SmartTech laser optimises LASIK procedure Nanosecond laser technology with innovative UV microchip laser system

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1 news SmartTech laser optimises LASIK procedure Nanosecond laser technology with innovative UV microchip laser system The rapid progress in laser technology is setting new quality standards that further advance medical technology. One prime example is the new SmartTech laser from SCHWIND eyetech-solutions, which is striving for a technological revolution in refractive surgery and significantly improves the LASIK procedure. Instead of a highly complex femtosecond laser, an innovative microchip laser is used, which operates with blue light in the UV range (355 nm) and produces ultrashort light pulses, each shorter than a billionth of a second. When compared to femtosecond laser systems using identical pulse energies, the emitted peak power in Watts is lower by a factor of more than one thousand. Short UV laser light wavelengths make it possible to achieve a focus three times finer than that of the femtosecond laser's infrared pulse. This means that focus diameter and length of the SmartTech laser are just one third compared to standard femtosecond lasers. The result: while infrared lasers disrupt several layers of corneal lamellae, the UV microchip laser system precisely separates individual corneal lamella. This leads to exceptionally precise cuts and smooth cut surfaces as well as to a better predictability of flap thickness. The flap can be lifted just as easily as with the mechanical microkeratome. A further advantage: the microchip laser is considerably more compact, durable and robust than the femtosecond laser under usual operating conditions. It merely requires a normal power supply and works without elaborate cooling systems. Issue 1/2011 page 1 of 12

2 news Safety above all Jerry Tan Eye Surgery with unique concept in Southeast Asia With around 4.8 million inhabitants in an area of just 700m², Singapore is the smallest country in Southeast Asia. The prosperous insular state nevertheless impresses with its continually strong economic growth and a high market potential for LASIK: 85% of Singaporeans are short sighted. It is the consistent implementation of safety and quality that makes Jerry Tan Eye Surgery so unique in this area and has allowed it to become a role model for many eye laser clinics in other countries. It was then natural for this clinic, which is located centrally on Orchard Boulevard in Singapore, to acquire and use SCHWIND AMARIS 750S technology. Cost plays an important role in the decision of Singaporeans to have eye laser treatment, and even though a LASIK treatment at Jerry Tan Eye Surgery, at 4,000 for both eyes is the most expensive in the whole of Southeast Asia, his clinic appointments are continuously in high demand from patients. This is primarily due to word Dr. Goh Suan Choo (Clinic Manager far left). Dr. Jerry Tan, Dr. Yong Ming Por and SCHWIND application specialist Tobias Ewering (centre of picture from right to left) together with the first patients treated with the SCHWIND AMARIS 750S at the follow up one day after the treatment. of mouth, i.e. recommendations from satisfied patients. Expectations are high and patients not only demand good daytime vision, but also expect excellent vision in dim light and as well as with night vision. "We stand out from the high volume standard LASIK centres, because we offer premium quality in all treatment steps and with our technology and service. We also have proven expertise in the dealing with complications. We advertise these unique selling points once to twice a year in the daily Singapore newspapers. The main concern of LASIK patients is possible complications during or after treatment. For example, many patients have heard about night vision problems after LASIK. Our studies on night vision problems and their cures help reassure patients and give them a sense of safety and security", says Dr. Jerry Tan, founder and head of the clinic. Overall a demanding mission, which the eye surgeon fulfils perfectly thanks to his longstanding experience and expertise. The reception area of Jerry Tan Eye Surgery LASIK Pioneer in Singapore In 1996, he was the first eye surgeon in Southeast Asia to carry out LASIK treatments. Dr. Tan continued to make page 2 of 12 Issue 1/2011

3 Dr. Jerry Tan with a patient during a preliminary investigation a name for himself as a pioneer, with Minimum re-treatment rate work on wavefront and topography The already low re-treatment rate has guided corrections. He trained in the continually decreased further in the USA and England and worked for 11 last few years and in 2010 was less years in Singapore public eye hospitals, he then left government service to Exclusively Dr. Jerry Tan carries out than 1% an obvious quality indicator. set up his own clinic in Presently with a team of five optometrists, five nurses, five administrators and a clinic manager and since October 2010 a further eye surgeon he offers a wide range of treatments: annually approx. 800 LASIK treatments, 250 cataract surgeries, 10 corneal transplants, 30 glaucoma operations and more than 200 treatments with Argon or YAG laser treatments are carried out in the clinic. Dr. Tan has carried out more than 12,000 LASIK treatments since Even without investing in advertising the clinic has Dr. Yong Ming Por examining a patient an impressive patient flow. Therefore, the LASIK treatments and supervises marketing the clinic services abroad is patients during the whole process not a priority. However, Dr. Tan and his from the evaluation of the pre-lasik team are currently considering promoting their activities in neighbouring and duled follow up. He personally cali- assessment right up to every sche- populous Indonesia, which is just an brates the SCHWIND AMARIS 750S hour by plane away from Singapore. before each case. With LASIK Dr. Tan follows a unique concept: initially the non-dominant eye is treated and then the dominant eye is treated one to two weeks later. "That way we can adjust to individual variations in the healing process and make our results more precise. This method, I feel, is safer for the patients. Simultaneous treatment of both eyes is more convenient for the doctor, but also brings the risk of a bilateral inflammation", says Dr. Tan. Also in other respects a great deal of importance is placed on the best possible patient care. For example, nervous patients can run through the complete treatment as a "full dress rehearsal" one day before the surgery. After the treatment and at least one hour of rest in the clinic, a free limousine service will take the patients home. And finally, on the same evening a senior staff member will contact the patients by telephone and enquire in detail about their post-operative progress. Continued on page 4 Issue 1/2011 page 3 of 12

4 news month after LASIK and should complete 30 training sessions. Jerry Tan says that the dedicated team of scientists, engineers, managers and technical specialists were what most attracted him to SCHWIND: "It is the people that make a company. They were willing to listen to a crazy guy with his crazy ideas. The SCHWIND team realised some of my requests and Dr. Jerry Tan, his team and SCHWIND service technician Alex Schroeck celebrate the Chinese New Year together on 9 February % corneal wavefront Since February 2011, Jerry Tan Eye Surgery has been using the SCHWIND AMARIS 750S. "Until now, the system has exceeded all our expectations. We are particularly pleased with the performance of the eye tracker and the flexibility of parameter setting for asphericity, size of optical zone and ablation depth. In my opinion, it is the combination of the ablation speed, the quick eye tracker and the static cyclotorsion control, which makes treatments with the corneal wavefront so highly accurate, says Dr. Tan. The initial results show that the astigmatic correction especially for high astigmatism cases is extremely precise. The eye surgeon has carried out 99% of all LASIK treatments with corneal wavefront: "The procedure allows me to obtain larger optical zones with gentle transition zone gradient. Coma is common and a natural higher order visual defect in our ethnic Chinese patients cornea. The aim of the best possible post-lasik vision quality is achieved here using the corneal wavefront technology to correct this. Additionally, the corneal topography is very precise. With the static cyclotorsion control, the axis orientation of the eye can be predicted precisely and no astigmatism is induced in the treatment. Dr. Tan continually invests in the newest technology. Since 2010, he has been offering his patients NeuroVision programme. It accelerates the neural adaptation of the brain after a LASIK treatment with the corneal wavefront technology. The programme is based on research which was carried out for the treatment of amblyopia, and trains the visual cortex to perceive better contrast sensitivity. The patients start computer based visual training one Jerry Tan Eye Surgery is located in Camden Medical Centre on Orchard Boulevard developed new solutions. In certain cases, they explained precisely why my ideas could not work in practice. I believe that I will be working with SCHWIND for many years and I am very glad to have met such a great group of people, so interested in advancing the art and science of refractive surgery. Contact: Jerry Tan Eye Surgery Jerry Tan, MD Head of Clinic Phone: [email protected] page 4 of 12 Issue 1/2011

5 New market in South Africa JHB Eye Hospital employs SCHWIND AMARIS technology The JHB Eye Hospital in Johannesburg provides a wide spectrum of treatments including retinal, cataract and trauma surgery as well as corneal transplants and ocuplastic procedures. At present twelve eye surgeons are performing refractive procedures. Since the acquisition of the SCHWIND AMARIS laser system in August 2010, patient numbers are significantly on the increase. So far the clinical results are excellent. The decision for the first AMARIS laser system in South Africa was made not only because of the unique technological features such as the active 6D eye tracking, the 0.54 mm Super Gaussian spot profile or Intelligent Thermal Effect Control. The JHB Eye Hospital was also attracted to The modern JHB Eye Hospital building has become a landmark of Northcliff, Johannesburg Treatment with the SCHWIND AMARIS laser at the JHB Eye Hospital SCHWIND because it is a mediumsized company sees itself as a partner with family enterprise totally its clients and places high value on dedicated to cutting edge excimer laser technology. The clinic shares SCHWIND s philosophy and values of integrity, teamwork, innovation and openness. comprehensive support throughout the complete life cycle of a laser system. This includes high quality technical service and continuous applicational training for eye surgeons and their staff. They also Hitech Lasers Moreover, the local support through support their clients with marketing programmes. The team consisting of the distribution partner Hitech the JHB Eye Hospital, the distributor Lasers and their outstanding service reputation in South Africa played an important role. Hitech Lasers was founded in 1974 as a small family enterprise and today operates as the largest distributor of medical laser solutions in sub-saharan Africa. The Hitech Lasers and SCHWIND eyetech-solutions has created a relationship to establish a new quality of life and vision for the patients on a continent longing to improve the peoples access to health and modern technologies. Issue 1/2011 page 5 of 12

6 news TransPRK: Single-step, no-touch technique Versatile approach for advanced surface laser ablation TransPRK (transepithelial PRK) is an advanced surface laser treatment because the epithelium is removed by the AMARIS laser systems more precisely and uniformly than with either manual or alcohol-assisted debridement. This single-step approach treats refractive errors by superimposing a defined epithelial thickness profile with a corneal aspheric ablation profile. TransPRK applies an epithelial thickness profile that is thinner in the centre than in the periphery. Because TransPRK applies the laser beam directly over the epithelium, it acts as a smoothing agent for the residual stromal bed. Corneal wavefront TransPRK in combination with corneal wavefront is preferable for patients who need a retreatment after radial keratotomy or corneal transplantation. Moreover, it can be used to treat haze, scarred corneal tissue, and keratoconus before corneal collagen crosslinking. TransPRK is a versatile approach it is useful in all cases where a difficult epithelial flap is expected or when the epithelium covers corneal irregularities of the stromal tissue. Using TransPRK ablation profiles shortens the overall treatment time, minimises the risk of dehydration, and speeds up the healing process. Clinical outcomes Clinical outcomes show very good, virtually identical treatment results for the conventional alcohol-assisted PRK and the TransPRK method which is significantly more comfortable for surgeon and patient. On the occasion of the ASCRS Congress 2011 in San Diego, Dr. Michiel Luger, Vision Clinics, Utrecht, The Netherlands, presented three-month results of 33 patients (66 eyes). Dr. Luger compared the clinical outcomes on efficiacy, safety, and high order aberrations, as well as subjective performance in patients that underwent TransPRK in one eye and alcohol-assisted PRK in the fellow eye. In the TransPRK group, 91% of eyes achieved postoperative UCVA of 20/20 or better; in the PRK-treated eyes it was 88%. Neither TransPRK nor PRK showed a deviation of more than one Snellen line from preoperative BCVA. With both methods, 91% of treated eyes were within ± 0.50 D defocus. Regular cornea before TransPRK Ablation of the refractive component Ablation of the epithelial component Stromal bed after TransPRK Re-epithelialisation process Regenerated cornea after TransPRK page 6 of 12 Issue 1/2011

7 Pforzheim LASIK Centre Premium quality concept with SCHWIND AMARIS technology Hans-Peter Haug, MD The Pforzheim LASIK Centre has positioned and established itself in the premium segment of eye laser surgery. Dr. Hans-Peter Haug and his team have implemented an elaborate, consistent quality concept, built on the surgeon s long-standing experience as well as individual and comprehensive patient care. Dr. Haug personally performs the in-depth pre-lasik assessment, consultation on adequate treatment methods, the laser treatments and every scheduled follow-up. Much emphasis is also placed upon qualified further education of the seven-member team. And lastly, the centre is equipped solely with high-tech medical devices of the newest generation, such as the SCHWIND AMARIS 750S. Laser systems and diagnostic devices are kept up to date through continuous upgrades. The strategy bears fruit. Most laser candidates are attracted as a result of recommendation by satisfied patients. Close cooperation with a network of assigned eye doctors and information evenings on a regular basis also provide for very good patient flow. The TotalTech Laser from SCHWIND has been employed in the Pforzheim LASIK Centre for the past two years. The upgrade to 750 Hertz pulse frequency was made in 2010 and recently the 1000th laser treatment with the SCHWIND AMARIS was performed. This laser system is presently the best eye laser on the market. Among the most important advantages for us are the high ablation speed, the six-dimensional active eye tracking and the fine laser spot, which ensures smooth corneal surfaces. Moreover, the timely and reliable support through service and customer support plays an important role. We are extremely satisfied with The Pforzheim LASIK Centre team the technology and with the treatment results, summarises Dr. Haug. Dr. Haug started in 1990 as one of the first eye surgeons in Germany with refractive surgery, and since 1993 he educates interested ophthalmologists in eye laser surgery on behalf of the German Commission of Refractive Surgery. To date he has performed more than 10,000 refractive treatments. Femto LASIK treatments make up 85 percent of the total volume, PRK accounts for another 20 percent. New in the treatment spectrum is the TransPRK the only surface treatment in which the epithelium is ablated with the laser. Contact: LASIK Centre Pforzheim Hans-Peter Haug, MD fon: + 49 (0) [email protected] Issue 1/2011 page 7 of 12

8 news Exemplary throughout the entire life cycle SCHWIND AMARIS sets standards regarding ease of maintenance and low service costs The unique technological features of SCHWIND AMARIS laser systems are well known. But did you know that SCHWIND also sets standards regarding ease of maintenance and low service costs during the entire life cycle? 1. Vacuum-guided laser beam Normally, laser systems use nitrogen in order to protect the laser beam from influences such as humidity or ozone. With the AMARIS laser systems the laser beam is guided through an enclosed beam path in a vacuum. This has significant advantages: blifetime resonator and laser optics Transport of the laser beam in a vacuum is very energy efficient no energy is lost. For this reason the AMARIS can be operated at an optimized energy level. Advantage: This ensures optic-preserving operation of the laser system. The lifetime of the resonator optics and laser optics is therefore longer and service costs are lower than those of other laser systems available in the market. bhigh quality of the laser beam The laser beam is hermetically sealed in a vacuum. No disturbing elements can impair the quality of the laser beam and there is no Inside view - CEO Rolf SCHWIND in the production department deviation of results to be expected 3. Replacement of components as, for example, could occur with The laser source is the most costthe use of nitrogen. This as well and service-intensive component of contributes to the especially precise a laser system. SCHWIND continually treatment results of the AMARIS aims to keep work expenditure and laser systems compared to other service costs as low as possible. laser systems. bthe laser source can be swivelled bno nitrogen bottle required out and doesn t have to be removed No use of a nitrogen bottle is required and thus there is no manual bin the case a component exchange for maintenance. changing of bottles. Furthermore, is necessary only the individual nitrogen quality is not an issue. module is replaced for example, when the laser resonator optics 2. Modular construction become worn, only the optics are The SCHWIND AMARIS laser control replaced and not the entire laser systems are modularly constructed source. If one were to compare the and distributed among several control AMARIS with a car, this would units. Laser upgrades are thus easy amount to the following: If the to carry out. They only require exchange or modification of parts to places only this part and not the fan belt is worn, SCHWIND re- a small extent. entire engine. page 8 of 12 Issue 1/2011

9 Service technician Daniel Fries swivels out the laser source 4. Longer gas lifetime With a new SCHWIND AMARIS, a gas exchange is necessary only once per week. Thus a gas bottle can be used significantly longer than with other laser systems available on the market. This reduces service costs. The gas exchange procedure is fully automatic. The user starts the gas exchange in the user software with a mouse click and does not have to manually open or close any valves or gas bottles. scale, are prevented. Treatments with the AMARIS laser systems can be performed up to two hours after a fluence test before the next fluence test is required. The entire test is finished within three minutes. 6. Close support A team of 20 specialists supports installation, upgrades, maintenance and supply of repair parts for the SCHWIND AMARIS laser systems. The specialists from SCHWIND s Technical Service department are on-call via the Service Hotline 365 days a year from 6:00 a.m. to 9:00 p.m. CET. In nearly all cases, a quick solution is achieved per remote diagnosis (ie. log file analysis). 5. Easy and objective calibration Calibration of AMARIS laser systems takes place in accordance with unique objective criteria. Contrary to other laser systems available on the market, evaluation of the result is carried out automatically. For example, subjective misadjustments based on evaluation of results with a colour Control unit Fully automatic gas exchange Issue 1/2011 page 9 of 12

10 news 13th International SCHWIND User Meeting Meeting of the user family 2011 in Beijing, China The participants of the SCHWIND User Meeting on the Great Wall of China Beijing, People s Republic of China in the megacity with nearly 17 million people, the SCHWIND users met for the 13th International User Meeting. With the choice of the event location, the company responded to the evergrowing number of users and the high demand for SCHWIND technologies in Asia. The international meeting was organized and conducted this time by SCHWIND together with the Chinese distributor Global Vision. More than 180 attendees from 20 countries came to Beijing from 27 to 29 May to hear scientific presentations and to exchange clinical experience. Key parts of the programme were free paper sessions including topics such as SCHWIND AMARIS technologies and treatment results, TransPRK and keratoconus screening, presbyopia treatment with PresbyMAX and the groundbreaking nanosecond technology with the SmartTech laser. A two-hour interactive panel discussion, where topics and questions of the SCHWIND users were lively discussed, Visit of the Forbidden City in Beijing Exchange of clinical experience page 10 of 12 Issue 1/2011

11 received enthusiastic response. The entire scientific programme was simultaneously translated for the numerous Chinese participants. Beyond the educational content offered at the user meeting, the attendees took advantage of the ample opportunities for intensive dialogue: For example, at the sightseeing tour to the Great Wall including open air dinner with impressive views of the surrounding landscape, or during the visit of an architectural masterpiece, the Forbidden City in the centre of Beijing. The SCHWIND User Meeting is a key platform for an efficient communications network with our user family. We aim to further intensify dialogue through on-site user meetings in our key regions, and so strengthen our contact with user communities all over the world, said CEO Rolf Schwind. Ample opportunities for dialogue Chinese distributor Global Vision Platform for communications network The registration team Simultaneous interpreter at work Musical entertainment Free paper session Open air dinner on the Great Wall of China Issue 1/2011 page 11 of 12

12 Sales are booming in South Korea 50th SCHWIND AMARIS laser installed in Anyang Seoul Eye Clinic The first SCHWIND AMARIS in South Korea was installed in October In April 2011, the Anyang Seoul Eye Clinic set the 50th laser from SCHWIND into operation in this country. SCHWIND AMARIS lasers currently achieve a very high annual market share. This is a remarkable success and all the more outstanding because six players intensely compete in the refractive surgery market to maintain a favourable position with their customers. Chance Jung, managing director of the SCHWIND distributor, Wooree Technologies, forecasts that SCHWIND technologies will soon take the top position Sales Achievement Award for Wooree The 50th AMARIS installation in South Korea: Dr. Joong Hee Jung, Anyang Seoul Eye Clinic and Chang-Yeong Seo, Field service engineer, Wooree Technologies in South Korea for the total number of installed laser systems. The fact that AMARIS sales are booming in South Korea results from combined efforts of the entire Wooree team. The distribution partner invested much time, energy and perseverance to provide optimum support. Our sales experts met nearly every evening with existing or potential customers. The service experts also worked on weekends and holidays to support users in the surgery room. Finally, the premium quality of the AMARIS technology together with the close and comprehensive support convinced the Korean eye surgeons that SCHWIND and Wooree offer a uniquely perfect performance package in the market, summarises Jung. The outcome: They were thrilled and recommended the SCHWIND AMARIS and the service support from Wooree to their peers. As a result of the numerous recommendations, Wooree enjoyed a steadily growing reputation and it continued to multiply. Wooree could ultimately win over customers from competitors. As recognition for outstanding achievement, Wooree was recently presented the SCHWIND Sales Achievement Award. Imprint SCHWIND eye-tech-solutions GmbH & Co. KG Mainparkstrasse Kleinostheim, Germany fon: +49 (0) info@ eye-tech.net page 12 of 12 Issue 1/2011