Essential Equipment of Ophthalmology

Slit Lamp 

slit lamp is a device consisting of a high-intensity light source that can shine a thin beam of light into the patient's eye. The lamp allows for examining the human eye's anterior and posterior segments, including the eyelid, conjunctiva, sclera, natural crystalline lens, iris, and cornea. The slit-lamp examination provides a magnified view of the eye in detail, enabling diagnoses to be made for various eye conditions. A smaller, hand-held lens is used to examine the retina.

 

Goldmann tonometer

Considered the Gold standard according to the AAO, a Goldmann is attached to a slit lamp and provides accurate and reproducible readings. Using a prism measures the force needed to flatten a 3.06mm diameter circle of the central cornea.

 

Non-Contact tonometer (NCT)

Also referred to as an "air puff" tonometer, it is a diagnostic tool used by eye care professionals to measure the intraocular pressure (IOP) inside a patient's eyes. A non-contact tonometer uses a small puff of air to measure the eyes pressure. An industry term for this is also called a "puff test."  

 

Autorefractor/Keratometer (ARK)

A computer-based instrument is used to help determine the eyeglasses prescription. The Keratometer is a device used to determine the curve of the cornea. These measurements are typically taken on patients who are being fitted for contact lenses or who may have corneal problems.

 

Optical coherence tomography (OCT) 

An instrument that takes transpupillary images of the retina to assist in diagnosing and treating retinal diseases.

 

Visual Field Machine (HFA)

The visual field is how wide an eye can see when focused on a central point. Visual field testing is one way an ophthalmologist measures how much vision there is in either eye or vision loss over time.

Visual field testing can determine if there are blind spots (scotoma) in a patient's vision and where they are. A scotoma's size and shape can indicate how eye disease, or a brain disorder affects one's vision. For example, this test shows any possible side (peripheral) vision loss from this disease with glaucoma.

Ophthalmologists also use visual field tests to assess how vision may be limited by eyelid problems such as ptosis and droopy eyelids.

 

Fundus Camera 

A fundus camera is a low-power microscope attached to a digital camera used to examine structures such as the retina, optic disc, and lens.

 

Topographer (Topo)

Corneal topography is a computer-assisted diagnostic tool that creates a 3D image of the cornea's surface curve. The cornea is responsible for approximately 70% of the focusing power of the eye. An eye with good vision has an evenly curved cornea, but if the cornea is too flat or too steep, the vision will be less than perfect. The most significant advantage of corneal topography is the ability to detect rare conditions invisible to conventional testing.

 

Biometer/A-Scan (Ultrasound)

A-scan ultrasound biometry, commonly known as an A-scan, is a diagnostic test used in ophthalmology. An A-scan provides data on the eye's length, which is used to screen for sight disorders. One of the A-scan uses in determining the eye's size for calculating intraocular lens power for cataract surgery. 

 

Phacoemulsification Machine (Phaco)

Phacoemulsification is a modern cataract procedure in which the eye's lens is emulsified with an ultrasonic handpiece and aspirated from the eye. Fluids are replaced with irrigation of salt solution to maintain the anterior chamber. This procedure is also now performed with a femtosecond laser.  

 

Green (532nm), Red(810nm), and Yellow(577nm) lasers 

The most commonly employed wavelength in vitreoretinal practice is 532 nm green, widely referred to as an Argon Laser, and is used for treating retinal pathologies with pan-retinal photocoagulation. The 577 nm yellow laser is slightly absorbed by xanthophylls and well absorbed by oxygenated hemoglobin, making it the laser of choice for lesions near the macula. Good results with dye lasers operating at this wavelength have been reported.1 Krypton lasers producing the 647 nm red wavelength have historically been used for photocoagulation of deep choroidal pathology.

YAG laser  

YAG lasers are used to treat posterior capsular opacification, a condition that sometimes occurs after cataract surgery. These lasers can also be used for peripheral iridotomy in patients with acute angle-closure glaucoma, which has superseded surgical iridectomy.

SLT Laser 

Selective laser trabeculoplasty (SLT) is a procedure that reduces intraocular pressure in patients suffering from glaucoma. The laser is applied using a unique contact lens to the eye's drainage system, where it stimulates a biochemical change that improves the outflow of fluid from the eye. An SLT laser is one of the lowest powered lasers used in Ophthalmology.  

Surgical Microscope

The human eye is a delicate organ, so performing surgery requires monitoring progress on a microscopic level. Surgical microscopes are designed to provide high contrast imaging of all parts of the human eye. When choosing an ophthalmic microscope, it is essential to pay attention to the type of optics employed. An apochromatic lens (or apo) will provide high light transmission, permitting high-quality imaging at lower light intensities. Specific models of ophthalmic surgery microscope provide multiple lighting options, such as switching between halogen and xenon. An ophthalmic surgical microscope can either be fixed or adjustable, and some models offer a second "observer" set of binoculars, some of which can independently adjust the focusing mechanism. Most ophthalmic microscopes are mounted to a rolling stand for versatility and to allow movement around the OR. However, ceiling-mounted microscopes also exist.

Conclusion

Laser Locators specializes in the preventative maintenance and refurbishment of all types of ophthalmic lasers and diagnostics. Whether you are only looking to service an existing device or want to take your practice to the next level, think of us first.

Contact us today for a complimentary consultation on how you can improve your ophthalmic practice.
joey@laserlocators.com
by Joey Colarulo, Vice President

About Joey Colarulo

Vice President

Joey has been the Vice President of Laser Locators since March 2015 and a Managing Partner since 2012. He joined the company in 2011.

Joey has significantly contributed to Laser Locators' growth, including the development of a full service and parts department. He has streamlined the sales and procurement departments by redeveloping processes and implementing new systems. Through Joey's efforts, Laser Locators has tripled its sales volume and added 13 new positions.

Joey has over 20 years of experience in global internet sales and marketing. His expertise in analyzing the marketplace and leverage the latest e-commerce technologies has enabled Joey to drive exponential sales growth year over year.

Originally from Philadelphia, Joey earned his Bachelor's degree in Financial Management and graduated Magna Cum Laude from Rowan University.

Outside of work, Joey is involved in the Westchase Charitable Foundation, a local non-profit that provides direct assistance to those in need. His interests include vintage BMWs and rare sports cards.

Clip-On vs. Integrated – 532nm Green Argon Laser

Uses and History

For years Green lasers have been the surgeon's favorite for retinal photocoagulation. We have seen advances in technology throughout our industry, making the lasers smaller, faster, easier to use, and more affordable. The photocoagulator has been a part of Ophthalmology since the 1950s. The xenon arc lamp photocoagulator produced a bright white light that closely mimicked sunlight, and it became commercially available in 1956. This device revolutionized the treatment of various retinal disorders and became an indispensable tool in the armamentarium of retinal specialists worldwide.

The argon laser emits blue-green wavelengths absorbed by the red hemoglobin in the blood and the cells under the retina. These wavelengths can pass through the fluid inside the eye without causing damage. For this reason, the argon laser is used extensively in the treatment of diabetic retinopathy. The argon laser can burn and seal the leaking blood vessels, also known as photocoagulation.

The argon laser can also treat Macular degeneration. In this procedure, the laser destroys abnormal blood vessels so that hemorrhage or scarring will not damage central vision.

Integrated 532nm Green Laser

Clip-On 532nm Green Laser

The clip-on style of green lasers has many benefits. First of all, they are smaller and more compact than an integrated laser since they attach to your existing slit lamp. Second, a member of your team, with the proper training and experience, can relocate the laser to a different office if needed. Lastly, since this clip-on style of the laser will be used in conjunction with an existing piece of equipment, the cost is typically less than that of an integrated laser.

While all these features have their benefits, clip-on lasers are not perfect. The fact that it is a moveable device also means that it needs calibration more often than a stationary system. Also, lasers need time to acclimate to changes in temperature or humidity. If traveling from office to office exposes the device to different climates, the laser's performance may vary.

Conclusion

Laser Locators specializes in the preventative maintenance and refurbishment of all types of ophthalmic lasers and diagnostics. Whether you are only looking to service an existing device or want to take your practice to the next level, think of us first.

Contact us today for a complimentary consultation on how you can improve your ophthalmic practice.

joey@laserlocators.com
by Joey Colarulo, Vice President

About Joey Colarulo linkedin button Clip On vs. Integrated   532nm Green Argon Laser

Vice President

Joey has been the Vice President of Laser Locators since March 2015 and a Managing Partner since 2012. He joined the company in 2011.

Joey has significantly contributed to Laser Locators' growth, including the development of a full service and parts department. He has streamlined the sales and procurement departments by redeveloping processes and implementing new systems. Through Joey's efforts, Laser Locators has tripled its sales volume and added 13 new positions.

Joey has over 20 years of experience in global internet sales and marketing. His expertise in analyzing the marketplace and leverage the latest e-commerce technologies has enabled Joey to drive exponential sales growth year over year.

Originally from Philadelphia, Joey earned his Bachelor's degree in Financial Management and graduated Magna Cum Laude from Rowan University.

Outside of work, Joey is involved in the Westchase Charitable Foundation, a local non-profit that provides direct assistance to those in need. His interests include vintage BMWs and rare sports cards.

The YAG Laser as used in Ophthalmology

Laser technology has revolutionized many fields. In ophthalmology, laser systems are used to photocoagulate, cut, remove, and stretch eye tissues. New types of lasers and applications continue to develop. This article will focus on the Nd: YAG laser and its role in treating ophthalmic disorders.

The first LASER was constructed in 1960 at Huges Research Laboratories.  LASER stands for Light Amplification by Stimulated Emissions of Radiation. A laser contains material that releases photons. This process amplifies, so the emitted photons are in phase and produce monochromatic coherent high-intensity polarized light. The power modulates by altering the energy or time (P = E/t). Q-switching and mode-locking refer to increasing laser power methods using shutters that synchronize the light phase, compressing output in time.

The Nd: YAG laser is a unique solid-state laser that utilizes a neodymium-doped yttrium-aluminum-garnet crystal as the medium. It is pumped with a lamp or diode and commonly emits infrared light at 1064nm. It can be used in either a continuous or pulsed mode. Pulsing YAG lasers are typically Q-switched to achieve high-intensity pulses, which can be frequency doubled to emit the light at 532nm.

There are a variety of ophthalmic applications for YAG lasers. They are commonly used to treat posterior capsular opacification following cataract surgery. YAG laser can be used to create a peripheral iridotomy for patients with angle-closure glaucoma. Panretinal photocoagulation can be performed with frequency-doubled YAG lasers. A couple of other applications include the treatment of recurrent corneal erosions and vitreous floaters.

A more detailed description of some of these procedures follows:

Posterior capsulotomy: When a patient has a significant posterior capsular opacity or "secondary cataract," a YAG laser is often used to open the posterior capsule centrally. Patients are pretreated with iopidine or Alphagan-P to prevent an IOP spike. Then under topical anesthesia, the laser treatment is performed with a slit-lamp delivery system using an appropriate contact lens (i.e., Abraham capsulotomy YAG lens) to stabilize the eye and focus the laser beam. The energy setting depends on the capsular opacification density, but the specific starting point is 1-2mJ, and the energy is titrating according to the tissue response. The YAG laser causes photodisruption with the shock wave traveling anteriorly. Therefore, most lasers have a focus offset control to allow the surgeon to place the laser beam posterior (up to 250 microns) to the HeNe beam focus point on the capsule. This process helps prevent the intraocular lens (IOL) from pitting. Most surgeons will also place the initial laser spots off-center to avoid inadvertently damaging the IOL near the visual axis.

Anterior capsulotomy: The YAG laser is also utilizing to cut the capsule in other conditions. Capsular block syndrome occurs when there is retained viscoelastic in the capsular bag behind the IOL. This process causes a myopic shift and is evident on slit-lamp examination as an apparent space between the posterior IOL surface and the posterior capsule. A YAG laser uses this to puncture the anterior capsule peripheral to the IOL optic to allow the trapped material to drain. Alternatively, a posterior capsulotomy can be created to achieve the same result. Anterior capsular contraction syndrome or capsular phimosis may occur with a small capsulorhexis. Making radial anterior capsulotomies with a YAG laser effectively treats this condition.

Peripheral iridotomy: Lasers have long replaced surgical iridectomies for the treatment of angle-closure glaucoma. This non-invasive laser procedure is performed prophylactically in eyes with narrow or occludable angles. The laser energy needed ranges from 4-10mJ depending on the iris thickness. This laser creates an iridotomy more efficiently than a green laser. A peripheral iridotomy could also be beneficial in pigmentary glaucoma. 

Vitreolysis: YAG lasers are commonly used to treat aphakic and pseudophakic malignant glaucoma. YAG Laser vitreolysis can also be performed on strands of incarcerated vitreous in the anterior chamber that cause cystoid macular edema. Straightforward, thin vitreous wicks may be challenging to lyse, so it is best to pretreat with pilocarpine to induce miosis, stretch the incarcerated vitreous, and then use bursts 5-10mJ aimed at a pigmented area of the strand or near the wound. A change in the pupil shape back to round indicates successful vitreolysis.

ZEISS Visulas III 

The ZEISS VISULAS YAG III laser brings together optical experience, technological excellence, and an understanding of clinical applications. It is supremely focused, yet gentle cutting action has earned the device its reputation as the "sensitive scalpel" amongst secondary cataract lasers.

The high-precision Super-Gaussian beam of the VISULAS YAG III focuses on the optimum amount of energy onto the point of treatment. This process allows successful disruption to take place at just 2.5 mJ in air. In turn, this will enable you to offer precise treatment to your patients using a minimal amount of laser energy. The pulse frequency of 2.5 Hz also facilitates a fast workflow and short treatment times. 

The Fine adjustment of energy Offering twenty-two levels of energy attenuation, the VISULAS YAG III provides ample flexibility for various treatment techniques. The subtle gradations at the low end of the output range allow optimum laser energy regulation for your patients' minimally invasive treatment. 

The variable focus shift sets the focal point of the aiming beam precisely before, behind, or directly at the laser's focal point. Thanks to this safety feature, damage to the tissue and intraocular lens is now also a thing of the past. This process means greater comfort for your patients. 

 

Nidek YC-1800 YAG laser

Nidek YC1800

The Japanese company, NIDEK, also offered a YAG laser called the YC-1800. This ophthalmic photodisruptor provides the latest in innovative laser delivery and technologies. Simple operation and ultra adjustability make the YC-1800 YAG Laser system one of the best on the market. A few of the feature’s user praise is the high-resolution optics for hitting the exact laser-treatment location. The S-Switch allows easy changes of the parameters while holding the joystick, and the system is efficiently upgrading to the YAG/Green Combo system. 

Portable & User-Friendly Design

The "S-Switch" located on the joystick offers high operability, allowing doctors to change parameters while holding the joystick.

It also permits faster and easier operation and eliminates the need to pull away from oculars to make adjustments.

One-Touch Lock

The YC-1800 can effortlessly slide back and forth around the unit and can be fixed and released anywhere you like with the one-touch lock, offering improved safety.

Compact Design

The YC-1800 is Nidek's lightest ophthalmic photodisruptor, which can be easily transported. The compact design also allows greater flexibility in locating your armrest, which improves ergonomics.

Versatile Combo Laser

The YC-1800 can be paired with NIDEK's Green Laser Photocoagulator, allowing for the treatment of a broader range of patients.

Reliability and Safety

The YC-1800 has the new technology to control the pulse number under the CPU "D-Pulse," providing higher stability against environmental conditions.

 

 

Ellex Ultra Q

Uniquely efficient

A very efficient and fast microsurgical YAG laser, Ultra Q's unique cavity design allows you to perform capsulotomy and iridotomy procedures at more efficient power levels and with greater consistency.

IOL-friendly photodisruption

With an Ultra Gaussian beam profile, Ultra Q focuses more energy into the center of the beam profile — reducing the energy needed to perform capsulotomy and iridotomy effectively. 

Iridotomy for Phakic IOLs

Ultra Q enables you to perform precise iridotomy to prevent pupillary block before inserting a refractive IOL. The aperture must be large enough to guarantee a balanced aqueous flow without allowing light to transmit back to the pupil. Ultra Q's efficiency means that you can achieve this outcome in a single shot.

Ellex also offers a laser that is unique to the market, which is the Ultra Q Reflex. This laser is specifically designed for treating Vitreous Floaters. The effectiveness of Laser Floater Treatment (LFT) has been transformed through the development of Ellex's Reflex™ Technology platform, which includes TCI™ for on- and off-axis visualization, a precise aiming beam, and a superior energy beam profile — all within a unique slit lamp illumination tower with a mechanical prism design that converges and focuses your sightline, target illumination, and treatment beam into one optical path.

 

Conclusion

Laser Locators specializes in the preventative maintenance and refurbishment of all types of ophthalmic lasers, not just YAGs. Whether you are only looking to service an existing laser or want to take your practice to the next level, think of us first. 

Contact us today for a complimentary consultation on how you can improve your ophthalmic practice.

Sales@laserlocators.com

by Joey Colarulo, Vice President

About Joey Colarulo linkedin button The YAG Laser as used in Ophthalmology

Vice President

Joey has been the Vice President of Laser Locators since March 2015 and a Managing Partner since 2012. He joined the company in 2011.

Joey has significantly contributed to Laser Locators' growth, including the development of a full service and parts department. He has streamlined the sales and procurement departments by redeveloping processes and implementing new systems. Through Joey's efforts, Laser Locators has tripled its sales volume and added 13 new positions.

Joey has over 20 years of experience in global internet sales and marketing. His expertise in analyzing the marketplace and leverage the latest e-commerce technologies has enabled Joey to drive exponential sales growth year over year.

Originally from Philadelphia, Joey earned his Bachelor's degree in Financial Management and graduated Magna Cum Laude from Rowan University.

Outside of work, Joey is involved in the Westchase Charitable Foundation, a local non-profit that provides direct assistance to those in need. His interests include vintage BMWs and rare sports cards.

Laser Locators Provides White Glove Deliveries

Tampa, FL, November 9, 2018 – Laser Locators has taken equipment delivery into their own hands to ensure outstanding quality and customer service.

truckandteam 1 Laser Locators Provides White Glove Deliveries

Transporting laser & surgical ophthalmic equipment is no easy task – it must be done very carefully. Not only does Laser Locators offer pick-up, delivery, and installation services, but the team is now committed to doing it themselves! Each piece of equipment will be handled by team members who work closely with the equipment on a regular basis. Their goal is to provide “white glove service” in order to surpass customer expectations.

“During our sales and delivery process, our goal is to often mirror the manufacturers’ protocol and treat our doctors as if they were buying new.  Having our own trucks being operated by our staffed employees exceeds this goal and further enhances the boutique style purchasing experience Laser Locators has continued to provide within our ever growing organization”, says Joey Colarulo, Vice President of Sales.

Laser Locators’ customized freight truck has the best in air ride suspension technology and is equipped with a custom liftgate, sleeper, and wood floor rear trailer. After a six month process of perfecting the vehicle with Freightliner Trucks, Laser’s new delivery truck is ready to hit the road.

“I believe this is a really big day for Laser Locators, for a lot of reasons,” says CEO Sean O’Donnell in regard to the company’s most recent purchase. “Being able to control the equipment from purchase to delivery gives us much more control over the quality of the product being delivered.”

They have the delivery process down to a science. They take all packaging materials with them after installation, and if there are any old, unwanted products, they can assist in disposal.

Between quality control, cost savings and customer service, this is an enormous progression for Laser Locators.

About Laser Locators:

Headquartered in Tampa, Florida, Laser Locators is a worldwide leader partnering with ophthalmologists to buy and sell new or refurbished ophthalmic lasers and diagnostic equipment. For more information on the wide array of products available, go to www.laserlocators.com. To schedule a tour of our 12,000 square foot state-of-the-art corporate headquarters, please call 813-855-0343.

5 Ways to Keep your Child’s Eyes Safe

childrens eye health 1 5 Ways to Keep your Childs Eyes SafeAugust is Children’s Eye Health and Safety month, reminding us of the importance of your child’s vision. Proper vision affects your child’s happiness. He or she should be able to enjoy childhood activities to the best of his or her ability. Reading, playing sports and even learning to tie a shoe all require hand-eye coordination which can be diminished by poor eye health. During our research, we spoke with published ophthalmologist Jonathan Davidorf, a laser vision correction specialist. Over the years he has seen many cases of eye damage that could have been prevented at an early age. In order to properly care for your child’s eyes, keep these five considerations in mind:

HOW TO SUPPORT EYE DEVELOPMENT
Just like any basic ability, eyesight develops over time. Your child’s vision develops significantly in the first eight months of life. The eyes must learn to focus, work together, and send the brain messages about the world. If these skills aren’t developing correctly, the chances of other developmental issues increase. Ensure that your child’s vision is developing properly by taking the following measures:

From birth to four months old, change the position of your child’s crib in his or her room regularly. Keep a nightlight or dim lamp in the baby’s room and talk to him or her as you move around the room. When the child is five months old, hang a mobile in the crib and allow plenty of exploration on the floor. Playing games like patty-cake also benefit development and hand-eye coordination.

At six months old your baby is ready for a full eye exam, but there is still developmental work to do. When your child is a year old, play hide and seek games like peek-a-boo, roll a ball back and forth for your child to visually track, and begin storytelling to facilitate visualization. When your child turns two, eyesight and hand-eye-foot-body coordination should be fully developed. However, it is essential to continue paying attention to your child’s eye safety.

HOW TO PREVENT EYE-RELATED ACCIDENTS
“Accidents involving common household products cause 125,000 eye injuries each year” (preventblindness.org). Most of these injuries can be prevented. Some major causes of common eye injuries include the misuse of toys, accidents from falling, and contact with harmful household products like forks, pens, detergents, and paints. Read toy labels attentively and avoid toys with pointed edges. Most importantly, use safety gates, cabinet locks, and corner cushions to eliminate hazards. Erring on the side of caution can take care of many potential dangers, but children are still at risk for different eye infections.

HOW TO RECOGNIZE SYMPTOMS OF AN EYE INFECTION
Children touch anything they can get their hands on which means they’re especially vulnerable to eye infections. Red, encrusted, swollen, itchy eyes are usually indicators of a health concern. Since babies and toddlers can’t clearly vocalize their problems, watch out for consistent eye rubbing. These symptoms may be caused by a virus or infection like keratitis or conjunctivitis. If your child seems to have extreme sensitivity to light, it could be due to elevated pressure in the eye. Constant eye-rolling may be related to muscle control, and excessive tears can indicate a blocked tear duct. Pay attention to your child’s eyes and visit the doctor if any of these symptoms arise. In addition to infection, environmental factors can also pose a threat.

HOW TO AVOID OUTSIDE DANGERS
Household products and bacteria aren’t the only factors that can cause eye issues. Many outside elements can damage the eyes too. The sun’s rays can harm children’s eyes as they develop. Choosing a protective pair of sunglasses is crucial. When selecting glasses, choose a pair that filters UVA and UVB rays. The shades themselves should keep colors natural: no hot pink or blue lenses. Make sure the glasses fit your child comfortably, also taking into account his or her active lifestyle. Glasses easily fall off and break, so choose a pair that is suitable for whatever activities your child engages in. Wide-brimmed hats can also provide extra protection by reducing the number of UV rays that reach the eyes.

If your child engages in sporting activities, more protection is needed. “Every 13 minutes, an emergency room treats a sports-related eye injury. And, 43 percent of sports-related eye injuries are to children ages 14 and younger” (preventblindness.org). Ensure your child is wearing a helmet and eye-wear when engaging in sports. Dr. Davidorf highly recommends wearing protective eye equipment during any sporting activity, especially when playing with toys like BB guns.

HOW TO ENCOURAGE EYE EDUCATION
As your child ages and grows more independent, you may have less control over his or her eye health and safety. For this reason, it is important to educate your child about healthy vision and how to care for his or her own eyes. To begin providing your child with a proper understanding of eye health, you can use a variety of online resources that are informative and kid-friendly. Here are a few examples:

Printables
Activity Sheets
Ask A Scientist

Dr. Davidorf’s most urgent tip: “get adamant and get checked while still young, because after seven or eight years old, you can’t make much headway.”

There are many components to consider when protecting your child’s eyes. By staying proactive and aware you can maintain your child’s good eye health. Laser Locators wants to ensure you know the facts when it comes to eye health and safety. Support your child’s eye development, prevent household incidents by child-proofing, recognize symptoms of eye issues, provide protection from the sun and sports, and encourage eye education. Annual eye exams are critical, but so is prevention and protection. Set a positive example by showing your kids that overall eye health and safety are required all year long.