Norlase is turning over a new leaf with its compact photocoagulator

Emerging Danish ophthalmic lasers company Norlase has developed a compact photocoagulator that's a tenth the size of competing systems. Voice control and its ability to slot on to an existing slit lamp are among other features that led to A/Prof GEORGE KONG being one of the first to install the system in Australia.

Associate Professor George Kong's private clinic, Mt Waverley Eye Surgeons in suburban Melbourne, was established five years ago, and geared towards his subspecialities in glaucoma and complex cataract. But the clinic also cares for a high number of retinal disease patients, many whom require laser treatment.

As one of the only Victorian ophthalmologists with a diode laser in his rooms, Kong had access to a highly effective therapy for his glaucoma patients delivering a wavelength of 810nm. While the laser could also be applied to retinal conditions such as retinal tears and holes, the system could be less efficient and comfortable in those cases. It is also less efficient in performing laser suture lysis for trabeculectomy procedures.

A green photocoagulator system was required, so he canvassed the market and sought the services of OptiMed Australia. The local ophthalmic equipment distributor had recently signed an agreement with emerging Danish ophthalmic device manufacturer Norlase to import its laser systems into Australia. It recommended Kong trial Norlase's LEAF Green Laser System.

It wasn't long before the manufacturer's compact green photocoagulator was installed in his rooms.

"Several features attracted me to the Norlase LEAF, including its compact size (10 times smaller than existing systems). It also mounts directly to my pre-existing slit lamp and the alignment is very easy to adjust. For a small clinic, space is always at a premium, so it's important to have equipment that doesn't occupy too much room," he says.

"The other thing that interests me is the option of performing subthreshold laser treatment, which I think will be increasingly used in the future in retinal conditions. Although this isn't being adopted widely yet, having that option means I will be futureproofing my practice to potentially reduce some of the frequency of intravitreal injections for some macular conditions."

For Kong, who became a RANZCO Fellow in 2016, it's been interesting to see a newcomer like Norlase enter the ophthalmic lasers market.

While a new player, the company has originated from years of laser experience from within a prolific global laser manufacturer. The firm describes itself as a developer of next-generation laser solutions for retina and glaucoma that also work to improve practice efficiency, patient care, and convenience for ophthalmologists worldwide.

Mr Oliver Hvidt is a co-founder of Norlase, which started as a university research project, alongside high-tech entrepreneur Mr Peter Skovgaard who has a PhD in high-power semiconductor lasers and more than 20 years of experience in bringing photonics technology from research to market.

LEAF is one of three products developed by Norlase, which also produces ECHO, described as the world's first ultra-portable pattern scanning laser, and LION, the first fully integrated, battery-powered laser indirect ophthalmoscope (LIO) and green laser.

According to OptiMed, the LEAF laser system is the size of a tablet or iPad, making it one of the most compact and versatile treatment additions to ophthalmic practices. Its sleek, smart design is said to be 10 times smaller than existing systems. It also features a built-in laser source which means there is no external fibre, eliminating one of the most common and costly service repair issues of laser photocoagulators.

Its size also means the system is portable so practitioners can easily share among multiple practices. Although Kong doesn't expect to transport the system between his Mt Waverley and Box Hill clinics – the latter which is primarily focused on cataract – he says it's nice to have this functionality for the future.

What he has been particularly impressed by, however, is Norlase's use of industry-first speech recognition that allows for convenient control of laser parameters.

"It means I can control the machine to change the treatment power or treatment intervals while I’m doing the procedure, without having to stop and manually change those settings," he explains.

"Treatment power is something that needs to be adjusted frequently in some cases, depending on the retinal reaction and also whether the patient has any discomfort. It can be awkward having to stop and change the power on the dial and then reapply the laser lens, but it's much easier now with voice control – it's a very useful function."

Fitting LEAF into the clinical workflow

Since acquiring LEAF, Kong mainly used the system for laser retinopexy treatment of retinal tears, and holes. For his medical retinal colleague, Dr Rathika Kandasamy, who works in the practice, it also allows her to perform procedures like panretinal photocoagulation for proliferative diabetic eye disease.

Being able to provide an optimal laser therapy for retinal patients at Mt Waverley Eye Surgeons was important for Kong and Kandasamy.

The LEAF system promises to be a game-changer for more routine retinal procedures in the clinic, but, as outlined earlier, Kong is also excited about its capability to perform subthreshold laser procedures. This approach encompasses all types of laser treatment that show no visible signs or colour change of damage – as intended in retinal laser procedures – but still has a therapeutic effect through lower power.

"I’m quite excited about this treatment option. There are a few published papers on the treatment of central serous chorioretinopathy (CSC) with subthreshold laser," he says.

"Increasingly, retinal subspecialties are looking at the use of this technology for these conditions and I think this is an ideal way to prepare my practice for the future, particularly with CSC patients. It is important to provide an effective treatment for macular conditions while keeping the risk of the procedure to a minimum."

Compelling technology at a compelling price

While the Norlase LEAF system is designed to allow ophthalmologists to treat more patients while maximising practice space and providing greater quality of care and safety, another interesting aspect is its price point.

The company is selling the system at what it describes as a "compelling" rate, making it easier for clinics to expand into laser treatments.

"That's another reason I ultimately went with this system – it comes at a reasonable price point as far as retinal lasers are concerned," Kong says.

"A lot of clinics find it difficult to justify investing in a retinal laser because retinal conditions require laser less frequently than something like a YAG system (for capsulotomies). So having a good price point will likely allow me to get a get a return on investment earlier."

Overall, Kong says it has been interesting to watch Norlase emerge as a new player with differentiated technology in the ophthalmic market. It's a development that can only help improve the clinical performance of eye specialists and patient outcomes.

"Overall, I’ve been very happy with the LEAF system. It's easy to use, the design is slick and compact, and the device controls using an intuitive touchscreen tablet have been straight-forward," he says.

"Having voice control and speech recognition, as I say, it is quite a neat feature, and of course there is the foot pedal to control the actual treatment. All in all, it's a great user experience, and the laser is very easy to control."