Dr. Reena A. Garg is an ophthalmologist at Visionary Eye Doctors in Maryland and specializes in the medical, laser, and surgical treatment of glaucoma and cataracts.

Dr. Garg learned phacoemulsification (phaco) using dual-linear control during her training but has since used other platforms during her career. She has mastered phacoemulsification on both major platforms and describes the adjustments she needed to make to successfully operate without independent control of vacuum and phaco.

Real-world Experience With Dual-Linear Control

For surgeons new to dual-linear control, when starting out with Stellaris Elite, Dr. Garg recommends using a safe and familiar technique to gain fluency with the dual-linear foot pedal. The most important thing is to change their mindset about what a machine can do. With the Stellaris Elite, the surgeon is not limited to using a small amount of vacuum before engaging phaco, since they are controlling each parameter independently. Dr. Garg suggests using vacuum alone while keeping the phaco tip in the anterior chamber since, with the venturi pump, the surgeon does not need occlusion to build vacuum. This will allow the nuclear piece to move towards the phaco tip because of enhanced followability. The surgeon does not need to move the tip to the periphery of the capsular bag, and no phaco power is needed to hold the piece on the tip. This exceptional followability with Stellaris Elite contributes to excellent chamber stability. After just a few cases, the surgeon will be comfortable using Stellaris Elite.

Stellaris Elite Has Adaptive Fluidics™ for Excellent Chamber Stability

The Adaptive Fluidics of the Stellaris Elite venturi machine proactively monitors and compensates for fluid flow into the eye, allowing the focus to be on the surgery and not the system.1 With Stellaris Elite, vacuum increases when the surgeon requires it through the use of the dual-linear foot pedal.1 These unique parameters allow for exceptional chamber stability through the continuous tracking of vacuum flow rate and automatic adjustment of infusion pressure.1

“The most important thing that cataract surgeons care about is less energy in the eye. With the dual-linear foot pedal, I can use less energy. Thus, the corneas are clear, and patients are so happy on post-op day 1 because they are seeing well right away. I think those aspects are invaluable for cataract surgery.”

- Dr. Reena Garg

Dual-Linear Foot Pedal Controls Vacuum and Phaco

The dual-linear foot pedal gives the surgeon full control of both vacuum and phaco. When the using dual-linear foot pedal, coupled with the venturi system in Stellaris Elite, there is independent control of flow and vacuum. For example, the surgeon can build vacuum using the foot pedal, without engaging phaco, to get purchase on a piece of the lens. Dr. Garg describes this feature as “really unique. I think most surgeons who haven’t tried dual-linear control are very surprised to find the control they get with Stellaris Elite’s dual-linear foot pedal.” Conversely, with a flow pump, adjustments are more complicated because there are 2 controls—maximum vacuum limit and flow rate—and each control impacts other parameters.

With the dual-linear foot pedal, the surgeon can yaw to increase or decrease vacuum when it is needed. To add phaco, the surgeon controls the pitch, or lateral movement, of the foot pedal. Integrated movements simultaneously control irrigation, ultrasound, and aspiration. This helps prevent unnecessary phaco energy from being used in the eye. Conversely, yaw can also be used to add phaco while pitch can be used to increase or decrease vacuum.

Stellaris Elite dual-linear foot pedal

For surgeons who have not experienced the dual-linear foot pedal, observing the unique foot motion and understanding what “yaw” means are important. Dr. Garg has had other surgeons watch her foot during cataract surgery to gain perspective on using the dual-linear foot pedal.

There are other advantages to dual-linear control: the settings don’t need to be customized prior to surgery and if settings must be adjusted, a surgical assistant doesn’t need to be involved. The foot pedal allows the surgeon to customize vacuum and phaco based on what is happening in the eye during the procedure. This is in stark contrast to other platforms where the surgeon has to have several settings for dense nuclei. The surgeon is forced to choose the appropriate setting prior to starting surgery, and then if they need to adjust, the burden falls on the assistant to make that change.

Using dual-linear “is really nice as a surgeon because you can customize each and every surgery. You are reacting to what the lens is doing in the eye. It is not a one size fits all approach,” according to Dr. Garg.

With flow-based peristaltic systems, vacuum and phaco are linked and cannot be independently controlled. Thus, the surgeon has only indirect control of vacuum by manipulating the flow rate.

“I think the best feature of the Stellaris Elite is the dual-linear control. As a surgeon, you have full control of every parameter in the eye when you are operating using the dual-linear foot pedal.”

- Dr. Reena Garg