Purchasing a stand-alone laser system or a laser system with a slit lamp adaptable delivery system is a choice that is specific to your practice. Having worked with both types, it really comes down to cost, space and office workflow in determining what will work best for you.
Slit lamp adaptable delivery system
In my current practice, space is constrained, so the slit lamp adapter (SLA) is an excellent choice for us. We use the IQ 532 laser system and SLA (Iridex) with our slit lamp and switch to Goldmann applanation, slit lamp laser or laser indirect ophthalmoscope (LIO) as needed. The slit lamp can be used as a diagnostic lamp while the adapter is still installed and connected to the laser console. Also, the IQ 532 has two delivery device ports, so if an LIO is used, the adapter can remain installed on the lamp and connected to the IQ 532. This works quite well in the standard-sized exam room because the adaptor requires little space. In my office, we simply hang the adapter next to the slit lamps so it’s easy for our techs to access.
Another benefit to a slit lamp adapter (over a stand-alone) is that the laser console is portable and can be moved between treatment rooms, offices and into the OR. One consideration to keep in mind with the smaller, adaptable unit is the potential of damaging the fiber optic cable that delivers the laser energy. Breakage can occur while placing and removing the slit lamp adapter repeatedly.
Additionally, achieving a smooth workflow will take some planning. You’ll want to work out a system to make sure you return to the patient quickly after the slit lamp adapter is set up and treat your patient so you don’t cause a backlog by having a patient occupying one of the exam rooms. It is crucial to make sure your staff is well trained and comfortable with manipulation of the laser and directing office flow.
Stand - alone
In larger practices with adequate room and staffing, the stand-alone laser is a good option. The Navilas 577s (OD-OS) and Pascal Synthesis (Topcon) are popular options offering microsecond technology. The footprint of these units is larger and optimally requires a dedicated treatment room. However, if you have staff to manage the patient and prep them for treatment, you can create great flow. This allows you to step in the stand-alone treatment room, perform the laser and then move on to the next patient in your exam lanes without pausing for machine adaptations.
With the stand-alone setup, there are no parts to switch out and, therefore, less risk of breakage from handling. The stand-alone offers ease and convenience but can be more expensive and requires a large space commitment compared with the smaller, adaptable laser units.
All said, choosing between a larger stand-alone and a smaller adaptable laser is a relatively easy choice boiling down to simple logistics: space, staff and cost.
Disclosure: Luo reports he is a consultant for AbbVie, Alimera, Allergan, Genentech, Iridex and Lumenis and receives research grands from Allergan and Lumenis.