New Technology at Milan Eye Center
By Cameron Johnson, MD

It is exciting to be able to share with you, our referring doctors, the some of the new technologies we have put in to place at Milan Eye Center in the last 6 months. We believe that by investing in new technologies such as these, we can continue to provide your patients with the latest, state of the art care.
Perhaps the most exciting new acquisition at Milan Eye Center is our new Ziemer Z8 LDV femtosecond laser system. This is the top of the line laser system manufactured by Ziemer. Compared to other femtosecond lasers, it has many advantages. One of these is the diversity of procedures that it can perform. It is the first Ziemer laser FDA approved for Femtosecond Laser Assisted Cataract Surgery. It is capable of performing a perfectly, centered, round capsulorhexis of the desired diameter every time. This is of much importance with regard to helping to center multifocal lenses. The exactly reproducible size and shape of the capsulorhexis also helps with consistency of effective lens position which may contribute to more consistent refractive outcomes. The Z8 also performs fragmentation of the lens to help reduce phaco energy needed, and clear corneal incisions that are reproducible for each procedure.
A great advance of the Z8 over its predecessor is the ability to use an OCT for guidance in the creation of Limbal Relaxing Incisions, so a uniform depth to a desired percentage of corneal thickness can be reproducibly achieved. This will enable LRIs to have a more predictable and precise effect.
The other procedures that can be performed with the Z8 include bladeless LASIK flap creation, laser assisted INTACS for keratoconus, laser assisted keratoplasty, and intrastromal pockets for corneal inlays.
It is important to note, that because the Ziemer laser aperture is placed much closer to the cornea during procedures, it is able to perform surgeries at a much lower energy than other femtosecond lasers. Due to its lower energy, small spot size, and high repetition rate there is less damage to surrounding tissue, resulting in less inflammation than lasers that require higher energy. Studies have found less of the profibrotic protein fibronectin expressed in the LASIK flap incision plane at 24 hours after flap creation with the Ziemer compared to a competing high energy device. Additional studies show less corneal cell death and a lower incidence of Diffuse Lamellar Keratitis.
The other new technology we are now offering that I would like to share with you is the iStent trabecular micro bypass shunt. This is a small drainage device that is inserted into the trabecular meshwork at the time of cataract surgery. It overcomes the juxtacanalicular resistance to drainage, and has been shown to lower intraocular pressure more than cataract surgery alone. A study showed that patients with iStent placement were twice as likely to be medication free at 12 months than patients with cataract surgery alone. iStent is currently FDA approved for the treatment of mild to moderate glaucoma.