With the Laser Endoscopy Ophthalmic System (Leos), BVI introduces a new platform for performing endoscopic cyclophotocoagulation (ECP), aiming to streamline the procedure, improve reliability, and expand its usability among cataract and glaucoma surgeons. Cleared by the US Food and Drug Administration (FDA) in April 2025 and commercially launched at the American Academy of Ophthalmology (AAO) meeting in October, BVI positions Leos as a modernized, intuitive system built around enhanced visualization and simplified workflow.
For glaucoma surgeons familiar with the earlier Endo Optiks ECP system, which remained largely unchanged for two decades, Leos is a notable departure. The design centers on standardization, digital visualization, automated features, and a single-use laser endoscope known as the VueProbe. Together with a portable console, 21-inch viewing monitor, touchscreen control panel, and wireless footswitch, Leos attempts to reduce the variability that characterized earlier ECP experiences.
“The Leos system is really the ECP that we’ve always wanted,” says Steven R. Sarkisian, Jr., MD, of Oklahoma Eye Surgeons. “It’s the ECP that we’ve been waiting for. The user interface and the clear images and the single-use probe with the perfect image every time simply make it a more pleasurable experience for all involved.”
Figure 1. The Leos system integrates a portable design with a sterile, high-resolution laser endoscope to streamline endoscopic cyclophotocoagulation during cataract surgery, enabling precise, wirelessly activated laser treatment under direct visualization. Ciliary processes are displayed on a 21-inch heads-up monitor.
Improved Visualization
Early clinical adopters describe visualization as the driving improvement of Leos, starting with the VueProbe’s 40,000-pixel digital imaging sensor, 120° field of view, autofocus, and auto-illumination capabilities.
“The key with endoscopy is visualization, and the resolution is very high—much better than anything we’ve had before,” said Robert Noecker, MD, a glaucoma and cataract surgeon with Ophthalmic Consultants of Connecticut. He emphasized that clear endoscopic views directly influence both safety and efficacy. “If you can’t see well, you’re going to be more conservative,” said Dr. Noecker, who has been performing ECP for more than 20 years. “The ciliary processes are your target, but if you have a hard time seeing them, it will be more challenging to do ECP effectively.”
Dr. Sarkisian described the visualization upgrade as a solution to long-standing frustrations with earlier ECP platforms. “The previous system was excellent, but the probes were reusable and fiber optic cable is very fragile,” he said. “Over time, cracks in the fiber optic cable could affect the integrity of your view. That was a significant complaint.” Leos eliminates that variability with a single-use probe delivering what he called “a perfect image every time.”
Both surgeons agreed that improved visualization reduces the likelihood of overtreatment. “It becomes a lot harder to overtreat, and consequently, the postoperative inflammation is a lot less with the Leos system,” said Dr. Sarkisian.
System Design and Hardware
The Leos console includes a large viewing monitor, an articulating arm with touchscreen control monitor, USB on-board video recording, and an HDMI port for video output (Figure 1). The system’s portable design allows it to be brought into small operating rooms (ORs) or used alongside cataract equipment. Touchscreen drapes enable sterile control of system settings by the scrub nurse.
The wireless footswitch offers laser control, image rotation, and pairing capabilities. The surgeons interviewed for this column noted that this direct control of image orientation—previously managed by staff—improves the workflow.
“BVI has configured the Leos so it’s more user friendly and a surgeon can be more independent,” said Dr. Noecker. “You don’t need as many hands on deck. Adjustments during the procedure are more automatic, and the ones you have to do manually are easier to perform.”
The single-use VueProbe’s ergonomic handle and 19-gauge, 30 mm curved cannula design allows for maneuverability within the small space of the anterior segment (Figure 2). The 810 nm diode laser, combined with red aiming beam and LED illumination, provides immediate feedback and stable visualization during treatment. The calibrated digital image orientation, autofocus, and autolight features eliminate the need for a circulating nurse to manually control these settings and adjustments.
“[Leos] can be set up before the surgeon even sits down, with the probe taped to the drape” said Dr. Sarkisian. “After your cataract surgery, you put your hand out and say, ‘Hand me the laser,’ and go. What’s left is the fun part of ECP: doing it.”
Figure 2. The The VueProbe laser endoscope provides a clear, digitally enhanced intraocular view with improved image orientation, automated focus, and illumination adjustments.
Simplified Workflow
Making the operating room workflow more efficient is another benefit of the Leos platform. Earlier ECP often required multiple team members to understand how to manage the system’s control buttons, image orientation, and focusing, which discouraged some surgery centers from offering the procedure. “The older version of ECP was more intense; you needed techs who knew which way to twist the dials and orient the images,” said Dr. Noecker. “Now the Leos does that part of it automatically, so a novice person can be trained relatively quickly to set up the platform.”
The automation and ease of use may allow this device to expand the use of inflow-based laser therapy for glaucoma, even to surgeons who have been reluctant to try it in the past. “Leos lowers the bar to be able to do the procedure well,” said Dr. Noecker. “You don’t have to practice and practice and practice to become an expert treater. This technology opens the procedure to surgeons who might not be as comfortable or experienced with ECP.”
Both surgeons noted an improved ability to perform “ECP+,” a technique of treating the posterior ciliary processes for greater IOP reduction. Dr. Sarkisian said it is now “easier to visualize the posterior aspect of the ciliary body,” which may broaden treatment possibilities for advanced glaucoma. Although the indications for ECP remain the same, he believes “it’s going to increase the desire to use it because it now fits into the workflow so seamlessly.”
Conclusion
BVI’s Leos system introduces digital imaging, simplified workflow, and single-use components to a procedure that has historically required more technical familiarity than many cataract surgeons preferred. By reducing variability in visualization, automating key adjustments, and allowing more independence for the surgeon, Leos and VueProbe address many of the limitations of earlier ECP systems. For experienced adopters, it appears to improve efficiency and consistency; for newer users, it may lower barriers to learning the procedure and encourage broader use of inflow-based laser therapy in both routine and complex cases. GP