If you're outfitting or upgrading your eye surgery ORs, here's advice on finding the right surgical microscope, the cataract surgeon's most important piece of equipment.

• Ceiling- or floor-mounted? Where to place the scope? Many eye-only centers ceiling-mount their scopes, which saves floor space, grants anesthesia easy access to the patient, and makes it easier for nurses and techs to move the scope and set up the room. There may be disadvantages with this option, however. A ceiling-mounted scope limits positioning for physicians and patients, can hinder the ability to quickly replace a malfunctioning scope, and might inhibit a multi-specialty center's ability to attract and accommodate other specialties that don't use the type of microscope it has permanently installed. Because we had plans to bring orthopedic surgeons on board, I opted for floor-stand scopes, and have been satisfied with that decision.
• Trial in real surgeries. When surgeons trial scopes, it's difficult for us to get an accurate sense of the equipment without an actual patient to operate on. Take the red reflex, for example, which provides enhanced visibility during the most critical steps in cataract surgery. I test-drove many scopes in the exhibit hall of an American Academy of Ophthalmology meeting, but I also had the advantage of operating at a hospital that contracted with a mobile surgical equipment and services company. Before we built our center, I contacted the owner and arranged to try as many different pieces of equipment as I could in real surgeries. One of the scopes I worked with had a brilliant red reflex that turned capsulorhexis in a patient with a dense cataract from harrowing to delightful. Since the centration and stability of the premium lenses you implant are driven by successful capsulorhexis, this is no small advantage. After trying it, I simply could not go back to my old scope.
• Cameras. I equipped both of our scopes with cameras that channel images to HD screens in our 2 ORs and to the nurses' station in the pre-op area. Even though the beam splitter that accomplishes this dims the available light in the scope, I still feel it's a valuable feature, since the nurses are able to track the progress of a case and time the preparation of the next patient perfectly.
• Do you need a backup? Having a backup scope on hand is always worth the cost. For our 2-OR ASC, we looked to the pre-owned market for our third scope. A refurbished or remanufactured model can save you some money, but do your due diligence and make sure you know exactly what you're buying and who you're buying from.
• Adding retina? We may add retinal surgery in the future. One of the biggest hurdles is cost. A standard ophthalmic microscope must be equipped with a wide-angle viewing device to take on posterior segment surgeries, which typically costs $25,000. Plus, you'll need 2 of them, so you can sterilize each between cases. A nearby hospital recently purchased a scope with the wide-angle view component integrated into it for about $150,000. We're still researching less expensive alternatives.

Good luck on your search for the right scope. When you find it, there is no better feeling than sitting in the comfort of your surgical suite and looking at a red reflex that resembles a Hawaiian sunset, confident about the case you're about to begin. OSM

Carl Zeiss Meditec
OPMI Lumera i
(800) 442-4020
www.meditec.zeiss.com/usa
Price range: starts in mid-$50,000s
FYI: Carl Zeiss Meditec's OPMI Lumera i features the company's proprietary Stereo Coaxial Illumination, which provides a brilliant red reflex, high contrast and depth of field in virtually every cataract surgery patient, even those with mature cataracts or small pupils. The microscope also accepts Zeiss's Resight Fundus Imaging System, which enables an unparalleled view of the posterior segment during retinal surgery. Touchscreen controls allow easy programming of user settings and a wireless foot pedal provides convenient, portable setup. The Lumera i is backed by Zeiss's more than 150 years of knowledge, expertise and service.

Endure Medical
LuxOR Q-Vue with AMP and Atlas Floorstand
(800) 736-3873
www.enduremed.com
Price range: $60,000 to $75,000, depending on configuration and accessories
FYI: The LuxOR Q-Vue — the name stands for "quad view" — incorporates a stereo, binocular assistant's scope with an independent light path, so it doesn't reduce the amount of light going to the surgeon's scope. It is essentially a separate microscope. Endure Medical's patent-pending AMP mechanism provides increased illumination and visualization for retinal specialists and assistants by pivoting the beam-splitter plate out of the optical path, allowing 100% of the light reflected from the patient's eye to be transmitted back through the optics. (Other ophthalmic scopes reduce the reflected light by 50%.) The company's new Atlas floorstand features electromechanical clutches that enable "free-floating" movement of the scope.

Leica Microsystems
M822 F20
(800) 526-0355
www.leica-microsystems.com
Price range: $50,000 to $150,000
FYI: Introduced at the American Academy of Ophthalmology's annual meeting in October, Leica Microsystems's M822 F20 microscope incorporates high-quality APO OptiChrome optics for razor-sharp, high-resolution images. A wider light path than other microscope models delivers a brilliant, consistent and stable red reflex that is easy to maintain throughout surgery. An exclusive, direct, LED illumination system offers reliability, clarity, contrast and true anatomical color rendition at safer low-light levels. A state-of-the-art documentation system accommodates surgeons' and procedure preferences to speed case turnovers, and an extensive array of optional accessories and a component-based design enable easy upgrades without replacing the entire microscope.

Microsurgery Instruments
EOM-2 Microscope
(713) 664-8873
www.microsurgeryusa.com
Price range: $3,800 to $4,300 depending on magnification option
FYI: Microsurgery Instruments' EOM-2, the second in its line of Economic Operating Microscopes, features high-quality optics and a range of accessories for viewing images and mounting the scope. The EOM-2 is available with 2 sets of magnification options: Model A enables 6x, 10x and 16x magnification, while Model B adds 4x and 25x magnification to those. Optional accessories include a digital camera, a CCD video camera, camera adaptors, an observation lens, a beam splitter and a 120-degree inclinable head. In addition to a table stand or wall mount, a floor stand ($350) or ceiling mount ($500) can be obtained.

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 apochromatic 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 beam splitter, 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.

Topcon Medical Systems
OMS-90 Operation Microscope
(201) 599-5122
www.topconmedical.com
Price range: not disclosed
FYI: Topcon's OMS-90 Operation Microscope offers high-quality optics, an assortment of available accessories and a choice of optional video systems that make it ideal, versatile equipment for general ophthalmic surgery and in-office procedures. It features coaxial illumination, a water-repellent and stainproof coated objective lens, a pupillary distance (PD) adjustment knob and 5-step magnification. With a focal length of 200mm, it also includes a parallel binocular tube and built-in yellow filter. The compact footprint of its base ensures efficient use of limited operating room floor space.