Two Specialties, One System:
How UNITY® VCS Is Transforming Ophthalmic Surgery at Duke Eye Center
5 minute read
Two Specialties, One System: How UNITY® VCS Is Transforming Ophthalmic Surgery at Duke Eye Center
At Duke Eye Center in Durham, North Carolina, innovation is more than a mission; it's a mandate. When Alcon introduced the UNITY® Vitreoretinal Cataract System (VCS), a dual-function surgical platform combining anterior and posterior segment capabilities, it marked a significant shift in ophthalmic surgery. For Dr. Kourtney Houser, a cataract and cornea specialist, and Dr. Lejla Vajzovic, a retinal specialist, UNITY VCS has redefined expectations of efficiency, precision and interdisciplinary workflow.
Consolidating Excellence: One Platform for Two Subspecialties
Historically, cataract and retinal procedures utilize separate, specialized systems. At Duke, this meant transitioning between the CENTURION® Vision System for phacoemulsification and the CONSTELLATION® Vision System for vitrectomy.1,2
"We used to coordinate cases and resources around machine availability," Dr. Houser recalls. "UNITY VCS has dramatically simplified our environment."
By uniting two high-performance systems into one, UNITY VCS offers streamlined turnover, reduced OR footprint, and a standardized user experience across subspecialties.3-8,*,**,†,†† Setup and teardown are 22% and 42% faster, respectively, compared to CONSTELLATION.8,**,†,††,°,°° Technicians report a quicker learning curve due to the intuitive touchscreen interface and the one-step prime-and-test feature. Compatibility with legacy accessories and shared Custom Pak inventory further simplifies operations.7
“It’s easier on our staff, our surgeons, and our patients,” says Dr. Vajzovic. “In a collaborative environment like ours, that kind of integration is truly transformative.”
Beyond workflow, the single-platform model reduces redundancy in equipment procurement and service contracts, allowing administrators to optimize capital investment across surgical departments.
But these benefits only scratch the surface of what is possible with UNITY VCS. While improving workflows and reducing OR footprint is top of mind for surgical practices, the next-generation technological breakthroughs are where Dr. Houser and Dr. Vajzovic are seeing the most impact.3-7,‡
Enhancing Anterior Segment Efficiency
For cataract procedures, Dr. Houser quickly identified UNITY® 4D Phaco as a standout technology. The phacoemulsification system offers 2X faster nucleus removal and delivers 41%Δ less ultrasound energy into the eye than OZIL, which, according to Dr. Houser, can be important for reducing collateral tissue stress.4,‡‡
"With 4D Phaco, I don't need to toggle between standard and dense phaco settings that balance longitudinal and torsional modes for dense lenses," she explains. "It's seamless, which means more confidence for the surgeon."
UNITY® Intelligent Sentry further stabilizes the anterior chamber by actively mitigating surge using dual vent valve technology and a proprietary sensor.6 Complementing Intelligent Sentry is UNITY® Intelligent Fluidics. Dr. Houser notes that, in her experience, the improved pressure dynamics provided by Intelligent Fluidics can be helpful for patients with compromised corneal endothelium.7,9-12
Another anterior feature Dr. Houser appreciates is UNITY® Thermal Sentry, which estimates and regulates temperature at the incision site in real time, limiting the potential for thermal injuries.7
"Even though wound burns are rare, the peace of mind it brings, especially with dense cataracts, is invaluable," says Dr. Houser.
These anterior segment features are also available on Alcon’s UNITY® Cataract System (CS), which similarly supports cataract practices in streamlining their workflows.7
Expanding Capabilities in Retinal Surgery
For retina procedures, Dr. Vajzovic, a long-time clinical educator, sees UNITY VCS's posterior segment features as significant advancements.
"We're not just operating faster, we're operating with greater control and stability," she says.
The HYPERVIT® 30k dual-blade vitrector, operates at 30,000 cuts per minute with a proprietary beveled tip.7,13,14 Meanwhile, the 27+DS gauge instrumentation is designed to perform as of 25-gauge tools while offering smaller incisions.5,§§
“That’s a major advantage for delicate retinal procedures,” she notes. “Our fellows are often more comfortable with larger gauge systems, but the 27+DS is designed to perform as a 25-gauge—making it easier to transition.”5,§§
In addition to faster cutting speeds with HYPERVIT, UNITY VCS introduces TetraSpot, the first and only multi-spot laser probe, enabling the delivery of one, two, or four laser spots simultaneously, reducing laser application time by up to 3.1 times.3,7,13,14,¶,§
The enhanced efficiency and stability benefits of these new system features not only help to simplify procedures for experienced surgeons but also support fellows as they learn surgical techniques, offering a controlled environment to practice complex procedures such as membrane peeling and peripheral laser photocoagulation.7,13,15,§,‖
Stable Pressure, Smarter Fluidics
Beyond cataract and vitreoretinal-specific features, perhaps most notable for both surgeons is UNITY VCS's Intelligent Fluidics suite. Intelligent IOP continuously monitors and adjusts pressure to compensate for changes in flow resistance or egress, enabling operating at more physiologic intraocular pressure (IOP) throughout procedures.7,8,10**,†,°,°°,¶¶,∞
“In pediatric retina cases—where patients often have lower blood pressure and IOP fluctuations can pose significant risks—the ability to maintain stable pressure has completely changed my surgical approach,” says Dr. Vajzovic. “It’s exactly where I want it to be, automatically. I don’t even have to think about it anymore.”
“It’s my favorite feature,” agrees Dr. Houser. “The stability Intelligent Fluidics provides has been a welcome enhancement when operating on patients with pre-existing corneal pathology.”
Intelligent Aspiration and customizable fluidics settings provide both surgeons with fine-tuned control tailored to their procedural needs, whether emulsifying dense nuclei or navigating a detached retina.7
To put it simply, operating at physiologic surgical conditions is critical for both vitreoretinal and cataract surgeons—and VCS enables providing stable IOP for both procedures.7,10,¶¶,∞
A Platform for Today and Tomorrow
Both surgeons highlight their view of UNITY VCS as an invaluable teaching tool, especially when paired with modalities like the hybrid tip.
"We're comfortable allowing them to take on more because we have excellent visualization and great surgical stability," says Dr. Vajzovic.7 "In my experience, the platform’s enhanced control can help provide an exceptional environment for learners and patients."
Dr. Houser echoes the sentiment:
"When you're training the next generation, every feature that increases confidence makes a difference."
Looking ahead, both physicians anticipate expanded software capabilities, AI-driven performance tracking, and more seamless integration with surgical planning tools.
"I see a future where the full UNITY portfolio helps evaluate surgeon performance metrics in real time," Dr. Vajzovic adds. "That kind of feedback loop could elevate education."
Conclusion
UNITY VCS is a clinical turning point. As case complexity and volume rise, platforms like UNITY VCS will be critical to delivering scalable, multidisciplinary excellence in the operating room.
"With UNITY, we're not just evolving the tools we use—we're elevating the entire experience for our patients and our teams," says Dr. Houser. "This system reflects where ophthalmic surgery is headed, and I’m proud to be part of that future."
** For posterior segment surgeries/posterior cassette pack
†(P < 0.001).
††~1.5 minutes faster.
°~1 minute faster.
°°~23 seconds faster.
‡Compared to CENTURION and CONSTELLATION Vision Systems. Based on bench data.
ΔBased on N=10 HPs, Artificial cataract lens IOP 55 mmhg vacuum of 450 mmHg.
‡‡Based on bench data.
§Compared to Constellation HYPERVIT 20k vitrectomy probe.
§§Versus Alcon's Non-Dynamic Stiffener 27+ technology.
¶Multi-Spot Laser Probe (MSLP) (4) is 3 times faster than Single Spot Laser Probe (SSLP)
¶¶Mean fluctuation at flow vs. setpoint of 2.36 ± 2.13, 4.19 ± 1.97, 1.84 ± 2.82, and 2.13 ± 2.86 mmHg during phacoemulsification, irrigation/aspiration (IA), vitrectomy, and extrusion/fragmentation, respectively.
∞IOP setpoint as low as 16 mmHg (posterior) and 20 mmHg (anterior) without exceeding a mean fluctuation of 4.19 ± 1.97 mmHg.
‖Based on bench data. Reduction in surge is correlated to less change in anterior chamber depth.
CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician.
INDICATIONS / INTENDED USE:
UNITY VCS: The UNITY VCS console, when used with compatible devices, is indicated for use during anterior segment (i.e. phacoemulsification and removal of cataracts) and posterior segment (i.e. vitreoretinal) ophthalmic surgery. In addition, with the optional laser this system is indicated for photocoagulation (i.e. vitreoretinal and macular pathologies), iridotomy and trabeculoplasty procedures.
UNITY CS: The UNITY CS console, when used with compatible devices, is indicated for use during anterior segment (i.e. phacoemulsification and removal of cataracts) ophthalmic surgery.
WARNINGS: Appropriate use of UNITY VCS and CS parameters and accessories is important for successful procedures. The console supports various accessories to perform various surgical procedures. Accessories include handpieces and probes, as well as tips and sleeves when necessary. Different accessories are required for different procedures and operating modes. Test for adequate irrigation and aspiration flow, reflux, and operation of each accessory prior to entering the eye. The consumables used in conjunction with ALCON® instrument products constitute a complete surgical system. To avoid the risk of a patient hazard, do not mismatch consumable components or use settings not specifically adjusted for particular consumable component combinations.
AEs/COMPLICATIONS: Inadvertent activation of functions that are intended for priming or tuning accessories while the accessory is in the eye can create a hazardous situation that could result in patient injury. During any ultrasonic procedure, metal particles may result from inadvertent touching of the ultrasonic tip with a second instrument. Another potential source of metal particles resulting from any ultrasonic handpiece may be the result of ultrasonic energy causing micro abrasion of the ultrasonic tip.
ATTENTION: Refer to the Directions for Use for the accessories/consumables and User Manual for a complete listing of indications, warnings, cautions and notes.
References
1. CENTURION Vision System Operator’s Manual.
2. Constellation Vision System Operator’s Manual.
3. Alcon Data on File, 2024. REF-24615.
4. Alcon Data on File, 2024. REF-24379.
5. Alcon Data on File, 2024. REF-24576.
6. UNITY Phaco Handpiece Directions for Use.
7. UNITY VCS/CS User Manual
8. Alcon Data on File, 2024. REF-25374.
9. Kokubun, T. et al. The protective effect of normal-IOP cataract surgery on the corneal endothelium, The 25th Annual Meeting of the Japanese Ophthalmological Society.
10. Alcon Data on File, 2024. REF-24899.
11. Vasavada, V. et al. Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial. J Refract Surg 30, 534-540, doi:10.3928/1081597X-20140711-06 (2014).
12. Suzuki, H., Oki, K., Shiwa, T., Oharazawa, H. & Takahashi, H. Effect of bottle height on the corneal endothelium during phacoemulsification. J Cataract Refract Surg 35, 2014-2017, doi:10.1016/j.crs.2009.05.057(2009).
13. Alcon Data on File, 2024. REF-24644.
14. Alcon Data on File, 2020. REF-09694.
15. Alcon Data on File, 2024. REF-25562.
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