Why the RoboMarker® System?
The RoboMarker® System is a complete pre-operative solution to corneal marking for both visible spectrum and infrared applications. It is a pendular system, calibrated by gravity, that uses 2 pendular weights and 2 high precision ball bearings to achieve accuracy to to within 1° of where the user sets the axis dial. It has 2 components:
- Stainless steel handpiece with self-leveling astigmatic axis dial and patient fixation light (RoboMarker®)
- Disposable corneal marking tips (RoboTips™) which come pre-loaded with ink, are available in two varieties (RoboTips™ VS and RoboTips™ IR) to accommodate both visible spectrum and infrared applications.
Other handheld corneal markers:
- Require an autoclave to sterilize the corneal marker (so multiple costly markers are required)
- Either require a marking pen/ink pad to ink the marking fins or cauterization of the cornea
- Results in wet ink being applied to a wet cornea, most often leading to marks that smear and wear off in 10 – 15 minutes
- Often require at least a two-step process (such as marking the horizontal and then using a Mendez axis ring) to deliver accurate marks
The RoboMarker® System has features that can increase surgical accuracy, patient comfort and safety, surgeon efficiency, and surgery center profitability. It can be used for both visible spectrum (VS) and infrared (IR) marking applications.
- ACCURACY: Two high precision ball bearings coupled with 2 internal pendular weights ensure that the RoboMarker® System is accurate to within 1° of where the user sets the axis dial. Every RoboMarker® handle is laser tested for accuracy prior to leaving the factory. Unique indexed weight alignment engineering ensures that the RoboMarker® is calibrated by gravity and never needs further calibration unless damaged. (Please do not attempt to use the RoboMarker® System in gravity-free environments.)
- PATIENT COMFORT: Patients are accustomed to looking at a fixation light during preoperative testing. The RoboMarker® System’s internal fixation light not only helps ensure proper head positioning, but also allows your patients to be marked in the same manner they were measured (by focusing on a light), reducing a potential source of error since the patient’s eye is more likely to be in the same position it was in when their astigmatism was initially calculated.
- SAFETY: Because RoboTips™ are sterile and single use disposable, there is never a concern for biofilm cross contamination or issues associated with TASS (Toxic Anterior Segment Syndrome).
- EFFICIENCY: The RoboMarker® System saves an estimated 5 minutes per case. Since the marks last, multiple patients can be marked preoperatively, so there’s no more dashing back to pre-op between each case. No need to look for an ink pad or marking pen either; RoboTips™ are preloaded with our special dry formula to leave beautiful marks that last for 2 hours. The RoboMarker® System also eliminates secondary marking in the OR; simply dial in the desired axis when marking during pre-op.
- PROFITABILITY: Using the RoboMarker® System in pre-op eliminates the need for soaking, cleaning, sterilizing, inspecting, packaging, documenting, and restocking of instruments and as such saves the surgery center valuable technician time. Preoperative marking outside of the OR allows for faster OR turnover. The RoboMarker® System is so accurate and easy to use that technicians can be trained to mark patients, further reducing surgeon time-per-case. This allows more cases to be done in a single surgical day, leading to greater profitability for surgeons, ORs, and ASCs.
- MULTIPLE FUNCTIONALITIES: Whether the RoboMarker® is used with visible spectrum or infrared applications, there is a corresponding tip that will deliver consistent, clear, long-lasting marks.
Digital marking systems do offer a promising new registration means to identify axis alignment, but they also:
- Require an acquisition instrument that often means a new office equipment purchase
- Require extra technician time for data input
- Require a pairing procedure with the operating microscope
- Are not 100% accurate, especially when depending on the results of one topographic instrument that may not reflect the true corneal cylinder over a range of optical zones
- Cannot provide “on the fly” marking for a patient that is not entered into the system
The RoboMarker® System is accuracy that you can carry in your scrub pocket. The system is gravity-calibrated, has multiple applications, a much lower per-case cost, and does not require a suite of its own or have an associated annual maintenance fee.
- NO SUITE NECESSARY: Tight on space or the money needed to upfit a room for a digital system? The personal RoboMarker® is a small, highly accurate handpiece, and corresponding RoboTips™ can be carried comfortably in a surgeon’s or technician’s scrub pocket.
- GRAVITY CALIBRATED: The RoboMarker®’s accuracy is based on gravity, there is no need to rely on any digital or electric system for proper use.
- EFFICIENCY: With the RoboMarker® System, there is no need to worry about the transfer of data from one system to another, saving time. Surgeons have the freedom to use the average corneal astigmatism value over a range of acquisition instruments, a technique that has been shown to offer advantages over using a single instrument value.
- MULTIPLE FUNCTIONALITIES: The RoboMarker® System can be used anytime accurate alignment is required. It is useful for Toric IOL placement, LRIs, LASIK alignment, and with any femtosecond laser.
- LOW COST PER CASE: Most digital systems are quite expensive both to purchase and to maintain with the resulting cost per case generally falling in the $50- $100 range, depending on a surgeon’s case volume. The initial investment in the RoboMarker® handle is the equivalent cost of 1-2 upgraded procedures, and the return on investment is immediate, more efficiently enabling accurate outcomes with a cost per case of $11-$14.
Video Title: Digital Ocular Alignment Systems and RoboMarker
When to use the RoboMarker® System
The RoboMarker® System can be used in all situations where you used a corneal marker previously. It can be used with femtosecond Lasers, TORIC IOLs, cataract surgeries, and in combination with astigmatism correction surgeries.
RoboTips™ VS can be used with visible spectrum laser platforms such as LenSx and Victus.
RoboTips™ IR are designed for use with infrared spectrum platforms such as Catalys and LENSAR. Our infrared marking formula is also useful for corneal crosslinking and intraoperative aberrometry systems that use infrared cameras.
How the RoboMarker® System Works
The RoboMarker® works with gravity. It is a pendular system comprised of two brass weights suspended between two high-precision ball bearings. The product is laser-tested at two different points during the manufacturing process to ensure accuracy.
The RoboMarker® axis dial has 5° increments, and is validated to mark within 1° degree of where the user sets it.
RoboTips™ come with the dry marking formula pre-applied to the fins of the tips. When this dry formula contacts the wet cornea, the result is crisp, long-lasting marks. Our marking formulas avoid the nearly universal problem of ink smear common in manual marking systems by applying a dry marking formula to the wet cornea rather than a wet ink solution, which is quickly blinked away.
How to Operate the RoboMarker® System
Steps for using the RoboMarker® System in the pre-op setting:
- Make sure the patient’s eye is numbed.
- Double click the endpiece of the RoboMarker®. (Activate the fixation light on the stainless handpiece with a long second click.)
- Attach a sterile, disposable RoboTip™ (pre-loaded with the VS or IR marking formula, as appropriate for your application) to the stainless steel RoboMarker® handpiece.
- Dial in the desired marking axis by rotating the indicator arrow (found below each marking fin) with the appropriate degree on the axis ring. (This is not limited to 180°, the surgeon may choose ANY desired axis; axes are labeled in 5° increments.)
- Have the patient sit up straight so that their torso is oriented vertically. (Remind them of the position they were in for in office preoperative testing and ask them to mimic that position keeping both eyes open but cupping their hand over the non-operative eye.)
- Ask the patient to look at the fixation light while holding the RoboMarker® System about 18 inches from the eye and gently bring the RoboMarker® towards the eye to be marked.
- Touch RoboTip™ fins to the cornea for 1-4, ensuring that both marking fins land on the cornea simultaneously. More pigment will be deposited with a longer touch, so gauge contact time based on how long it will be before a given case.
- If using an infrared tip (RoboTips™ IR), gently retropulse the eye just before lifting the tip off the cornea to ensure proper ink deposition. (Our infrared formula sticks to the epithelium whereas our visible spectrum formula stains the epithelium directly.)
- Hold the eye open for 10 seconds to allow the marking pigment to set.
- Instruct the patient to keep both eyes closed until surgery, reminding them that this is important for the sake of keeping the information needed to treat their astigmatism intact. The need to keep both eyes closed is especially true for the infrared formula because it is applied onto the cornea so constant blinking after application can eventually blink it off. If you have a patient that is too curious to keep their eyes closed it is often helpful to lay them flat and put a gauze over their eye so they aren’t tempted to look around and blink their eyes.
General RoboMarker® System Use and Maintenance
RoboTips™ come with the dry marking formula pre-applied to the tip fins, giving them a metallic appearance. When this dry formula contacts the wet cornea, the result is crisp, long-lasting marks.
The marking formula is already dry on the RoboTip™. This yields longer lasting marks (marks last up to 2 hours) specifically because it is dry.
Our RoboTips™ have an expiration date that is displayed on the back of the individual tip package as well as on the side of the box. Surgilūm’s single use products have 2 year shelf life validation.
Single use RoboTips™ should be stored in a dry area within their original individual packaging. Use immediately once opened.
RoboTips™ are a single use disposable item. In order to avoid any cross-contamination, you should use a new sterile RoboTip™ for each new patient. If one fin swivels accidentally (due to non-simultaneous touch down of the two fins on the cornea), there is enough marking formula on the tip to remark the same patient.
The tip is sterile and designed for single use, but there is enough ink for two marks. However, using one tip for more than one patient may cause cross-contamination.
RoboMarker® System marks last up to 2 hours. (Although we have seen them last even longer!) Make sure you hold the eye open for 10 seconds after it has been marked to allow the marks to set, and then have the patient keep his or her eyes closed until the time of surgery.
We included a fixation light in the RoboMarker® handpiece to reduce a potential source of error in the marking process. Since patients are initially measured with a fixation light in the lane, it makes sense that they would be marked using the same technique with which they were measured.
The RoboMarker® handpiece contains an integrated fixation light, which mimics the fixation light of preoperative testing equipment. The fixation light has 3 different settings: White, Flashing Red, and Color Change.
- To turn on, push the activation button at the end of the handpiece twice, holding for two seconds on the second click, initiating the White light setting.
- Push the activation button again (3rd time) to reach the Flashing Red setting.
- Push the activation button again (4th time) to reach the Color Change setting.
- The fixation light will automatically shut off after three (3) minutes of inactivity or on the fifth (5th) click of the activation button.
The RoboMarker® handpiece circuit was designed with a 2-click turn on process to ensure that it won’t turn on accidentally in your scrub pocket and burn battery life unintentionally. The good news is even if you forget to turn it off after using it, it will shut off automatically after 3 minutes of inactivity to protect your battery life.
The lighting is simply surgeon preference. Some doctors use the blinking red as a timing mechanism; if it will be awhile before you get to a given patient’s surgery, you may want to hold the tips on the cornea a bit longer (4-5 seconds), depositing more marking formula.
If you are having any issues with your fixation light, please first replace your battery using the protocol below in “How do I change the battery?” If you still have trouble after this step, please contact us at firstname.lastname@example.org. Remember your RoboMarker® will still work beautifully without the fixation light, but you will have to revert to asking your patient to use a distant object for fixation.
Your RoboMarker® handpiece has a very fine line at the midpoint of the handpiece body; this is where the two halves unscrew to give you access to the battery compartment. The upper housing is the piece that includes the axis dial and fixation light. The lower housing has the on-off button.
To remove and replace the battery:
- Ensure the fixation light is in the OFF position and a single use RoboTip™ is NOT inserted into the dial.
- While holding the upper housing, gently twist the lower housing (part of the handpiece in a counterclockwise direction.
- Once the two portions are completely separated, remove the battery from the lower portion.
- Replace battery with a new ½ AA 3.6 volt battery.
- Insert the replacement battery with the POSITIVE (+) terminal facing the rotary axis dial and fixation light end of the handpiece.
- Align the upper and lower housings and screw together until tight; when appropriately tightened, the junction between the upper and lower housing should be barely visible.
- Test the RoboMarker® by cycling through the fixation light options to ensure the battery is installed correctly.
- Please dispose of used batteries appropriately as designated by your local waste management regulations.
The RoboMarker® handpiece takes a ½ AA 3.6V battery which activates the integrated fixation light only. Please call Surgilūm at 910.202.2202 to order a new battery at $10 ea.
Please know that your RoboMarker® still works properly, even while waiting for the new battery. The battery solely operates the integrated fixation light, which is an added benefit for patient comfort.
Clean the RoboMarker® handpiece with either an alcohol wipe or a soft cloth such as those used for eyewear lenses or electronic screens.
The RoboMarker® handpiece and the single use RoboTips™ are warranted to be free of defect in materials and workmanship. If any defects are discovered, please contact us at 910-202-2202 or at email@example.com.
- Surgilūm is pleased to maintain the RoboMarker® handpiece under a limited 1-year repair/refurbish warranty.
- RoboTips™ have limited shelf life, which is labeled on package.
Surgilūm’s warranty is conditioned upon proper storage, use, and maintenance in accordance with applicable written recommendations. Surgilūm’s warranty shall not apply if: (i) A product is not used in accordance with its instructions or if it is used for a purpose not indicated on the labeling; (ii) Any repairs, alterations, or other work has been performed by buyer or other on such item, other than work performed at Surgilūm’s authorization; or (iii) The alleged defect is a result of abuse, misuse, improper maintenance, accident, or the negligence of any party other than Surgilūm.
RoboMarker® System Technique Video Tutorials
Video Title: RoboMarker Patient Approach
Video Title: RoboMarker Technique Video
Video Title: Do I need a speculum to use the RoboMarker?
Video Title: Eye drift while using the RoboMarker
Video Title: Finger break technique using the RoboMarker
Answers to additional questions about the RoboMarker® System
Lidocaine jelly is thick, so we recommend using a couple drops of proparacaine (the thinner numbing drops) to thin it out before marking. You can still get a good mark without doing that, but you might get some ink runoff.
Video Title: Using the RoboMarker in LASIK Procedures
Video Title: Slit Lamp vs. RoboMarker
Video Title: Ora vs. RoboMarker
Video Title: RoboMarker Ink and Infrared Camera Platforms