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Synthesis Ophthalmic Scanning Laser Systems Page 81 of 141
88292-EN, Rev D
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 application is
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