Since Bausch + Lomb (B+L) announced FDA approval of its TENEO Excimer Laser Platform for LASIK surgery in January 2024, anticipation of how this laser can improve the efficiency, accuracy, and comfort of LASIK for patients with myopia and myopic astigmatism has been growing. TENEO is the first excimer platform to be approved in the US in nearly 2 decades. According to B+L, it is also the smallest and the fastest.

Efficiency and Speed

Operating at 1,740Hz, “TENEO’s advanced eye-tracker is the fastest on the market for an excimer laser,” claims Anthony Wallace, vice president and general manager of B+L US Surgical. “It is 3 times the speed of the laser’s ablation, ensuring precision regardless of eye movement.”

Mr. Wallace adds that TENEO corrects at 1.2 seconds per diopter, which again is faster than its competitors. “The fastest laser plus the fastest tracker is a winning combination,” he says.

Users say this also contributes to better outcomes. “We believe the high-speed repetition rate can lead to…quicker recovery and potentially more accurate treatments with less time for stromal bed dehydration,” says George Waring IV, MD, a cornea, cataract, and lens implant surgeon and founder of Waring Vision Institute in Mount Pleasant, South Carolina. Dr. Waring was the first surgeon to use the FDA-approved laser in the United States and was also involved in the research, development, and FDA trials for the laser.

Y. Ralph Chu, MD, founder and medical director of Chu Vision Institute in Bloomington, Minnesota, agrees that having the fastest laser available is highly beneficial when it comes to patient outcomes. Dr. Chu was also involved in the FDA trials for this laser.

“It’s not just about doing the surgery fast, it’s about patient management,” he explains. “We know that the less time the flap is exposed, the less evaporation will occur, which contributes to better results.”

No Nomogram Required

A key difference between TENEO and other excimer lasers is that no nomogram is required, which saves time in surgical planning for both the surgeon and the staff, explains Dr. Waring. There are also safety implications to this, he continues, as it reduces the risk of transcription errors.

“Any time there are additional data points or inputs that need to be entered, opportunities exist for the wrong input to lead to data error,” he says. “Any time that you can reduce the potential for human error, it’s a significant benefit to consider.”

Dr. Waring says the intuitive nature of this technology minimizes the learning curve, as well.
“Since the platform does not require a nomogram or physician adjustments, it’s ‘plug and play,’” he says. “It is intuitive and streamlined, not just for the surgeon, but also just as much for patients and their level of comfort during the procedure. Like using any other intuitive piece of digital technology, most surgeons will adjust to it quickly.”

Most importantly, all these factors have also led to better outcomes, continues Dr. Waring, who led a multicenter study published in the Journal of Refractive Surgery. The study showed that at 9 months, 97.8 percent of eyes studied achieved uncorrected distance visual acuity of 20/25 or better, and all eyes achieved corrected distance visual acuity of 20/25 or better. Mean manifest refraction spherical equivalent improved from –5.67 ± 2.52 D before surgery to –0.04 ± 0.32 D after surgery.

“These are some of the best results that we have seen to date,” Dr. Waring says. “We also saw improved contrast sensitivity relative to contact lenses, and improved night-driving symptoms like glares and halos after LASIK and relative to wearing contact lenses. This can improve quality of life for patients.”

Ergonomics and Footprint

According to B+L, ergonomics and aesthetics were also considered in TENEO’s design. The treatment bed swings out for easier access and can be customized for optimal head positioning, enhancing patient comfort. TENEO also features a 360-degree swiveling microscope to adjust to the surgeon’s height and posture.

“The comfort of both the surgeon and the patient is important,” says Mr. Wallace. “Surgeons perform procedures all day and need to be comfortable. Comfort can also be a significant factor in how the patient perceives the overall experience of the procedure.”

The appearance and size of the laser are also notable. According to Mr. Wallace, the entire laser, including its bed, is less than 30 square feet, making it the most compact laser on the market.

“This is an attractive, sleek, and modern-looking laser that has a small footprint, allowing it to fit more easily into our office than older, bulkier lasers,” says Dr. Chu. “Whether they say it or not, we know that patients like to see modern technology on display.”

There is “square footage efficiency” in using a compact laser, adds Dr. Waring.

“Space is money—and you’re saving money by using less of it,” he says. “A smaller footprint also means you can add additional equipment in the lane or in the laser room, which you might not have been able to previously accommodate. And it optimizes flow. A seamless flow for patients moving in and out of the space is something that does matter.”

Patient Selection

TENEO is currently approved for treating myopia and myopic astigmatism. Dr. Chu says it helps that doctors do not have to “overthink” who makes a good candidate for a procedure with this laser, as the current FDA guidelines spell it out.

“If the patient is a good candidate for a LASIK procedure and they are in the range for the FDA approval, they’re a great candidate for TENEO,” he says.

But Dr. Chu adds that surgeons should expect those approvals to evolve.

“Approval is already in the works for a full range of corrections, and these are coming down the pipeline in the not-too-distant future,” he says. “This means many more will be able to benefit from this laser down the road.” OM

Reference

1. Waring GO, Stonecipher K, Lobanoff M, et al. Safety and Effectiveness of Laser in Situ Keratomileusis Using the Teneo 317 Model 2 for Correcting Myopia and Myopic Astigmatism: Results of the U.S. FDA Clinical Trial. Journal of Refractive Surgery. 2024;40(8):e544-e553. doi: 10.3928/1081597X-20240611-03