…it first of all would not be called ”phako machine“ or ”vitrectomy machine“ since it would handle both with equal perfection, just as a good vitreoretinal surgeon does both with equal skill.

At this meeting we can discuss at length which is the best machine. Unfortunately none of the machines available to us is really perfect. Therefore, in this presentation I would like to list and explain those features that a machine must offer to be considered really good in my eyes.

  1. Flow control
    is an absolute must. This must be precise and extremely responsive to movements of the foot pedal, a goal that is easily achieved with todays electronics technology and the availability of amazingly precise and fast stepping motors. More than a decade ago I upgraded from venturi to flow control and these days I see no situation in the posterior segment where venturi is of any advantage whatsoever. Using flow control you do not need expensive cutters capable of lightning speed cut rates – a huge savings in complexity. Even in the anterior segment I see no reason why a flow control pump cannot be designed and programmed to be as responsive as todays venturi pumps. So for the sake of reduced complexity, cost and space requirements I would forgo a venturi system altogether.
  2. Simplicity

    The current trend to ever more complex machines adds cost and countless sources of potential technical failures (resulting in more cost). You do not need a space shuttle to do your shopping at the supermarket. I am known to be a technology freak, but in this case simpler is better (K.I.S.S.). Just one example: chips embedded in peripherals (cutters, light pipes etc.) add complexity and are only designed to ensure that the sales of consumables keep flowing. There is no benefit to hospitals, doctors or patients. This and many other features on modern machines are superfluous.
  3. Reduce Waste

    On the one hand we are supposed to recycle even the wrapper of a lollipop but in medicine we indulge in an obscene orgy of destruction of perfectly usable extremely expensive instrumentation. To use the lingo of the day: that is not sustainable!
In our institution we use cutters that quite legally can be cleaned and re-sterilized many times over. This saves tons of waste and enormous amounts of money and we have not had an endophthalmitis in 20 years!  It can be done. Any company developing a system where the ”consumables“  are turned into ”reusables“ will have major ethical and economic arguments in its favor.
  4. Robustness and Easy Diagnostics and Repairs

    One major reason for the fact that most of the developing world has virtually no vitreoretinal services, is the susceptibility of the machines to breakdowns and lack of availability of repair services. Better than fixing a machine is having one that does not break down in the first place, thus keep it simple. If consumer cameras these days can work in the desert, the jungle and the antarctic without breaking down, it must be possible to develop a surgical machine that can withstand high temperatures, humidity and dust. If it should break down in spite of all this, diagnostics must be possible long distance via the internet and major sensitive components must be modular and easily exchangeable without a company technician on site.
  5. Cost

    Simplicity, reduced waste and robustness already translate into massive cost savings. That way those areas of the world where 2/3 of the population lives and only 1% of vitreoretinal services are offered, could gradually move into the 21st century. This would mean a huge new market for the manufacturers and a major advance for health services in those countries. In the end even the rich hospitals in the developed countries would figure out that it is cheaper to move the machine with the 47 printed circuit boards into a cubbyhole as a backup and use the machine I envisage instead.

Financial disclosure: the author owns a patent related to ophthalmosurgical machinery

Contact Details:

Email: k.lucke@retina.to

Klaus Lucke