The phaco machine needs to act as a trusty friend to the cataract surgeon, offering an energy supply that efficiently emulsifies the lens while maintaining excellent fluidics for anterior chamber stability. A new system in Australia achieves this – and goes much further in terms of safety and simplicity.
For Melbourne-based glaucoma specialist and cataract surgeon Dr Brian Ang, surgery can be stressful enough – especially when things don’t go to plan. In such instances, the surgeon needs to fall back on their training, and trust the equipment won’t complicate matters further.
In cataract surgery, the phacoemulsification (phaco) system is one of the key items in the ophthalmologist’s toolkit. The technology was first developed by Mr Charles Kelman in 1967 in what was considered a major leap forward, allowing the removal of an emulsified cataractous lens through a much smaller incision. With its evolution over the ensuing decades, surgeons have come to expect safety, performance, efficiency, familiarity, and simplicity from their phaco machine. And in more recent times, they want a system that’s eco-friendly.
Ang’s pre-existing phaco system had not been updated for some years. It wasn’t able to maintain anterior chamber stability as well as the newer systems could and didn’t have a dual linear function (separating vacuum/aspiration from phaco) on its foot pedal.
Some of his overseas peers had been using the Sophi phaco system, developed in Switzerland and introduced into Australia by Designs For Vision (DFV), a Paragon brand. The device has been designed with mobility, simplicity, and safety in mind – and in the world of cataract surgery, it’s all about optimisation to improve the experience for surgeons and patients.
“When doing cataract surgery, I want to have the reassurance that the system will work as intended – there is no point adding extra stress by using inefficient and difficult-to-use phaco systems,” Ang explains.
“Some of my colleagues in Europe are already using the Sophi phaco system and have spoken highly about it. I like the excellent anterior chamber stability, minimal post-occlusion surge, and the dual linear setting which I use when chopping. I also love how the foot pedal can be moved over the floor like a hovercraft.”
“The system has done very well so far, even in difficult cases. I think it is a great phaco system that ticks the two essential criteria for me: safety and performance.”
Outward simplicity due to complexity within
Sophi has been designed to satisfy several requirements in modern-day cataract surgery, but its fast and responsive Triple Pump Fluidics is the key. It offers higher anterior chamber stability due to its IOP Control Pump infusion, which does not rely on gravity or infusion pressure. The dedicated Infusion Pump controls the anterior chamber by measuring flow and pressure of irrigation, and responding to pressure changes. Meanwhile, the surgeon can choose their preferred aspiration (Peristaltic Pump aspiration or Clean Venturi aspiration).
According to Mr George Krokidis, national surgical product manager for DFV, the system is highly mobile. Being the first battery-operated phaco system lasting for up to 20 surgeries, it operates free from any connection cables, including power, data, and air lines. It is also equipped with an integrated air compressor. Importantly, its pedal is also cable free.
“Sophi’s mobility is the result of its smart design: it’s completely wireless, has a small footprint – a great space saver in theatre – with a mono-brake handle, a ‘hover’ pedal, rotatable display, and tray,” he says.
“With so much already going on in theatre, and increased use of new technologies with additional monitors and cables, it’s refreshing to have a new system that bucks this trend and keeps to a minimal space. Bluetooth connectivity to other devices also makes Sophi future-ready.”
Sophi’s manufacturer has also prioritised simplicity in its design. This is achieved by using modern assistance systems, and clever use of the latest technology. This includes an intuitive and fast graphical user interface and set-up, voice audio and visual sensory info/feedback to assist the surgeon and surgical team.
Safety and hygiene is the third most important element. The system contains what is described as a world-first Clean Venturi system and automated Cassette Slot-In-System which helps to reduce the risk of contamination.
“The automated Cassette Slot-In-System reduces the risk of contamination, and with the Clean Venturi system foil prevents contamination of the device and air with patient’s eye fluids. The Cassette Control Guard also helps to monitor the cassette’s expiry date.”
Sophi’s smart design of consumables also leads to high functionality and economic benefits, while offering waste reduction from a lean and (optional) reusable cassette.
“The system uses a lean cassette for less waste, and allows the use of glass or plastic bottles, or bags of balanced salt solution (BSS). Moreover, the use of the ‘day cassette’ and disposable tubing significantly reduces the waste per case,” Krokidis says.
Features impress experienced ophthalmologist
Sophi’s attention to waste reduction was one of the attributes that stood out for Dr Robert Harvey, an ophthalmologist based in rural Victoria.
“In terms of features that have impressed me the most since installation, the lack of wires and tubes gives a clean streamlined appearance. Each patient has a cassette with tubes leading to the lightweight handpiece, but the bottle of BSS lasts for several patients leading to significant cost savings,” he says.
Harvey has more than 20 years of ophthalmic experience in the UK and Australia and today is a general ophthalmologist who subspecialises in glaucoma. Inevitably this means he treats many eyes with shallow anterior chambers and loose zonules through pseudoexfoliation.
“The phaco machine needs to be reliable with excellent power to get through tough cataracts and maintain excellent fluidics to keep the anterior chamber stable,” he says.
“The machine is easy to set up. The foot pedal is wireless and usually locked in position or glides like an ice puck when getting positioned. All functions are configurable, and the machine gives verbal feedback.”
Overall, Harvey has been pleased with his patient outcomes after using the system. Although dense cataracts are not the norm in Australia, Sophi handles these effectively thanks to a ‘High Vac’ designed phaco tip and the use of sinusoidal signal to control the handpiece. This means the energy used is more efficient and considerably reduced.
“Corneas are clear post-operatively. Dense cataracts can be demolished by increasing the frequency of pulses,” Harvey says. “DFV supplied the demo machine which we have now purchased and they provide valuable in theatre training for the surgeon and theatre nurses.”
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