Archive April 2014 XV, No. 4

Ophthalmic Microscopes Leap Forward

5 new features that will make life better for surgeons and patients.

Clifford Hendricks, MD


ceiling-mounted scope DROPDOWN A ceiling-mounted scope offers many ergonomic advantages, says Dr. Hendricks.

I was happy with our ophthalmic microscopes, but when they got so old that the original manufacturer discontinued service on them, we felt it was time to see what else was available. I expected to see some improvements, but what I saw far exceeded my expectations. The improvements are not just window-dressing — they truly can make care better and more efficient, and improve the experience for everyone, including the surgeon, the staff and the patient. Here's a look.

1. Better red reflex
Over the last 10 years, nearly all microscope makers have vastly improved their lighting so that a significant part of the light travels to the retina and reflects back. This improved indirect lighting improves the contrast and shadows, and makes it much easier and more efficient to work inside the eye. For me, this improvement stands out above all the others. The size, consistency and quality are amazing.

Seeing better helps me work faster and better. When I'm doing a capsulorhexis, for example, and something starts to go wrong, I can see it and correct it much earlier. It helps when I'm polishing the capsule after lens removal, too. It also eliminates a lot of the repositioning that used to be endemic to the procedure. With my old scope, it was important for the staff to keep the patient positioned so that the irises were parallel with the plane of the floor; any tilt could cause a loss of the red reflex. I also periodically had to move the scope from side to side — so-called XY movement — to keep it centered. The new technology is much more forgiving.

A high-quality red reflex also helps during femtosecond laser cases, because sometimes those reduce the size of the pupil. It also works well with our ORA system when we do aberrometry. We're able to capture the image quickly without multiple tries.

A better red reflex can even save money. We used to use a lot of trypan blue with patients who had dense cortical cataracts. But the contrast is so good with the new scope that the cortical cataracts show up as black instead of white.

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