Partnerships can be powerful things. One Western Australian ophthalmologist who has set up a clinic with her husband has found another pairing that is providing great patient outcomes.
When Dr Yachana Shah moved from Broome to Perth five months ago, she expected the usual adjustments that come with a major relocation: new colleagues, a new clinical environment, a new rhythm. What she didn’t expect was how much she would enjoy working alongside her husband, Dr Vaibhav Shah.
The pair have since launched West Coast Eye Surgeons, a new clinic in Duncraig, while both continue public appointments at Sir Charles Gairdner Hospital.
Balancing two subspecialties – cornea/anterior segment for her, retina for him – has brought a professional element to their personal relationship that Dr Shah says she didn’t entirely foresee.
“We actually work together surprisingly well,” she says. “Vaibhav has a very calm and composed way of looking at things, and I’m a bit more opinionated and decisive.
“It balances out better than I expected.”
There’s another partnership that Dr Shah also values highly.
In her anterior segment work, Dr Shah has gravitated to the Bausch + Lomb Stellaris Elite phacoemulsification system for cataract surgery – a platform she says “fits neatly into the way I like to operate”.
“I genuinely enjoy using the Stellaris Elite,” she says. “The fluidic control, the direct vacuum, the foot pedal – it gives me a sense of steadiness and responsiveness that makes cataract surgery feel calmer.”
From India to Australia
Dr Shah’s road to Western Australia was anything but linear. Both she and her husband trained in India, but when they moved to Perth to help him complete his fellowship, both were drawn to Lions Outback Vision and its outreach work.
They worked with Dr Angus Turner to help set up an ophthalmology clinic in Broome, where they spent more than five years serving regional and remote patients.
“We saw complex pathology, and we learned to be resourceful and adaptable,” she says. “It really reinforced how important good surgical systems and reliable equipment are.”
The Shahs then returned to Perth, where she divides her time between cornea and cataract surgery at Sir Charles Gairdner Hospital and the growing private workload in Duncraig.
Her cataract patients, she notes, span the typical metropolitan demographic: “Mostly older patients with age-related cataracts, but also a good number with comorbidities, ocular surface issues, or previous surgeries. And on the corneal side, it’s everything from transplants to keratoconus to tumours – a very wide spectrum.”
In that mix of routine and complex cases, the Stellaris Elite has become Dr Shah’s preferred phacoemulsification platform.
For her, the system’s defining advantage begins with its Venturi-based direct-vacuum design.
“With peristaltic systems, you often have to wait for occlusion to build adequate vacuum,” she explains. “But with direct vacuum I get instantaneous aspiration the moment I need it. It’s fast, it’s predictable, and it reduces the little surprises that can happen in the chamber.”
That immediacy allows her to keep the surgery flowing smoothly. “The vacuum doesn’t lag. I don’t feel like I’m fighting the machine to get the behaviour I want.”
Supporting that is the platform’s Adaptive Fluidics, which automatically modulates infusion pressure to maintain chamber stability.
“The machine is proactively keeping the chamber formed. You can feel it – there’s less surge, less fluctuation, and in my hands that translates to a gentler experience for the eye,” Dr Shah says.
She pairs this fluidic stability with the system’s Attune phaco technology, which she feels handles a broad range of cataract densities without forcing her to adjust her technique dramatically.
“Across cataract grades, the ultrasound delivery is efficient, and it emulsifies consistently,” Dr Yachana Shah says. “It means I can stay focused on the choreography of the case rather than constantly compensating for variable power.”
The Power of the pedal
But if there is one feature she cites most enthusiastically, it is the wireless dual-linear foot pedal.
“It’s excellent,” she says simply. “The dual linearity – being able to control vacuum and ultrasound independently with such precision – is incredibly intuitive.”
The pedal’s responsiveness, she says, has influenced her surgical rhythm.
“The feedback is immediate. When I press, I get exactly what I want. There’s no drift, no delay. It lets you operate with confidence, and that confidence is something your scrub nurse and your patient both feel.”
Control of the ultrasound energy input is important, she says. “I use phaco energy at around 20% and I use continuous mode of phaco . . . in my hands I’ve found using power at a low setting has worked very well for all kinds of cases.”
Working at the lower energy level inside the eye means she can preserve endothelial cells in the cornea.
“With every intraocular surgery, especially anterior segment surgery like cataract surgery, there is endothelial cell loss, so the less the amount of phaco energy you introduce, the less the endothelial cell loss,” Dr Shah says.
That has been backed up by research.
Dr Shah has contributed to analysis of a dataset showing endothelial cell loss in about 233 cases, and also cell loss in 66 eyes affected by Fuchs endothelial dystrophy. “We found that the percentage of endothelial cell loss in normal eyes (using the Stellaris Elite system) was 4.2% and in eyes that were affected by Fuchs, it was 5.5%.”
“If you look at similar studies in literature and meta-analysis (using other devices), you will find that the endothelial cell loss is almost always in double digits, and you’ll find them in the 10 to 15% range.”
The data highlighted “fantastic outcomes”.
Use of the Stellaris Elite system was partly responsible, she says, as well as being “very intentional” in the style of surgery and doing everything possible to mitigate against cell loss.
Dr Shah’s surgical technique on Stellaris Elite leans into the system’s fluidic precision. She tends to work with low vacuum (up to 250 mmHg) and lower ultrasound energy (up to 20%). Her preferred approach is a direct phaco chop technique, trusting the vacuum’s predictability and ultrasound control to carry most of the load.
“The platform lends itself to a controlled but efficient style,” she says. “You can stay in the safe zone while still moving briskly through the case. That combination is what makes my day in theatre feel smoother.”
Her patients benefit from that efficiency through shorter time in the chair and, potentially, a more stable post-operative course. “Patients recover well, and that’s the outcome we all want.”
Advice for others
For colleagues weighing their next phacoemulsification platform, she suggests focusing on how a machine behaves in real-world conditions, especially in the surgeon’s own hands.
“Every device looks good on paper,” she says. “What matters is how stable it feels when you’re inside the eye, and how predictably it responds to your inputs. For me the Stellaris Elite delivers that sense of control.”
She adds that surgeons shouldn’t underestimate the benefit of seamless ergonomics and foot-pedal control. “When the pedal feels natural, the whole surgery feels natural.”
Ultimately, she says the Stellaris Elite has earned its place in her work because it matches the way she thinks and operates.
“It supports you without demanding constant attention. For surgeons building efficiency, or for busy practices looking for reliability across both standard and complex cases, it’s definitely a system worth considering.”
