PASCAL
®
Synthesis TwinStar Ophthalmic Scanning Laser Systems
Page 81 of 142
88293-EN, Rev C
Endpoint Management with Landmark Patterns (optional)
Endpoint Management with Landmarks ON
Endpoint Management with Landmarks OFF
EpM
(
Endpoint Management):
Refers to a software feature that allows delivery of laser
energy which is a user-selected percentage of a laser dose pre-determined by titration.
This pre-determined titration dose is the “100%” level, corresponding to the energy
produced by the displayed “power” and “exposure” parameters on the Treatment Screen,
and is expected to be determined by ophthalmoscopically visible (sub-visable) test burns
delivered by the physician. With Endpoint Management enabled, the laser power and
exposure duration are reduced to deliver the user-selected percentage of the output
energy settings. For example, if the user titrates to a power/exposure duration setting that
delivers 4 mJ laser energy, an EpM setting of 75% would provide 3 mJ for each exposure.
Duty cycle within each laser pulse remains constant (100% duty cycle) with Endpoint
Management.
EpM percentage ranges from 10% to 95%.
To increase the dose above the 100% level, the user is expected to re-titrate laser power
with additional test burns. By providing fine control over delivered energy, EpM allows the
user to control the laser output to levels where ophthalmoscopically visible lesions are not
achieved, while referencing a dosage with a visible effect (the 100% dosage).
The EpM features are only enabled on retinal treatment patterns for use in retinal
photocoagulation. The use of EpM is otherwise restricted by the physician.
LM (Landmark):
Refers to a feature of the Endpoint Management software application
that allows delivery of two energy dose levels within a single pattern. When EpM is
enabled, the user can optionally enable Landmark patterns. With EpM enabled, the
outermost spots, the LM exposures, in the pattern are set to the 100% dosage (100%
nominal power and exposure duration displayed on the treatment screen), while the inner
spots are delivered at the current EpM % setting. With EpM enabled and Landmarks
disabled, the entire pattern is delivered at the current EpM % setting.
The purpose of LM patterns is twofold – to indicate the location of patterns delivered with
EpM, which may be less ophthalmoscopically visible than the 100% exposures, and to
provide visual feedback to the physician for dosimetry. In treatments without the use of
Endpoint Management, it is routine for physicians to use the visual appearance of lesions
to guide their adjustment of laser power in order to maintain a constant lesion grade.
Exposures with a low EpM % setting do not provide such guidance, but by delivering the
outermost spots (the Landmarks) in the pattern at the full 100% titration dose, this visual
cue is maintained. As the Landmark burns in the pattern vary in effect as the laser
