Trident Eye Surgery Center in Charleston, S.C., was recently in the market for 2 ophthalmic microscopes. Over the course of a year, I worked with surgeons there to trial 4 scopes based on the user-friendly controls, ergonomic eyepieces, superior optics, bright light sources and video-capture capabilities of each.

The 2-OR center's previous operating scopes were purchased in the 1980s. They were still functional and largely effective, but we had recently spent close to $6,000 to replace faulty parts. When we could no longer find replacement bulbs for the scopes' light sources, we knew it was time to upgrade the models that had become dinosaurs by today's standards. I worked with the surgical techs to research the market, which narrowed our choices to 4 leading brands. We decided that trialing each scope made the most sense.

Some centers conduct trials based on surgeon utilization. I'm not in agreement that you should limit the trial to physicians who are at your facility most often. Our trials, therefore, ensured that each of our surgeons had ample face time with each scope to gauge its effectiveness. That demanded clear communication with the companies' sales reps. After contacting manufacturers to coordinate delivery and setup of their scopes in our ORs — which was a major ordeal — my clinical coordinator remained in constant touch with company reps to ensure they were available to give surgeons a tutorial on their scopes and to answer any questions that they might have.

Matching surgeons' and vendors' schedules was an arduous process, but it ultimately helped us select the scope that was right for our docs and the facility. Be prepared to devote enough time to make that happen. It took about 6 months for all 4 manufacturers to set up their scopes (we trialed each individually for a month or two at a time) and set aside the time to work with each of our surgeons.

Scoping the options
Let's look at a few key scope features (see "Sketches of 4 Ophthalmic Microscopes" on page 52):

1. User-friendliness. The latest scopes let you pre-program surgeons' preferred starting position coordinates, which promotes clinical efficiencies by letting staff quickly reset scopes between cases with the push of a button. Electronic brake systems have replaced mechanical brakes, which combine with touchscreen controls on some models to make intraop scope positioning more precise and easier for staff and surgeons. Wireless foot pedals are also available, which limit the number of cables and cords — and tripping hazards — laid across the floor. Also consider scopes with ocular extensions, which let surgeons sit back from the light source in more ergonomically friendly positions during surgery.

2. Optics and illumination. Ergonomic and user-friendly concerns are important, but your surgeons will likely be most interested in scopes with the best optics. My surgeons were very impressed with the improved resolution offered by the scopes we trialed and told me they believed the recent upgrades made to the optics and light sources would lead to improved surgical outcomes.

These days, a scope that enhances the red reflex (the reddish-orange reflection from the eye's retina) is considered a standard of care. That feature provides surgeons with improved visualization of structures in the eye's anterior segment. Look for scopes that combine red reflex with stereo or coaxial xenon light sources that bathe the eye with brighter, whiter, more natural light, which lets surgeons operate with improved clarity, depth-of-field and tissue contrast.

3. Video capture. My surgeons put video capture and storage capabilities near the top of their wish lists because of their interest in educating potential patients about the procedures we offer. Many new scopes come with integrated 1- or 3-chip cameras and storage devices for recording and capturing high-quality digital or high-definition images. Record-ing in HD is nice, but consider that storing the images might require additional cash outlays for monitors, video boards, cables and storage devices that are HD-compatible.

Time to buy
Weigh a scope's cost against the features your surgeons covet and the reliability you'll appreciate. Limit the choices to a handful of top contenders before presenting them to your surgeons. Work with knowledgeable surgical techs or a single surgeon to help zero in on the features that matter most in the OR.

Now might be a good time to leverage the slumping economy into a good deal on your next scope. The rep selling the 2 scopes we eventually purchased seemed more eager than usual to make a sale. He took 2% off the second scope's price and pushed back the first required payment by 3 months. In the end, the 2 new scopes cost us about $200,000.

When weighing the cost of new or refurbished scopes against the clinical benefits, consider that upgrading to the latest scope offerings gives your surgeons a key piece of equipment that contributes to better clinical outcomes. Also remember that ophthalmic scopes are durable pieces of equipment that remain useful for a long time (our old scopes served us well for close to 2 decades). A significant cash outlay now can outfit your facility with reliable and clinically superior equipment that let your surgeons perform better, safer surgery for years to come.