Better from the Beginning
Dr. John Doane, MD, FACS, initially got to experience the VISUMAX 800 when it was first introduced to a select number of clinics in America, including Discover Vision Centers in Kansas City, where he serves as Medical Director. “It was really helpful for us,” he explains. “We looked at the eyes of 27 patients who were treated bilaterally with small incision lenticule extraction (SMILE) in this early rollout and took in feedback from the surgeons using the system.” The results of this evaluation? Those questioned reported being happy with their SMILE cases after using the new system, specifically finding lenticle dissection easy and the effectiveness of the new process of centering the treatment to be near perfect.1
After using the VISUMAX 800 for over six months, Dr. Doane explains why it has been so well received. “It’s my experience that better instruments typically lead to better results,” he says. “By making the surgical process easier and less stressful for surgeons, you lengthen their surgical careers, decrease fatigue, and provide better outcomes for patients.” There are several ways in which the VISUMAX 800 makes SMILE easier for surgeons, even compared to its predecessor. The first is simply the speed with which the new laser operates, which, at two million spots placed per second during the treatment of the patient, is four times faster than the previous model.2 “The increased precision of tissue photodisruption, and easier identification and dissection of the anterior and posterior interfaces of the SMILE lenticule that this allows, results in less stressful and quicker surgery for the staff, surgeon, and patient,” Dr. Doane explains. “And, because there's less physical manipulation, recovery should be quicker.”
But this speed isn’t just limited to the laser. “With the VISUMAX 800, the software runs at a much faster clock speed, so the overall throughput is faster,” says Dr. Doane. “With its predecessor, I was frequently waiting for it to get ready to do the next step of the procedure, but now, with the VISUMAX 800, it’s ready and actually waiting for me to do my next step in the surgical process.” In addition to its speed, the VISUMAX 800 offers surgeons automated treatment centration through CentraLign and astigmatic registration of the treatment on the cornea, aligned with the corneal astigmatic major axis, through OcuLign. Both of these advancements have aided Dr. Doane’s ability to achieve excellent results, as exemplified by the feedback provided in post-operative patient satisfaction surveys and the post-operative visual measurements of his patients, even right from the beginning. “All 12 of the eyes of the first six patients I treated are 20/25 or better, and with a shorter treatment time, there’s a more comfortable experience for patients,3” he highlights.
Data that Speaks For Itself
The area of refractive correction has long been driven by innovation. “I've been performing refractive surgery for 24 years now, and it's been interesting to observe the progression of technology,” recalls Dr. Sidney Gicheru, MD. “We started off with microkeratomes, then the femtosecond laser, and then SMILE vision correction through VISUMAX.” However, with so many potential choices for surgeons, he’s also seen discord regarding the best option for patients. “At meetings, you’ll come across various people—some of whom are pro-LASIK and others who are pro-SMILE,” he says. “In those cases where there's a difference of opinion, I always believe that it is best to look at clinical studies.” Doing this and hearing the reports of SMILE with VISUMAX led him to order his own, sight unseen, in 2016.
“ZEISS actually has a SMILE clinical compendium online, containing various studies that compare LASIK to SMILE,4” signposts Dr. Gicheru. One study, in particular, demonstrates the equivalent safety, gain or loss of vision, visual recovery—at one month and three months—and three-month best corrected visual acuity between LASIK and SMILE with VISUMAX.5 “Where SMILE really shines is with high myopes,” he adds, pointing to a second study.6 “At six months, there’s a slight advantage with SMILE achievement of uncorrected visual acuity of 20/20 compared to LASIK. And that's really what we see in our clinic anecdotally.”
The recently released VISUMAX 800 takes these results and delivers them in a faster, more effective package,3 and with fewer higher order aberrations compared to its predecessor7—something Dr. Gicheru and his patients appreciate. “What we've enjoyed the most about the VISUMAX 800 is just the speed,” he says. “Our patients have really been wowed by it too. Just two days ago, I saw a patient who had actually driven nine hours to have surgery with me because he specifically wanted SMILE surgery with the VISUMAX 800—and even he was still surprised by how quick it was.”
It's because of these advancements that the VISUMAX 800 offers, including CentraLign, that SMILE with this system has become so popular. “At my practice, we offer the whole suite of refractive surgery, but despite this, around 85% of the procedures I do now are SMILE,” explains Dr. Gicheru—and he doesn’t see things going back. “I think we’re going to see more people receiving SMILE and a turn to lenticule extraction over LASIK in the future. It's just an evolution of technology.”
Rapid Benefits For All
When SMILE first came to America, Dr. Bruce Rivers, MD and his team performed a prospective study, evaluating the effect of the surgery on military performance.8 “We observed soldiers’ performance in the firing range prior to surgery, and then again six weeks after SMILE, to assess the difference it made,” he explains. “Our biggest takeaway was that the soldiers’ performance post-SMILE was excellent, and was just as good as it would have been had they got LASIK or PRK.” This, combined with a second retrospective study comparing Dr River’s first year of performing SMILE to LASIK and PRK,9 validated its performance and outcomes to the US Military—and demonstrated an additional benefit the procedure has over other options: the rapid healing and superior early recovery it enables. “Prior to SMILE, around 70% of military patients were getting PRK, but once we started doing SMILE, those numbers quickly changed,” recalls Dr. Rivers. “Now we see about 50% of people receiving SMILE over both LASIK and PRK. It’s definitely made a big difference in the military.”
In Dr. Rivers’ estimation, SMILE is not only here to stay; its popularity will only increase, and there will be a demand that may see more surgeons taking up the surgery. “The VISUMAX 800 gives new surgeons, who want to start performing SMILE, an easier transition into the surgery,10” Dr. Rivers says. For example, one aspect of SMILE that the VISUMAX 800 can help with is potential complications arising from a loss of suction. “I think the reason they want you to do 50 flaps when you’re first starting SMILE is because you really have to get used to the low suction, which is easier for patients to break,” explains Dr. Rivers. “With the new VISUMAX 800, because the treatment is so quick, there’s less of a concern of this—there's potentially 65% less suction loss.2 I've been performing SMILE since around 2016, and in all that time, I've only had a few suction losses—and that was without the new system, which makes it even less likely.”
But this doesn’t mean that only surgeons new to SMILE stand to gain from making the switch to the VISUMAX 800. “Probably the biggest thing it offers is the reduced time,” Dr Rivers highlights. “Overall, when you compare the VISUMAX 800 to its predecessor, assessing each aspect—including the lenticular delineation, section, and docking times—the overall surgical time is being reduced by around three minutes,8 which in a high volume practice is just really significant.” And he has found that surgeons aren’t the only ones noticing this. “I'm often surprised at how much research patients are doing,” he explains. “Before we got the VISUMAX 800, a lot of people would call to ask if we had it yet and when we were going to get it. What in particular continues to amaze me is the number of patients who come to us specifically because the VISUMAX 800 is so much faster.”
