SUPERIOR OPTICS A focused beam of light is critical for a good operating experience. Surgeons say the ideal headlight should shine brightly and fit like a well-worn hat.

Comfort matters. Mobility, too. But most of all, surgeons want their headlights to illuminate the surgical field with high-intensity, shadow-free light. They want to be able to create and control a focused beam of light across the entire depth of the visual field. "Illumination is critical. If you can't see, you can't effectively operate," says University of Kentucky otolaryngologist Sanford Archer, MD, FACS, FAAOA.

Is brightness always better?
Many factors determine how well a headlight illuminates the field, not the least of which is precision, the ability for surgeons to control the light's brightness and beam, to deliver brighter light where they need it: at the center of the spot, not the edges.

But there's more to consider than just brightness. Brighter is not always better, says Dr. Archer. Operating with too bright a light, he says, is like taking a photograph with too great a flash. "Everything gets whited out and all the hues blend into one another so that it's hard to differentiate," he says.

The light should be focused and not create glare, which can make it hard to see the color and topography of tissue. To avoid creating shadows, the luminaire should be positioned coaxially with the surgeon's vision. You should be able to draw an imaginary line directly in front of the bridge of the nose that bisects the lighting unit and the pupils as the surgeon looks down during surgery.

Who's the surgeon?

The illumination needs of a plastic, hand or oral surgeon differ from those of a spine surgeon operating in a deep cavity. An ENT surgeon works with his head about 2 feet away from the patient. General surgeons usually work with all the OR lights on while other surgeons may work in a darkened OR.

"Who's the surgeon? ENTs like to have a small, very high beam, a small aperture, a very narrow field and very good intensity," says spine surgeon Mark Drzala, MD, of New Jersey Spine Specialists in Summit, N.J. "Other surgeons might want a larger field with less intensity."

Your surgeons will appreciate a fully adjustable aperture. It should be easy to decrease or increase the light's intensity by closing or widening the aperture, says Dr. Drzala. Some lights have sliding intensity switches mounted on the headband. Dr. Drzala notes that when he reduces the aperture on a xenon bulb, the light's intensity increases as it focuses. Closing the aperture on LED lights makes the light more intense, but it doesn't fill the surgeon's field of vision. "When we drop down the aperture on our LED headlights, it's not the crispest light," he says. "For some reason, the edges aren't as sharp when we lower the intensity." Closing the aperture on a xenon bulb, on the other hand, will focus the light with laser-like precision, which might be preferred by ENT docs demanding a high level of magnification and intense light.

Does the light give off a blue or yellow hue? Ideally, the light should mimic the height of daylight, giving the most "natural" illumination and accurate visualization of the surgical site. A blue-white not only makes the subject look better than a yellow-white, but it's also easier on the eyes.

NATURAL COLORATION The brighter light provided by LEDs renders tissue more favorably. LEDs maintain their intensity with no perceivable drop off in brightness as compared with xenon bulbs.

TRY THIS QUICK TEST
Are Your Headlights Bright Enough?

Here are 5 signs that your headlights aren't up to the job:

• The headlight doesn't stay bright. This is more a function of the type of bulb the headlight uses: fiber-optic xenon or light-emitting diodes (LEDs). Xenon bulbs, which provide a bright, focused beam, gradually lose intensity over time and require replacement. LEDs are more expensive than xenon bulbs, but have a much longer life and are much cooler. LEDs use solid-state semiconductors instead of filaments to generate light more intense than xenon bulbs with little heat and a color temperature that can reach 10,000 ?K.
• Your surgeons have to keep adjusting the overhead lights or asking their partner to shine their headlight their way to complete the case.
• The headlamp drifts and recoils after surgeons set it. You'll want a lamp that's easy to adjust and stays where you need it.
• The light's bright in the middle, but dim on the sides. The light should be even, from edge to edge.
• It's uncomfortable. The ideal headlight should feel like a comfortable hat. Does the cooling apparatus that some headlights include make them heavier or unwieldy? Does the headlight create pressure points that you'll have to pad with gauze during every use in order to avoid soreness or irritation?

— Compiled by Dan O'Connor