Taking Big Leap Forward: The First Six Months with a New Digital Duet

November 1, 2021
Thomas Castillo, DO

The decision to purchase the new Digital Duet SLT-YAG system was an easy one. Our practice got our last SLT-YAG laser from Lumenis back in 2003, and it was an excellent instrument that proved very reliable—in 18 years, we only had one service call for a chin rest. When we decided we wanted a new laser, we went straight to Lumenis. Our rep, who had stayed in touch about other Lumenis technologies, told us they were about to release the first digital SLT-YAG laser, which also featured a built-in camera. Lumenis launched the Digital Duet a week later, and we ordered it right away. Now that we’ve been using the Digital Duet for six months, here’s what stands out.

Thomas Castillo, DO

Clarity – Since getting the Digital Duet, I’ve done about 60 cases—primarily YAG laser capsulotomy, iridotomy and SLT. The Digital Duet has exceptionally crisp slit lamp optics. I can see the angle, trabecular meshwork and scleral spur very clearly, and it stays in focus, so I don’t have to continuously adjust. Treating the trabecular meshwork is much easier and more efficient. An SLT procedure is only as good as the view of the angle, for which we rely not only on the excellent optics of the Digital Duet but also on using a good gonio laser lens. The Hwang-Latina 5 Bar SLT Gonio Laser lens (Ocular Instruments) included in the Digital Duet purchase is a great lens.

Reimbursable imaging – As a bonus, the Digital Duet has created an additional revenue stream for our practice. With the digital camera, we capture external photography of pathology, a billable service. We not only capture images that we used to take with a regular camera, such as eyelid pathologies, but we also get images of corneal pathology using the slit lamp, with the same clear, detailed view we get during SLT. There’s no adaptor or additional expense like most slit lamp cameras—it’s built into the Digital Duet. To date, I’ve done about 30 photos or videos of ocular pathologies for documentation or for follow up: corneal changes from amiodarone, pterygia, band keratopathy, entropion, ectropion, iris heterochromia and corneal lacerations, to name a few.

Documentation – The device also automatically records everything I do, including the laser power I select and the number of shots I take, removing a lot of documentation work and saving valuable time and costs. And digital imaging and video capabilities also allow us to document pathologies as well as angle imagery and treatment outcomes. Digital Duet, We print images for our records as well as to share them with referring doctors. If we begin using electronic medical records, Digital Duet data and images will be saved to the system and be shared with referring doctors electronically.

Patient and staff education – The images and video are great for educating patients as well as staff. We show patients their pathology, such as an image of the open angle, as well as their treatment, such as video of an SLT procedure. The images and video make education very clear, and patients like it, so it helps us build our relationships and establish the trust we need to move forward with treatment decisions and ensure compliance. Staff better understand pathologies and treatments, which enriches their conversations with patients.

A Sound Investment

To me, the Digital Duet’s key advantage is the quality of the instrument. We’re getting robust clinical results and excellent imaging, and we expect the device to last for years, just as our old Lumenis SLT-YAG laser did. With its predicted longevity, as well as the increased procedure efficiency and the new revenue stream from imaging, we expect a good return on our investment. And we got the Digital Duet at the perfect time, when SLT volume is on the rise because it is now an accepted first-line therapy.1 I think the Digital Duet will allow us to do a better job with our laser than ever before, and the efficiency now allows me to schedule more patients in my normal clinic hours.

1 Gazzard G, Konstantakopoulou E, Garway-Heath D, et. al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393 (10180):1505-1516.

Risk and warnings: Digital Duet/Trio are intended for use by trained physicians. For all indications, use is contraindicated when media opacities interfere with clear visualization. Selective laser Trabeculoplasty is contraindicated for eyes with neovascular or angle-closure glaucoma; risks include iritis and transient IOP rise. Posterior Capsulotomy is contraindicated for eyes with extensive corneal dystrophy and chronically elevated IOP; risks include IOP rise, rupture of the hyaloid face, retinal damage, and uveitis. Iridotomy is contraindicated for eyes without pupillary block; risks include transient elevation of IOP, hyphemia, and damage to the lens/retina/choroid. Inadvertent photocoagulation with Smart532, especially close to the fovea or the optic nerve head, can cause permanent visual loss. Major retinal vessels should be avoided. For a complete list of contraindications and risks, refer to the operator manuals.

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