelihood of achieving 20/20 visual acuity or better.

Read more:
http://www.allaboutvision.com/visionsurgery/cost.htm#ixzz1EzitrC4h

FDA Microkeratome Femtolaser Adverse Events
• Microkeratome and Femtosecond Flaps FDA Medical Device Reporting
(MDR)
• From 1994 through 2011 February
– 352 Microkeratome related Adverse Events
– DLK, Partial Flap, Severed Flap, Toxic Keratopathy, double vision, dry
eye

– 16 Femtosecond related Adverse Events
• DLK
• Adverse Event defined as Flap complication

Cataract Surgery
• LenSx received regulatory clearance for use of a femtosecond laser for
creating an anterior capsulotomy in August 2009 and for use in cutting a
corneal incision during cataract surgery in December 2009. More than 500
cataract surgeries using a femtosecond laser have been performed in
Europe by Zoltan Nagy, MD, of Semmelweis University, Budapest, Hungary,
according to the release.
• ALISO VIEJO, Calif. — The first patients in the United States have
undergone cataract surgery using a femtosecond laser to cut the flap,
according to LenSx Lasers.
• All capsulotomies in the surgeries were perfectly centered and achieved
diametric accuracy of ±0.25 mm, by Stephen G. Slade, MD, of Houston,
wounds were self-sealing and patients were implanted with a premium
IOL, the release said. March 2010 OSNSupersite

Cataract Surgery

Nagy Z, Takacs A, Filkorn T, Sarayba M. Initial clinical evaluation of an
intraocular femtosecond laser in cataract surgery. J Refract Surg. 2009
Dec;25(12):1053-60 doi: 10.3928/1081597X-20091117-04.

Cataract Surgery
Key Opinion Leaders
Industry
Safety
Surgeon
Accuracy
Patient

2010 Advancements
Huang D.Beveled astigmatic keratotomy performed with femtosecond laser in
post-keratoplasty eyes.Paper presented at:the American Academy of
Ophthalmology’s Refractive Surgery 2010; October 15,2010; Chicago,IL.

Slade SG.First 50 accommodating IOLs with an image-guided femtosecond
laser in cataract surgery.Paper presented at:the American Academy of
Ophthalmology’s Subspecialty Day 2010;October 15,2010;Chicago,IL.
Uy HS.Femtosecond laser fragmentation for higher-grade cataracts.Paper
presented at:the American Academy of Ophthalmology’s Refractive
Surgery 2010;October 15,2010;Chicago,IL.
Talamo JH.Integrated OCT for incision placement in femtosecond laser
cataract surgery.Paper presented at:the American Academy of
Ophthalmology’s Refractive Surgery 2010.October 15,2010.Chicago,IL.


Schwind Nano
Zeiss Visumax Zeimer Femto LDV Abbott AMO
IF Laser

Conclusion

Dr. Jose Barraquer
Dr. Charles Kelman Dr. Marguerite Mcdonald
Dr. Ionnis Palikeras
Svyatoslav Fyodorov

Dr. Theo Seiler Dr. Ron Kurtz
Dr. Ramon Castroviejo

2011 Feb 26History Of Femtosecond Lasers In Ophthalmology Flores

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2011 Feb 26History Of Femtosecond Lasers In Ophthalmology Flores