Dr. K. Alex Dastgheib is in private practice in Garden Grove and Newport Beach, California with over 20 years’ experience in cataract surgery. The Dastgheib Pioneer Award in Ocular Innovation, established in 2014, is given annually at Duke University for his pioneering work from 1992-1994 in establishing the presence of VEGF in neovascular AMD. Recipients of this award have made a major change in the practice of ophthalmology.
Dr. Dastgheib spoke with us about his experience in treating very hard, blinding cataracts.
Real-World Experience in Treating Blinding Cataracts
At the recent American Society of Cataract and Refractive Surgery (ASCRS) meeting in April of 2022, Dr. Dastgheib and his coauthors presented one of the largest consecutive case study ever of phacoemulsification in blinding cataracts.1 Dr. Dastgheib performed phaco surgery on 325 consecutive eyes with a best-corrected visual acuity of counting fingers or worse. “Every case was successful. A posterior chamber intraocular lens was placed in every eye. The average 6-week postop uncorrected or pinhole visual acuity was 20/30. So, these patients went from blindness to 20/30. I have been doing this for over 20 years and I know this is not common.”
While the 325 surgeries were done using a variety of phaco platforms, Dr. Dastgheib noted that “My favorite is the Bausch and Lomb platform which includes Stellaris Elite.”
“For me, one of the most important qualities of the Stellaris Elite vacuum-based system is that I don’t need to go fishing for pieces near the periphery. I can point the tip at the piece and the piece comes to me.”- Dr. K. Alex Dastgheib
Dr. Dastgheib’s Ideal Phaco Machine
Dr. Dastgheib described his ideal phaco machine as one “that’s an extension of my eyes and hands. One that instantaneously and seamlessly delivers the next surgical move.” He does not want a machine that requires him to adjust his movements in the eye. He wants the phaco machine to be an extension of him. The vacuum needed to move a piece of the cataract to the tip is intuitive. He doesn’t want to worry about getting too close to the capsule.
Dr. Dastgheib wants 3 things in a phaco machine:
- Cutting efficiency to help avoid excess energy in the eye
- Followability so he doesn’t need to fish for pieces
- Chamber stability to prevent post-occlusion surges and help ensure the capsule is protected
Cutting Efficiency is Optimized with Stellaris Elite
Attune Energy® is a key component of Stellaris Elite. Attune Energy optimizes energy delivery, thus minimizing the amount of energy used which minimizes the risk of postoperative corneal edema. With dense cataracts, a greater amount of energy can be utilized, if required, to help the phaco tip cut through the hard nucleus. With Stellaris Elite, the surgeon has the control to determine the amount of energy that is needed depending on the case.2
Stellaris Elite Provides Exceptional Followability
The followability with Stellaris Elite is excellent. This property allows pieces of broken nucleus to move towards the phaco tip. Thus, the surgeon does not need to fish for the pieces and risk rupturing the capsular bag. The exceptional followability with Stellaris Elite contributes to exceptional chamber stability.
Stellaris Elite has Adaptive Fluidics™ for Excellent Chamber Stability
The vacuum-based Stellaris Elite system has Adaptive Fluidics™ technology that proactively monitors and responds to commanded vacuum.3 With Stellaris Elite, the surgeon gets vacuum on demand; phaco tip occlusion is not required to initiate vacuum.3
Conversely, with a flow-based pump, adjustments are more complicated–maximum vacuum limit and flow rate must be independently identified and set up into the system– and each control impacts other parameters. Occlusion is required to generate vacuum with a flow-based system, so it can be difficult to achieve linear vacuum control during surgery.
Connect with a representative today if you would like to hear more about how to demo the system in your OR.
Dr. K. Alex Dastgheib completed his residency in ophthalmology at Duke University and four fellowships at the Wilmer Eye Institute, Johns Hopkins, the National Eye Institute, NIH, the Dubroff Eye Center, Maryland, and the John Moran Eye Center, University of Utah.
Financial disclosure: consultant to Bausch & Lomb