Cataract

• Cannula for capsular polishing, Pat. Application 1989
  
  
  
  
• Ultrasonic polishing of the lens capsule, registration 1999
• Holding tweezers for ICL cartridges (Cartridge Holder, Katana, USA)
• Implantation spatula tweezers (Deutschmann, Zittau)
  
  
  
  
• Head positioning system for eye surgery, Pat. 1988
• Irrigation hook with iris retractor, "Irrigation hook" (Geuder, Heidelberg)
• Installation cannula for Vision Blue with Cat. mat. (Bausch& Lomb, Germany)
  
  
  
  
• TCI Topography Controlled Incision, 2002
• "TDI - a new concept in refractive cataract surgery", Array-roundtable, AMO, Kiel, 5.7.2003
• TDI - Topography double incision, Poster, Lecture
• WORCS (Wavefront Oriented Refractive Surgery), 2001, 2002
• "Managing Astigmatism in Cataract Surgery: MICS, TDI, toric IOL or LASICAT?", Afro-Asian Congress of Ophthalmology, Istanbul, 18.-22.6.2004

• Crushing of the eye lens by means of optical energy, "laser phaco", with a patent application 1985
• 2002 concept "Femtokatarakt", with a patent application 2003
• 2004 Presentation of the concept (LASICAT, Video ASCRS 2004 in San Diego) 
• "Limiting aspects in LASICAT", Poster WOC AbuDhabi 2012

The use of the femtosecond laser for cataract surgery, which we co-initiated in 2003/2004, is now used worldwide.

In addition to a total lack of iris aperture function, even minor defects can lead to imaging errors and glare. These include congenital colobomas or those resulting from accidents. For these indications, we worked with Mr. Morcher to design a whole series of rings with segmented apertures. These were then implanted for a wide variety of indications, and the results were presented in the USA at the ASCRS 1998.

For the congress video on implantation in albinism, we received both one of the coveted Oscars at the ASCRS film festival and the poster prize in recognition of the overall capsule tension ring concept.

▲ Dr. Rasch receives the Academy Award for Best Picture

The ASCRS video library recognized the concept as an important innovation and Dr. Rasch as the “innovator.” The capsule tension rings with iris and coloboma apertures are now manufactured by several companies and implanted worldwide. The Dutch company Ophtec produced colored versions in brown and green.

Capsule tension rings are additional implants for lens surgery. They are inserted into the capsular bag together with the artificial lenses in order to “tension” it. This can be useful for better centering of the IOL or in cases of loose fibers in the lens suspension.

Originally, capsular tension rings had small circular loops at both ends of the rings, which occasionally led to perforation of the capsular bag if it was very loose.

▲ Original capsule tension ring

The idea arose to give the leading end of the clamping rings a larger curve. This significantly reduced the risk of capsule bag perforation (publication DE 196 37 692 A1, 1996). Here, too, the first model was manufactured for us by Morcher (Type 2). We would like to take this opportunity to express our sincere thanks to Mr. Morcher's team in Stuttgart for their constructive cooperation over many years.

Numerous companies adopted this design. Today, it is the global standard.

▲ left: Fig. from disclosure document “The new guide end,” right: Modification with “sharp edge”

A completely different problem can arise when implanting toric IOLs (for more severe corneal curvature). In rare cases, the capsular bag is not round and the lens that has already been implanted may twist slightly out of the desired position. For such cases, we designed a capsule tension ring that prevents unwanted rotation of the IOL: the Type 50 B as a “rotation brake.”

▲ Capsule tension ring as a rotation brake, Fa Morcher, Typ 50B

The iris of the eye acts as a diaphragm with the pupil for sharper vision, similar to the “iris diaphragm” of classic cameras. If the iris is missing or has major defects (due to accident, illness, or congenital causes), there is no sharp image on the retina. Patients are usually severely dazzled, for example, in cases of albinism.

▲ Left: Iris defects, right: Plate aperture

The pupil-forming implants available on the market in the 1990s consisted mainly of black PMMA plates with a hole that filled the front of the eye. These relatively large implants often led to complications in the cornea and increased pressure. When a patient with such iris defects was scheduled for lens replacement surgery (cataract surgery), we came up with the idea of implanting an aperture at the same time as the artificial lens during the procedure: in the capsular bag.

The advantages of the new concept:

• smaller incision,
• smaller implant,
• relaxation of the lens capsule,
• no disadvantages for neighboring tissue, fewer complications.

Within a short period of time, the Morcher company in Stuttgart produced several models of capsule tension rings with ring-shaped aperture functions.

When the implants were ready, we lacked the first “suitable patient.” Then a request came in from New York: Dr. Ken Rosenthal had a difficult case for which he thought the aperture ring he had heard about would be suitable. So it came about that we performed the first operation with this novel implant there in the USA. He operated, Dr. Rasch was to assist him and tell him how to implant the capsular tension rings. After the successful operation, he asked with a smile: “It was your first case too?”

▲ Dr. Rosenthal at the American Congress of Eye Surgery and the Academy Awards ceremony

The following year, Dr. Rosenthal received a film Oscar from the ASCRS, the American Society of Cataract and Refractive Surgery. Further awards followed ...

In addition to TV reports accompanying patients, ARD also reported on our work in the Potsdam eye surgery center and on the “artificial iris” from Potsdam in its Tagesthemen news program.

LAL - Light Adjustable Lense

The LAL is an intraocular lens that can be modified in terms of its refractive power after implantation in the eye using special UV radiation. This makes it possible to achieve the goal of “vision without glasses” even more accurately. In 2008, the Potsdam Eye Clinic in the Graefe House was one of the first clinics in Europe to introduce this new technology. With the development of special additional implants (disclosure document DE 10 2010 017 240 A1), we contributed to improving the procedure and increasing safety for our patients.

We designed sector apertures for the capsular bag as radiation protection for “light adjustable lenses” and patients with albinism.

▲ Use of an aperture on the patient

The second generation of LAL is now set to open up new perspectives for cataract surgery.

In the 1970s and 1980s, diagnostic devices in ophthalmology consisted primarily of precision mechanical and optical components. In Western Europe, the first devices came onto the market in which computer-assisted measurement techniques played an increasingly important role.

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However, they all had one thing in common:

A separate device with a single function was developed for each measurement task.

This often meant that patients had to move from one examination chair to another. So-called examination units represented the first step forward. Here, the individual devices were swung in front of the patient one after the other.

At the end of the 1970s, Dr. Rasch had the good fortune—as was usually the case by chance—to meet one of the leading minds in the GDR in the field of optoelectronics, Prof. Jürgen Waldmann. Numerous ideas, concepts, and patent applications for a new type of eye diagnostics were developed jointly in the following years. Interestingly, they even developed ideas for novel solutions for optoelectronics together: one example is a novel chip, not yet realized at the time, that combines emitters and sensors, i.e., illumination and receivers, on a single chip. (Patent specification DD 233 463 A1, 1984) It was not until much later that this new generation of chips became a reality.

▲ Prof. Jürgen Waldmann

At some point, the idea arose of combining a range of very different eye examinations in a single device using specially designed arrangements of optics, optoelectronic (and other) sensors, and emitters (e.g., LEDs): “Multifunctional diagnostics for the eye.” (Patent specification DD 233 299 A1, 1984)

A direct coupling of illumination, diagnostics, and radiation therapy in a single element also dates from this period (PS DD 250 590 A1, 1985). Companies specifically approached in Germany rejected the idea with disbelief. Even the opportunity to demonstrate a simple prototype at various international trade fairs generated a lot of interest but no potential buyers.

Today, this “way of thinking” can be found in most ophthalmic diagnostic devices. It has also become common practice to think multifunctionally in other areas (see smartphones).

▲ Image 1: First model, 1988; Images 2-4: Projection of light points onto the cornea to determine the corneal topography (image taken with the first CCD matrix camera, made in the GDR) “Multifunctional camera” – first functional model in 1988, Image 5: Topography 30 years later: Cassini-2018 (from left to right)

Can visual acuity be improved “endlessly” with personalized LASIK?
With the development of diagnostic devices for measuring aberrations in the eye, refractive surgery has also created a way to surgically correct these aberrations and thus increase visual acuity. There have been euphoric reports in the media about the new surgical possibilities: 400% visual acuity?

Since this could not be the case and current visual acuity always depends on many factors, we examined over 2,000 eyes of young people in Potsdam to demonstrate the dependence of aberrations on a wide variety of influencing factors. The poster presented at the European Society of Cataract and Refractive Surgeons (ESCRS) Congress in 2001 became the first critical contribution to personalized laser surgery internationally and was honored with the (only) award at the congress at that time.

▲ Left: FOCUS magazine; right image: Poster award from the European Society of Cataract and Refractive Surgeons (ESCRS) (2001)

Can the axis of corneal curvature measured in a sitting position be safely transferred to patients who are treated in a lying position?

In the surgical correction of refractive errors, the correction of corneal curvature (astigmatism) is an essential part of the treatment. We wondered how the axis position changes from sitting during measurement to lying down during surgery. In a study conducted in 1999, we were able to show that an eye can rotate by 10 degrees or more when the body position changes. This can lead to significant deviations from the desired surgical result. Our resulting demand on the industry to develop a technical solution that would allow the axis position to be transferred and corrected from a sitting to a lying position using iris recognition was rejected or ignored at the time.

Today, all lasers for personalized treatments have such capabilities, both for laser correction of the cornea (LASIK) and for femtosecond laser-assisted cataract surgery (LASICAT). This demand of ours at the Potsdam Eye Clinic in the Graefe House has been implemented.

▲ Left: Aberrometry on iDesign with iris registration, right: Eye recognition on VISX

▲ Left: After measuring the eye with the Cassini Topographer: recognizing the iris structure on the LensAR; right: treatment planning on the LensAR

• "Do we need the CIA in Cataract Surgery? Endoscopic follow-up during cataract surgery: Initial admission January 13, 1999 Potsdam, published in Videocompetition of ASCRS Seattle 1999, Videocompetition of DOC Nuremberg 1999
• "Do we need the CIA in Cataract Surgery?", Videocompetition, XVlI.Congress ESCRS, Vienna 1999, 2nd prize, Art.Cat.
• "Interface cleaning by I/A-Tunnel-Technique – case report
• "Topographie oriented Double-Incision (TDI) – a new concept in refractive Cataract surgery", ESCRS Munich, 06.-10.09.2003
• "Topography-Oriented Double Incision – A new concept for Managment of Astigmatism in Refractive Cataract Surgery", ASCRS, San Diego, 01.-05.05.2004
• "Laser in Cataract Surgery – LASICAT", Afro-Asian Congress of Ophthalmology, Istanbul, 18.-22.06.2004
• "Topography oriented Double-Incision (TDI) – a new concept for management astigmatism in refractive Cataract surgery", Afro-Asian Congress of Ophthalmology, Istanbul, 18.-22.06.2004
• "Topographie oriented Double-Incision (TDI) – a new concept in refractive Cataract surgery", ESCRS Paris, 18.-22.09.2004
• "Laser in Cataract Surgery - LASICAT", ESCRS Paris, 18.-22.09.2004
• "Management and implantation of the Acriflex 62 Toric IOL", ASCRS, San Francisco, 17.-22.03.2006
• "Management and implantation of the ACRFLEX 62 VR TI—the first personalized and individually produced toric IOL. Initial results.", DOG, Nürnberg, 25.-28.05.2006
• "Management and Implantation of LU 804 VR-T (Toric Individual) the first individual produced toric IOL." XII. Oph. Balticum, Riga, 24.-26.08.2007
• Collaboration on basic research and development of wavefront-guided diagnostics and development of new surgical laser technologies Volker Rasch, Axel Weber
• "Reproducibility and Reliability of the Wavefront Analysis by Zywave Aberrometer - Influences of Zywave, by Patients and Examiners", Posterpräsentation, 5th ESCRS Winter Refractive Surgery Meeting, Cannes 2001, prize of congress