Purpose:
The Navilas® laser, (OD-OS, GmbH; Teltow, Germany) is a novel new technology which combines laser photocoagulation with imaging function including fluorescein angiographic images which can be digitally annotated during review. Navigated laser photocoagulation involves creation of a treatment plan by drawing proposed laser spots on a fluorescein angiogram. This treatment plan is then projected and aligned in real time to the live fundus view where laser is applied to the predetermined locations by the treating physician. This study was undertaken to determine the time necessary for planning and treatment while performing navigated laser photocoagulation treatments for macular disease utilizing the Navilas device.
Methods:
Screen recordings were taken from routine treatments made during sessions at multiple institutions. All treatments were performed strictly for clinical purposes without preconceived knowledge of a study involving timing. The screen recordings were then retrospectively analyzed for type of treatment, number of laser shots fired, the duration of treatment plan creation (measured from the time the fluorescein angiogram review began and the planning image was selected to time of marking the last planned treatment spot) and total time of laser application. Only uninterrupted macular treatments were included in the statistical analysis.
Results:
A total of 93 evaluation and treatment sessions were included from 3 sites. No complications were encountered during treatments and all laser applications were safely applied to predicted areas. An average of 125 spots were applied to each eye. The median total time (planning phase plus treatment time) was 7 min 47 sec (+/-3Min 32sec). The median time for evaluating the fluorescein angiogram and creation of the planning image was 2 min 35 sec (+/- 1 min 29 sec). The median amount of treatment time per laser application was 3.34 +/-3.42 seconds or 0.30 laser shots per second. Treatments combining grid laser with direct targeting of microaneurysms (focal) were faster than either grid or focal treatments alone.
Conclusions:
Navilas is a novel, new device which provides a time efficient platform for evaluating fluorescein angiographic images and performing macular laser photocoagulation.