Commanding the ZEISS Cataract Workflow

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Sponsored by ZEISS

Redefining Phacoemulsification Expectations with the ZEISS QUATERA 700

Content guidance: Bryan Monson, MD, MBA, and Steven Vold, MD

In the surgical environment, time efficiency is optimized when devices, systems, and personnel work in sync to curtail redundancy and react swiftly to prevent potential errors. With interconnectivity and advanced software controls, the ZEISS QUATERA 700 is designed to provide cataract surgeons with the high-tech user experience they want and the high-caliber phacoemulsification performance they expect.

Take a look to understand how the advanced fluidics and digital integration of ZEISS QUATERA 700 take cataract surgery to the next level.

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Engineered for Performance

When all the elements of phaco fluidics are balanced to achieve a stable anterior chamber, cataract surgery is safer, faster, and less taxing on the surgeon.

The ZEISS patented QUATTRO Pump® of QUATERA® 700 from ZEISS actively compensates for incision leakage to simultaneously titrate infusion and aspiration (I/A) volumes in real time. Sensors synchronize fluid exchanges regardless of whether the machine is in flow or vacuum control mode while maintaining the target intraocular pressure (IOP) level. When occlusion is detected, ultrasound energy activates automatically to reduce repulsion of fragments, and synchronized fluid exchange virtually eliminates1 post-occlusion surge.

Let's see the ZEISS QUATERA 700's features in action:

Followability: Pieces come to the tip.

Video courtesy of Inder Paul Singh, MD.

Holdability: Fragments remain at the tip and are removed with increased on time and no additional ultrasound energy in this case.

Video courtesy of Inder Paul Singh, MD.

Chamber Stability: In this case the anterior chamber remains stable under high vacuum. Iris and posterior capsule tissue are not affected by vacuum.

Video courtesy of Inder Paul Singh, MD.

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Watch full videos of the ZEISS QUATERA 700 in action »

Engineering in Operation

There are many considerations when evaluating a new phacoemulsification machine, but the real test of performance comes down to first-hand experience. Later in this infographic, we'll hear from Bryan Monson, MD, MBA, and Steven Vold, MD, about their initial experiences with the ZEISS QUATERA 700.

Choose a case scenario below to see how they described the ZEISS QUATERA 700 performance in their hands:

The difference in fluidics with the synchronized fluid exchange system with the ZEISS patented QUATTRO Pump can be seen clearly during a case involving a light adjustable lens. I would normally expect incisional leakage due to the gap around the 2.2-mm probe through an enlarged main incision during the OVD removal, but the ZEISS QUATERA 700 maintained a stable chamber in this environment.

I realized the significance of synchronized fluid exchange during a implantable collamer lens case. I would normally expect fluid fluctuations due to bimanual irrigation and aspiration through a 3-mm incision, but the ZEISS QUATERA 700 maintained a stable chamber in this environment.

The followability with ZEISS QUATERA 700 really shined through for me during an intraocular floppy iris syndrome case. I would normally expect extremely constricted maneuverability due to proximity to the pupil, but the ZEISS QUATERA 700 coaxed fragments right to the tip in this environment.

I realized the significance of followability during a 3- to 4-mm small pupil case. I would normally expect to use an iris expansion device due to constricted working space, but the ZEISS QUATERA 700 pump fluidics reduced the amount of manipulation needed in this environment.

The difference in fluidics with the synchronized fluid exchange system with the QUATTRO pump (patented) can be seen clearly during a case involving a light adjustable lens. I would normally expect incisional leakage due to the gap around the 2.2-mm probe through an enlarged main incision during the OVD removal, but the ZEISS QUATERA 700 maintained a stable chamber in this environment.

Observation by Bryan Monson, MD, MBASteven Vold, MD

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upgrading my or with the ZEISS Quatera 700

Bryan Monson, MD, MBA

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Our practice is built upon three key pillars that inform our technology decisions and ensure exceptional patient care: best-in-industry technology, world-class surgical outcomes, and a commitment to industry-leading patient safety.

I applied this disciplined approach when first evaluating the ZEISS QUATERA 700. I closely monitored the chamber stability during the surgery by observing the behavior of the nuclear fragments. I found that there was almost no need for a second instrument to bring pieces to the tip or to protect the posterior capsule as there was no discernible post-occlusion surge. One of the most remarkable aspects was how efficiently the nuclear fragments reengaged the tip with high flow rates. This resulted in a reduction in both the surgical time and the total amount of potentially eye-injuring energy imparted into the eye.

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"Efficiency has reduced my overall phaco time by approximately 50% and decreased the total phaco energy required by 80-90% ...The absence of corneal and sectional haze around the incision on day one is the most significant benefit."

— Bryan Monson, MD, MBA

I have used the ZEISS QUATERA 700 in various surgical scenarios, including dense lenses, pseudoexfoliation, nanophthalmos, intra-operative floppy iris syndrome (IFIS), weak zonules, and have been impressed by the QUATTRO pump's ability to compensate for incisional leakage.

Seeing how the ZEISS QUATERA 700 performs in demanding surgical situations gave me the confidence to increase vacuum and flow rates to the point where I now use 100% vacuum and higher flow rates relative to my original settings. Even in routine cases, the ZEISS QUATERA 700 provides a layer of stability and safety because I can keep the phaco centered at the pupil margin. With other systems that I've utilized throughout my career, often I redirect nuclear fragments with a second instrument. I noticed almost immediately that I wasn’t chasing fragments with a second instrument with this device. In fact, I have become confident with the predictability such that, in most cases, I no longer use a second instrument. Within several cases, you’ll be able to recognize the fluidics patterns and feel confident adjusting the vacuum and flow rate parameters.

The system's efficiency has reduced my overall phaco time by approximately 50% and decreased the total phaco energy required by 80-90%. In most cases, it is unnecessary to use both a dispersive and cohesive viscoelastic, and a cohesive viscoelastic alone is sufficient. The absence of corneal and sectional haze around the incision on day one is the most significant benefit. The rapid recovery of cornea and vision has been noticeable to both patients and our collaborating optometry colleagues.

Another attractive aspect about the ZEISS QUATERA 700 is that it integrates into the entire ZEISS digital workflow. The newest, most intriguing advancements taking place in lens-based refractive surgery involve the integration of vast amounts of preoperative data. The ZEISS portfolio offers a comprehensive and cohesive system that seamlessly integrates our imaging devices, ZEISS IOLMaster 700 biometrics, and lens selection with ZEISS VERACITY Surgery Planner, benefitting our patients and team. By using statistical methods, algorithms are now trained to classify and uncover key insights, improving a surgeon's accuracy. Crowdsourcing of outcome data from a growing number of surgeons worldwide further refines outcomes. These insights are then used to make surgical decisions and develop custom surgery plans with next-generation precision outcomes for every patient’s unique eye in our care. In my experience, these advancements are modernizing the field by providing next-level safety and outcomes, leading to more predictable results than ever before. It's undoubtedly one of the great endeavors in the history of surgery.

This ZEISS digital workflow starts with our state-of-the-art imaging suite through to the point of contact in surgery creating what we call a “surgical cockpit.” This allows for live, augmented overlays to assist the surgeon during incision locations, toric alignment, and other surgical steps in real time. Additionally, the system has improved our preoperative time out process by providing case-specific data and a live screen view for the operative team, resulting in enhanced operating room safety.

When we compare intraocular lens surgery to other surgical fields, intraocular lens surgery involves a significant number of variables to consider, which is why instant access to real-time surgical information can make a huge difference. In my opinion, the ZEISS QUATERA 700, as part of the ZEISS Cataract Workflow, truly provides a next-generation surgical experience.

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Bryan Monson, MD, MBA

Cataract and refractive surgeon; Owner, Monson Vision, Logan, Utah

bryan@monsonvision.com

Dr. Monson is a consultant for Carl Zeiss Meditec, Inc.

Hear from Steven Vold, MD »

Thoughtfully Designed for Interconnectivity

To optimize the cataract workflow, data should flow seamlessly between devices and applications to provide information and control to the surgical staff when, where, and how they need it. Alone, the ZEISS QUATERA 700 is an advancement in phacoemulsification systems, but when combined with compatible diagnostic devices and preoperative surgical planning software, the display screen becomes an integrated surgical control panel.

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Patient Information

Important patient data are clearly displayed on the ZEISS QUATERA 700. Connect the system with your ZEISS VERACITY Surgery Planner or ZEISS IOL Master 700 to facilitate a paperless timeout check.

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Sterile Cockpit

Beyond visualization of surgical parameters, surgical teams modify settings on touchscreen display as an alternative to foot pedal control.

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Microscope View

Incorporation of heads-up displays in the operating room allows surgical team members to monitor case progression and anticipate the surgeon’s needs. With a built-in feed from the microscope, the ZEISS QUATERA 700 screen offers surgical staff a clear view of what the surgeon sees. When used with ZEISS CALLISTO eye, intraoperative guidance overlays can be controlled and incorporated into the workflow steps.

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Patient Information

Important patient data are clearly displayed on the ZEISS QUATERA 700. Connect the system with your ZEISS VERACITY Surgery Planner or ZEISS IOL Master 700 to facilitate a paperless timeout check.

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Sterile Cockpit

Beyond visualization of surgical parameters, surgical teams modify settings on touchscreen display as an alternative to foot pedal control.

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Microscope View

Incorporation of heads-up displays in the operating room allows surgical team members to monitor case progression and anticipate the surgeon’s needs. With a built-in feed from the microscope, the ZEISS QUATERA 700 screen offers surgical staff a clear view of what the surgeon sees. When used with ZEISS CALLISTO eye, intraoperative guidance overlays can be controlled and incorporated into the workflow steps.

a physician's perspective

Steven Vold, MD

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In the 20 years I have been practicing, I've seen a remarkable evolution in cataract surgery with more powerful systems and better fluidics. Newer technologies have the potential to change how we perform cataract surgery.

I noticed two big game changers in the first month of using the ZEISS QUATERA 700. First, it is an incredibly efficient technology. Using the power of the machine and fluidics, you can put the phaco tip in the middle of the eye with high vacuum settings and fragments come to the probe. If you blink while removing a mild-to-moderate density nucleus, that nucleus will be gone. It is really that efficient. I find that I am manipulating the iris much less, especially in IFIS cases or patients with small pupils, in addition to using less phaco power and less BSS. I think those factors contribute to safety and clarity of corneas we see on day 1 postoperatively.

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"If you blink while removing a mild-to-moderate density nucleus, that nucleus will be gone. [ZEISS QUATERA 700] is really that efficient."

— Steven Vold, MD

Second is an incredibly stable anterior chamber because of the ZEISS patented QUATTRO Pump, which handles comfortably under high power and vacuum settings. The machine monitors the intraocular pressure and allows us to maintain lower pressures than we've ever used before, and yet the chamber stability is remarkable. With the fluids bringing the nuclear fragment to the tip, I felt an incredible confidence that even in the densest lenses, the corneal endothelium was protected and fluid fluctuation was minimal.

Analogous to going from a standard gas-powered car to something like a Tesla, new users need to learn to drive the phaco system a little differently. I would encourage surgeons to start with a phaco technique similar to what they're used to so they can evaluate the differences more easily. For me, I started to feel comfortable with it after about 15 to 20 cases. I found myself continually increasing vacuum and power levels, especially with more dense lenses, which allowed me to become much more aggressive in removing lens material.

In our practice, we basically use all major devices in the ZEISS Cataract Workflow. The ZEISS IOLMaster 700 captures biometrics and digitally sends preoperative data to the ZEISS QUATERA 700 and ZEISS ARTEVO 800. So now with this new technology, we not only have all the advances of the ZEISS QUATERA 700, but we are also able to integrate preoperative and intraoperative data in one fell swoop which I think is a better, safer, and more user-friendly way of performing cataract surgery.

I've had the privilege of using all the other phaco systems on the market, and as we know, these are all great technologies. Each represents incremental changes that aim to improve patient outcomes, and the ZEISS QUATERA 700 represents another step forward in this technology evolution.

Steven Vold, MD

Glaucoma, cataract and refractive surgeon; Owner, Vold Vision, Fayetteville, Arkansas

svold@voldvision.com

Dr. Vold is a consultant for Carl Zeiss Meditec, Inc.

Step-by-Step Using ZEISS QUATERA 700 in a Typical Case

Kerry Solomon, MD

Skip ahead to hear Dr. Solomon discuss the following:

More Surgical Videos

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Flip-and-Chip Technique with ZEISS QUATERA 700 multi burst mode

Inder Paul Singh, MD

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Stop-and-Chop Technique with ZEISS QUATERA 700

Inder Paul Singh, MD

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3+ Nuclear Sclerotic Cataract with Posterior Subcapsular Cataract

Bryan Monson, MD, MBA

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Cataract Surgery with the ZEISS QUATERA 700

Steven Vold, MD

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1. Virtual elimination of occlusion break surge effect achieved by IOP recovery within 200ms independent of IOP and aspiration settings

The statements of the doctors reflect only their personal opinions and experiences and do not necessarily reflect the opinion of any institution with whom they are affiliated. The doctors alone are responsible for the content of their experience reported and any potential resulting infringements. Carl Zeiss Meditec, Inc and its affiliates do not have clinical evidence supporting the opinions and statements of the doctors nor accept any responsibility or liability of the authors' content.

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Sponsored by ZEISS