Dr. Robin Ross - Global Retina Institute, Arizona, US
"With this navigated laser, first time in my 20+ years career that I had a full PRP in one eye, while the patient graded the pain as a 1 and asked to have the other eye treated same day. The diminished pain experience improves the odds of follow-up within our patient population. Our team really feels with the Navilas® we give people a fighting chance at saving sight.”
Dr. Ross, you recently introduced navigated retinal laser treatment to your private practice. Can you describe your initial clinical experience with this laser?
The Navilas® laser system is like going from a Model T to a self-driving Ferrari with a number of treatment permutations that benefit patients of diverse retinal pathologies.
In one case, I placed over 1,700 spots for PDR treatment and the patient reported no discomfort and promised to return for additional treatment. This was significant because the patient had a history of non-compliance for appointments elsewhere due to the pain from previous laser treatments.
With Navilas®, it was also the first time in my 20+ years career that I had a full PRP in one eye, while the patient graded the pain as a “1” (on a 10-point scale) and asked to have the other eye treated the same day.
The diminished pain experience with Navilas improves the odds of follow-up within our patient population which greatly enhances our chances of saving sight.
How does this positive patient feedback compare with alternative treatment methods that are available?
We had another patient who had multiple retinal holes in the far periphery. She was treated by LIO previously. This patient had been very uncomfortable with this treatment, ultimately requiring subconjunctival lidocaine. So when her other eye needed treatment, we switched to the navigated laser. After finishing the treatment on Navilas® she asked “is that it?”, and was surprised at how comfortable she was throughout the treatment.
Patient presented with multiple holes in the far periphery, felt uncomfortable during LIO treatment. Next treatment was planned on the Navilas® laser.
After finishing on Navilas (parameters documented on picture), she asked “is that it?”, and was surprised at how comfortable she was throughout the treatment.
"What a world of difference being treated with the navigated laser versus a conventional laser. It was virtually pain free with only a 1 or 2 on the pain scale (vs. a 9 on the conventional laser). I had a very mild soreness the next day and that was it."
My prior laser was a PASCAL pattern laser and I feel the pain threshold is significantly less with the Navilas® than with the PASCAL. Navilas® permits treatment under infrared, allows for protection of areas where you don’t want treatment, and the pre-planning with eye tracking actually speeds up treatment.
Also, some of our monocular patients who we successfully treated with Navilas® would not have tolerated conventional laser. In these patients, we would have opted for intravitreal injections and deferred conventional focal laser because of the worry we might place inadvertent laser proximal to the fovea. But the “caution zone” of the Navilas combined with the eye tracking protects the fovea and optic nerve. Also focal and microsecond pulsing can be combined in one treatment depending on the edema.
Your work is dedicated to improving access to eye care locally and globally. How can the Navilas® laser support this mission?
Our team really feels like with Navilas®, we give people a “fighting chance” at saving sight – especially for patients who are already monocular.
We recently were asked to see a group of uninsured patients with advanced diabetic retinopathy age <55 who were Lost to Follow-up (LTFU). Recent work by Obeid et al focuses on “real world experience” among LTFU patients with PDR, which maybe as high as 25%.1 This work also highlights the disparity across race and income.
PRP maybe a real treatment consideration for loss to follow-up - especially among high-risk groups. Unfortunately, the working poor can’t afford to come back for monthly intravitreal injections and this may impact outcomes.2
The comfortable PRP experience with Navilas may close the gap the US healthcare system has not effectively bridged yet. We were able to see first-hand the potential public health benefits of the Navilas® OD-OS system.
We always say, “vision is more than eyesight” and Navilas® should be commended for their forward thinking vision.
Thank you very much for this interview.
Robin D. Ross, MD, MPH, CPH, Global Retina Institute, Arizona, US
Dr. Robin Ross has more than 20 years of experience in practicing ophthalmology. She is running her own private practice, Global Retina Institute, in the Phoenix area in Arizona, USA. Ten years ago, she and her husband founded the non-profit organization, Red Rover Ventures.
Dr. Ross is engaged in multiple projects which seek to improve access to eye care locally and globally. She is also pursuing this work as a Director of Global Outreach at the University of Arizona College of Medicine in Phoenix. Read more about Dr. Ross’ work in this article: http://retinatoday.com/2018/06/many-mountains-to-climb
1. Obeid, A., Gao, X., Ali, F. S., Talcott, K. E., Aderman, C. M., Hyman, L., Ho, A.C., Hsu, J. (2018). Loss to Follow-Up in Patients with Proliferative Diabetic Retinopathy after Panretinal Photocoagulation or Intravitreal Anti-VEGF Injections. Ophthalmology, 125(9), 1386-1392.
2. Obeid, A., Su, D., Patel, S., Uhr, J., Borkar, D., Gao, X., Fineman, M., Regillo, C.D., Maguire J.I., Garg S.J., Hsu, J. (2018). Outcomes of Eyes Lost to Follow-up with Proliferative Diabetic Retinopathy That Received Panretinal Photocoagulation verus Intravitreal Anti-Vascular Endothelial Growth Factor. Ophthalmology, 1-7.
Which capabilities of Navilas® have impressed you most?
The screen-based treatment is ergonomically comfortable for the doctor and also allows for better interaction with your patients and students. Our field has about a 30% rate of neck and musculoskeletal complications over the course of our careers. An observer or student can also learn as a great teaching tool off the monitor screen.
I was also impressed with the speed of performing the treatment once mapped.
You plan the intended laser spots on the screen – basically painting with your finger directly on the fundus picture or your external diagnostic image. And then you just execute this plan by pressing the foot pedal. With the separation of pre-planning and treatment, each physician can implement a different workflow for their clinic volume.
The microsecond pulsing mode combined with the ability to digitally document what you treated and integrate with your EMR is really great.
I think the eye tracking to guide the laser is really revolutionary. I also like the “caution zones”, which means the ability to place exclusion zones where you don’t want treatment.
The ability to treat under infrared is very comfortable for patients.
Having both focal and PRP lens as non-contact may find another population benefit.