Invest wisely in an ophthalmic microscope, for your eye surgeons will be using it for at least the next 10 years. Your purchasing decision should be based on the functionality of what your surgeons need as well as what you can reasonably afford. Here are some key factors to consider.

What types of eye surgery does your facility host? Do your surgeons just bring cataract cases, or do they also perform retinal surgery? Depending on the mix of subspecialties you see at your facility, you may have to seek out scopes with particular features and functions. Most basic ophthalmic microscopes will let physicians perform cataract surgeries as well as glaucoma and cornea procedures. Practically all that's required for those types of cases are a good illumination source with variable intensity and oculars with adjustable inclination that the surgeons find comfortable.

Illumination. You have 2 options: xenon and halogen lighting. Xenon bulbs tend to last longer than halogen bulbs, but they're also more expensive. Plus, there's a difference in the color of the light they produce. Halogen has a slight yellow tint, while xenon is a cooler blue-white, and some physicians prefer one over the other. Some scopes offer both halogen and xenon settings, letting physicians choose which light they'll use in a case.

Red reflex. Most ophthalmic surgeons rely on red reflex to assist in the illumination of a cataract case. The method by which light is bounced off the retina to obtain the red-hued backlighting is critically important. Traditional methods employ a single broad beam and require scope inclination and patient cooperation to get an optimal red reflex. In contrast, the use of twin beams that are aligned with the scope's oculars reflect the light back more directly for an enhanced red reflex that complements the stereoscopic vision of the microscope. This advance in illumination has revolutionized what can be seen and done in the anterior segment.

Posterior segment surgery? If your physicians perform retinal surgery as well as cataracts, your purchasing decision will need to accommodate another level of technology and you'll need to budget for attachments supporting posterior segment surgery. Retina surgery requires that the scope's ocular be equipped with a binocular indirect ophthalmomicroscope (BIOM) and inverter, which let the surgeon visualize the posterior segment. A filter is needed to shield surgeons' eyes from stray energy during laser use. Plus, if it's not ceiling-mounted, a retina-ready scope needs a robust floor stand to counterbalance the increased weight of components on its articulating arm.

Video recording. Most surgeons don't routinely document their cases on video, largely because most don't teach clinical peers or tour the lecture circuit. Though it's frequently passed by in an effort to contain costs, a video recording component can be an valuable option to have at your disposal. In my view, it's extremely important to be able to create video documentation of any of your surgeries. It's not about the conference podium, but the possibility for self-improvement. Even if you're confident in your skills and obtain great results, even if you're not teaching other physicians, you can still teach yourself something about your technique and the way you handle both difficult and routine cases.

A surgeon who takes the time to view his cases with some distance will be able to perform at a better level. Granted, the microscope's camera cannot record every single aspect of a procedure, but it doesn't lie in the information it presents you, and the surgeon can be honest with himself about what occurred. It's also useful for training surgical support staff, to prepare them for potential contingencies. I don't keep an archive of every case I do, but you never know when something unusual will occur, so the recording device is usually running.

That said, you don't have to spend big on a top-of-the-line, bleeding-edge high-definition recording system to capture quality video. While high-def offers an impressively sharp picture and greater flexibility for editing if you're sharing your video with a class or conference-goers, standard-definition resolution and a basic digital recording system can produce quality video if it's for your own in-house use.

Ceiling-mounted vs. floor stand. I worked with ceiling-mounted scopes as a resident, and with floor-stand scopes since then. Both will do the job. Some surgeons have a preference for one style over the other, but it's the cost difference between them that makes the ceiling-versus-floor decision one that shouldn't be taken lightly. While a microscope on a floor stand is mobile and literally self-supporting, a ceiling-mounted model may require budgeting for expensive structural renovations above your OR's ceiling, and becomes a permanent fixture in the OR.

Once it's been installed, however, a ceiling-mounted scope does offer certain logistical advantages over floor-stand scopes. It's easier to move from one eye to the other, from one side of the table to the other or temporarily out of the way to allow access to the patient's airway. Staff don't have to worry about standing in the way of a floor-stand scope's footprint. Plus, its fixed location means there'll be less concern about the potential for damage while it's being transported between ORs, corridors and storage areas.

Whether it is ceiling- or floor-mounted, make sure that the microscope you choose is one that your physicians will be comfortable working with. Depending on your case volume and surgical schedule, they may be spending several hours at a stretch looking through it during a succession of cases, so avoiding back and neck pain should be a priority for them and their facilities. Scope height positioning, the adjustment and angulation of the oculars and the ability to control scope movement with a foot pedal while their hands remain in the surgical field are key considerations on this front.

Friction locks vs. electromagnetic locks. When it comes to scope positioning, traditional friction locks are mechanically loosened and tightened at the joints. They work quite well, and are the economical choice, but as mechanical devices there's the possibility of wear and eventual breakdown unless they're handled with care. Electromagnetic locks are released with a twist of a handle, the scope is floated into place and the position is locked with another twist. They're a more expensive option, but also longer lasting and more reliable. Consider who and how many people will be using and transporting the equipment. A small facility employing just a few physicians and surgical staff can most likely train personnel on the proper handling of mechanical locks, as well as other equipment features that require respect. In a larger facility where numerous ancillary staffers might come in contact with the scope during the course of the day, electromagnetic locks will likely help preserve your investment.

New vs. refurbished. Cost is the bottom line in practically every equipment purchasing decision, but a fixation on finding the least expensive option can prevent you from acquiring the most efficient choice. As you shop around for an ophthalmic microscope, you may look into the pre-owned and refurbished market. With some equipment, it's not advisable to buy last year's model because you may fall too far behind the technological curve. Surgical microscopes, however, tend to stand up over time, and quality remanufactured models are available at deeply discounted prices.

But there are as many reasons why you might want to invest in the newest equipment your budget will allow. While the optics on a refurbished scope may work flawlessly, the size of the lenses on older scopes may differ from those on newer scopes. This may present difficulties if you later choose to add on retinal surgery components, a recording device or other newer accessories, which might not adapt as efficiently as they would on a newer scope. The longevity of parts availability is another concern, as is the potential resale value of an already remanufactured scope.

Take a test drive
There are a lot of ophthalmic scopes on the market, from top-of-the-line models to stripped-down basic versions. When you're comparing each manufacturer's offerings, you can look at websites and product literature, you can talk to your colleagues at other facilities, but you can't beat hands-on trialing, whether that's in the conference exhibit hall or with a demo model in your own OR. The technical details of a scope may not strike you as critically important until you test-drive a mechanism that's counterintuitive.

Carl Zeiss Meditec
OPMI Lumera 700 Microscope
(800) 442-4040
www.meditec.zeiss.com/usa
List price: starts in the low $100,000s
FYI: Zeiss's new ophthalmic microscope features Stereo Coaxial Illumination (SCI), which provides a brilliant red reflex in virtually every cataract surgery patient, even those with mature cataracts or small pupils, says the company. The OPMI Lumera 700 also offers an optional keratoscope for assistance in determining corneal astigmatism. For retinal surgery, it offers an optional integrated slit module and auto inverter tubes, and is compatible with the company's new Resight wide-angle fundus viewing system.

Endure Medical
LuxOR Microscope System with Illumin-i
(800) 736-3873
www.enduremed.com
List price: starts at $35,000
FYI: Endure Medical's new LuxOR microscope features the company's patent-pending Illumin-i module integrated into its optics. This innovative technology provides a consistent, brilliant red reflex and detailed visualization. Physicians' and staff's ergonomic concerns are addressed by 0 to 215 binoculars, state-of-the-art digital electronics, touchscreen controls and a waterproof footpedal. Optional video systems (including single-chip, 3-chip and HD cameras), digital recording devices and assistant attachments are also available through the company.

Leica Microsystems
M800 Series Ophthalmic Surgical Microscopes
(800) 526-0355
www.leica-microsystems.com
Price range: $50,000 to $125,000
FYI: The M800 series of ophthalmic microscopes provides consistent, reproducible, direct illumination for clear viewing, says the company. The Quad Zoom feature gives 100% stereoscopic vision and illumination to both the surgeon and the assistant. A variety of ergonomic binoculars are available, letting all surgeons work comfortably at the scope, and the auto-reset function offers time savings during room turnovers. Plus, Leica's new, exclusive HDMD AIO is a compact, integrated high-definition surgical documentation system.

M??ller-Wedel
M??ller Allegra 900 Ophthalmic Microscope
(513) 734-3111
www.moeller-wedel.com
List price: starts at $51,000
FYI: Distributed in the United States by MD Microsurgical (www.mdmicrosurgical.com), the German-made M??ller Allegra 900 is designed for speed and flexibility in ophthalmic surgery, but is also adaptable to ENT, hand and reconstructive surgery purposes, says the company. With its newly designed electromagnetic brakes, the microscope is easy to move, but stable in the working position. It is equipped with high-resolution apochromatic optics, a 1:6 zoom, a red reflex enhancer, 10x wide-angle oculars and X-Y coupling.

Prescott's
Omni-I
(800) 438-3937
www.surgicalmicroscopes.com
List price: $29,500
FYI: A high-quality microscope at an affordable price, Prescott's Omni-I features apo-chromatic optics and an exceptional red reflex, says the company. It offers focal lengths of 175mm or 200mm, a visual field diameter of 65mm, a zoom range of 4x to 24x with a 1:6 zoom ratio and motorized X-Y coupling of +/- 25mm in all directions. Available options include a beamsplitter, stereo observer optics, a C-mount video adapter and a dual stereo attachment. The scope provides 100W illumination with a backup bulb and is supported on a counterbalanced articulated arm. A 2-year parts and labor warranty comes standard, and Prescott's direct service representatives are available anywhere in the United States.

Seiler Precision Microscopes
Evolution Zoom Surgical Microscope
(314) 218-6365
www.seilerinst.com
Price range: $34,995 to $50,000
FYI: The Evolution Zoom is a multidisciplinary surgical microscope designed specifically for surgery center and small hospital settings, says the company. Its compact design and affordable pricing are backed up by such high-end features as motorized zoom, motorized focus, X-Y coupling, xenon illumination and smooth movement.

Topcon Medical Systems
OMS-800 OFFISS Operation Microscope
(201) 599-5122
www.topconmedical.com/categories/surgical.htm
List price: not disclosed
FYI: Optical Fiber Free Intravitreal Surgery System (OFFISS) technology lets surgeons use both hands in the surgical field without the need for fiber-optic illumination when using the 40D front lens, says the company. Offering image clarity and illumination for all types of ophthalmic surgery, the OMS-800 OFFISS features a double-focusing mechanism, electromagnetic locks and a programmable, multifunction footswitch. Its ergonomic, space-saving design provides a large work area and ensures physician comfort. A bulb exchange mechanism immediately rotates a spare lamp into place should the main lamp fail.