Introducing Tango Reflex

The new Tango Reflex™ from Ellex combines multiple treatment platforms — SLT for glaucoma, laser vitreolysis for floaters, and capsulotomy and iridotomy treatments – in a single laser system.

Featuring an intuitive tablet user interface, the multi-modality Tango Reflex™ allows you to perform the full range of anterior and poster YAG laser procedures, as well as SLT, with greater precision and clinical efficacy.

tango-reflex

One Advanced Laser. Four Treatment Modalities.

SLT

Selective Laser Trabeculoplasty

A simple in-office procedure, selective laser trabeculoplasty (SLT) has been shown to lower IOP as effectively as medication, and to offer a consistent safety profile. Best of all, it is efficacious at every stage of the glaucoma treatment algorithm. On average, SLT achieves a reduction in IOP of 30% when used as a first-line option.

Since its U.S. introduction in 2001, the use of SLT as a primary therapy has slowly taken hold. When SLT was first launched, however, glaucoma specialists typically reserved SLT for patients on maximally tolerated medical therapy, which led to suboptimal results.

Various studies by Shlomo Melamed1 and Ian McIlraith2 have since shown that SLT is most effective when used as a primary therapy. A 2015 meta-analysis that included five studies and a total of 492 eyes with OAG found that SLT and topical medication demonstrated similar success rates and effectiveness in lowering IOP, further recommending the role of SLT as a first-line therapy3.

  • Melamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study. Arch Ophthalmol. 2003;121(7):957-960.
  • McIlraith I, Strasfeld M, Colev G, Hutnik CM. Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma. J Glaucoma. 2006;15(2):124-130.
  • Li X, Wang W, Zhang X. Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma. BMC Ophthalmol. 2015;15:107.

From Drugs to Lasers

SLT is particularly well suited to patients who are known to be non-compliant with medication. It is also effective as adjunct therapy with drugs, and as alternative therapy when drugs or surgery fail. Most importantly, SLT can deliver effective IOP control without the compliance issues and side effects associated with drug therapy.

SLT is not “ALT Lite”

SLT achieves the desired therapeutic effect whilst avoiding the coagulative damage that is associated with argon laser trabeculoplasty (ALT). Unlike ALT, it achieves a sustained IOP reduction over the long-term and can be repeated, if needed.

High Benefit-Risk Ratio

When you consider the risk of complications and side effects associated with SLT versus other glaucoma therapies, SLT has one of the highest benefit-to-risk ratios of all ophthalmic procedures.

Compliance-Free

A highly effective primary therapy option, especially in non-compliant patients or in patients who have difficulty taking medications, SLT can also be used to reduce the number of medications required to control IOP – and thereby free your patients from the compliance issues and side effects associated with medications.

A More Economical Approach

SLT has been found to be a more economical approach when compared to topical medications. Not only can SLT alleviate the ongoing expense of medications for the patient, but it also offers significant economic benefit for the wider healthcare system.

SLT Snapshot
  • SLT is a therapy and not a surgical treatment – it is gentle, does not destroy tissue and can be repeated.
  • SLT can lower IOP as effectively as medication.
  • SLT is a highly effective first-line therapy, and is particularly well suited to patients who are known to be non-compliant with medication (due to problems of literacy, lifestyle and mental or physical challenges)
  • SLT can be used as a replacement treatment if medication is not well tolerated.
  • SLT is a highly effective adjunct treatment in combination with medications.
  • At least one in three glaucoma patients will benefit from SLT.
  • SLT is not argon laser trabeculoplasty (ALT), which causes permanent damage to the structure of the TM.
LEARN MORE ABOUT SLT

Whitepaper

SLT: A Comprehensive Treatment Solution for Glaucoma

LFR

Laser Floater Removal

Laser vitreolysis, also referred to as “Laser Floater Removal”(LFR), involves the use of a nano-pulsed ophthalmic YAG laser to vaporize vitreous strands and opacities and does not carry the same risks of infection, bleeding or retinal detachment that comes with vitrectomy. And with recent advancements in YAG laser technology, including Reflex Technology™ from Ellex, ophthalmologists can offer their symptomatic floater patients treatment with laser vitreolysis with greater safety and efficacy than ever before.

Virtually every individual has experienced or will experience the visual shadows caused by vitreous strands and opacities, commonly referred to as “floaters,” during their lifetime. For most, this event is a minor and short-lived inconvenience, but for some it can become a disabling condition.

The negative effect that floaters can have on a patient’s quality of life has traditionally been largely underestimated. In symptomatic patients, floaters can drastically impede vision, so much so that they not only affect visual quality and functioning, but can also have a psychological impact.1,2

  • Sebag, J. Floaters and the quality of life. Am J Ophthalmol. 2011; 152 (1): 3-4.
  • Wagle AM, Lim WY, Yap TP, et al. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011;152(1):60-65.

The overriding school of thought states that patients with floaters should be advised to learn to tolerate them and, in extreme cases, a vitrectomy should be offered. Due to the risk of complications associated with the procedure, however, including infection, macular edema and retinal detachment, many ophthalmologists are reluctant to perform vitrectomy and instead reserved it for the most severe and distressing cases only.

In more recent times, discussion has centered on whether patients with symptomatic floaters should undergo treatment with laser vitreolysis (also referred to as “Laser Floater Removal”, LFR. Laser vitreolysis involves the use of a nano-pulsed ophthalmic YAG laser to vaporize vitreous strands and opacities and does not carry the same risks of infection, bleeding or retinal detachment that comes with vitrectomy. And With recent advancements in YAG laser technology, including Reflex Technology™ from Ellex, ophthalmologists can offer their symptomatic floater patients treatment with laser vitreolysis with greater safety and efficacy than ever before.

About Laser Floater Removal

During the procedure the laser emits a short and small burst of energy at a potent power density. This energy converts the collagen and hyaluronic molecules found in a floater into a gas, which is then resorbed into the eye. On average, most patients can expect a 60% to 90% improvement in the mass and/or amount of floaters.It is important to note that modern laser vitreolysis is a different procedure.Compared to its early clinical use in the 1980s, modern laser vitreolysis provides more efficient and safer energy profiles — offering reliable and repeatable outcomes that provide a low rate of complications, combined with a high degree of patient satisfaction.

Modern Laser Floater Removal

Traditional YAG lasers typically have larger and less-controlled plasma with more inconsistent power output and were equipped for capsulotomy and iridotomy procedures only. Since it can be difficult to focus on small structures — such as vitreous strands — when using these systems, collateral ocular tissue damage may occur.

Indeed, previous attempts at laser floater removal were not successful for a number of reasons, including:
  • Lack of visualization
  • Energy settings too low
  • Number of shots not enough
  • Inefficient energy beam

In contrast, Reflex Technology™ from Ellex features an ultra-Gaussian beam mode, teamed with a fast-pulse rise time and a small-spot size: with a higher-power density and tightly controlled plasma, fewer shots are required to perform procedures with less cumulative energy delivered to the patient.

Furthermore, Reflex Technology™ incorporates a proprietary slit lamp illumination tower design, which converges the operator’s vision, the target illumination, and the treatment beam along the same optical path and onto the same optical plane. The illumination tower can be used coaxially to enhance the view of the target opacity and more effectively vaporize it.

In short, Reflex Technology™ minimizes the potential for focusing errors and reduces the risk of damage to the natural lens or the retina.

ON AXIS
  • Gives you great visualization of the middle and posterior vitreous
  • Allows for spatial context – especially near the retina
  • Red Reflex helps with contrast for certain floaters
  • Hard to see anterior floaters well…
OFF-AXIS
  • Can’t see floaters behind anterior vitreous
  • Beneficial for visualizing anterior floaters
  • Lose red reflex which allows for floaters to appear “white”
  • Helps with defining posterior capsule
  • Decreases glare in some situations

Whitepaper

The Clinical Impact of Floaters

Capsulotomy

A precise capsulotomy is essential for IOLs that correct presbyopia through implantation in the posterior chamber’s capsular bag. Tango Reflex™ creates a capsulotomy opening that is precisely controlled, without causing damage to the lens – even if the lack of a ridge makes the capsule adhere to the optic.

Good IOL centration, in terms of the pupil, optimizes lens performance. In contrast, decentration can cause halos and poor vision. The goal is a perfectly centered, precise capsulotomy that will not affect the tension of the bag and the position of the IOL in the visual axis.

Precision-Perfect Capsulotomy

Good IOL centration, in terms of the pupil, optimizes lens performance. In contrast, decentration can cause halos and poor vision. The goal is a perfectly centered, precise capsulotomy that will not affect the tension of the bag and the position of the IOL in the visual axis.

Stage 1: Capsulotomy in Multifocal IOL

Images courtesy of Karl Brasse, MD, MRCOphth (Germany)

step-2-of-yag-caspulotomy-in-multifocal-iol

Stage 2: Capsulotomy in Multifocal IOL

Images courtesy of Karl Brasse, MD, MRCOphth (Germany)

step-2-of-yag-caspulotomy-in-multifocal-iol

Iridotomy

With refractive IOLs the iridotomy aperture must be large enough to ensure a balanced aqueous flow, yet small enough so that no light is transmitted back to the pupil, which can cause double vision. The Tango Reflex™ enables you to create a precise size of the iridotomy, often in a single shot that uses lower energy than other YAG lasers.

Refractive IOLs that are designed to correct myopia, or hyperopia (also known as Phakic IOLs) can be placed in front of the iris or between the iris and the natural lens. To prevent any possibility of IOL-induced pupillary block, these lenses require peripheral iridotomies prior to surgery. The iridotomy aperture must be large enough to ensure a balanced aqueous flow, yet small enough so that no light is transmitted back to the pupil, which can cause double vision.The Tango Reflex™ enables you to create a precise size of the iridotomy, often in a single shot that uses lower energy than other YAG lasers.