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What Your Eye Surgeons Want in a Microscope
Poll your surgeons and it's highly likely they'll list the following factors as the keys to their scope choices.
T. Hunter Newsom
Publish Date: October 5, 2015   |  Tags:   Ophthalmology
eye surgeons and microscopes HAVE A LOOK In addition to wanting efficiency and comfort in their scopes, eye surgeons are loyal to microscopes that deliver precise visualization and control.

Ophthalmic surgical microscopes are a major purchase. Your surgeons are going to be working with those machines for the next 10 to 15 years, easily. Unlike their choice of intraoperative lenses, which they can change every couple of months to get better results, the microscope you buy this year will be in your OR for the long haul. That's why many surgeons have strong loyalties toward the scope manufacturers who satisfy their visualization, comfort and service preferences. And that's why you shouldn't necessarily let price be your guide when you're considering your options. Questions to consider:

1. How good is its red reflex?
It can be difficult to describe what the red reflex is to someone who hasn't seen it, but it's not hard to explain its importance to cataract surgeons. Picture the red-eye effect in family snapshots. Reflecting light off the retina in a similar fashion during surgery helps to backlight the eye's interior and makes the invisible distinction between the lens and the capsule clearly visible. In short, retroillumination lets you see more and, as a result, lets you operate more efficiently and more safely. Recent years have seen several manufacturers significantly improve their microscopes' red reflex abilities, and this has been perhaps the biggest selling point for many physicians.

2. Are the controls capable?
The functionality and intuitive convenience of the controls are second in importance only to the red reflex. Since the ability to operate the scope while leaving the hands free for surgery is critical, foot pedal controls are the key. Once, while trialing 2 scopes, it actually tipped the balance for me when Scope A's red reflex was a couple of degrees better, but Scope B's foot pedal was far superior. Foot pedals vary in shape, configuration and amount of pressure required on the buttons. As with video game controllers, one manufacturer's foot pedal is not interchangeable with another's platforms, so a user's comfort and perceived ease of use with each individual control can play a big part in his scope preference.

3. Are additional advances available?
Above and beyond red reflex and convenient controls, some microscopes incorporate automated features that can assist your physicians' efficiency from use to use.

There are arguments in support of both ceiling- and floor-mounted scopes — the one reduces the footprint occupied by OR equipment, for instance, while the other is less susceptible to the vibrations that impact a facility's structure — but easy movement and positioning, and stable locking, are necessities for either option.

A scope's settings make a huge difference in how effectively a physician can visualize the site and how efficiently he works. Since we're talking about at least a half a dozen dials here to control the light, aperture, PD settings and other details, scopes that let you program in doctors' names and their preferred settings offer an easy, automated way to keep track of their preferences and efficiently set them up for a case.

The development of digital marking and measuring systems that show you where to make your incisions has led to the integration of this image-guided technology into scopes, providing overlays of patient data that are viewable through the eyepieces. And microscopes that are able to accommodate image inverter components, thereby supporting posterior as well as anterior segment surgery, are a must if there's any possibility that your facility will be hosting retinal surgery.

LuxOR LX3 Ophthalmic Microscope

LuxOR LX3 Ophthalmic Microscope
(800) 862-5266
Pricing: not disclosed
FYI: Part of Alcon's Cataract Refractive Suite, the LuxOR LX3 microscope features Illumin-i technology, which provides collimated instead of focused light for an expanded visual field and a 6-times-larger, highly stable red reflex zone, regardless of pupil size, centration, eye tilt or patient movement, says the company. A 45% increased depth of focus means clear visualization of the entire chamber at once and less need for mid-procedure focus adjustments. The optional Q-Vue assistant scope offers another 3D view without diverting light from the surgeon's optical pathway. Even the floor stand has been engineered for efficiency, with an electromechanical clutch system for easy positioning, an ergonomic design that hides cords and cables, a touchscreen video control and a 360 ? base rotation with extra-long reach.

Huvitz HOM-700 Advanced Surgical Microscope

Coburn Technologies
Huvitz HOM-700
Advanced Surgical Microscope

(800) 262-8761
Pricing: not disclosed
FYI: An ophthalmic equipment manufacturer spun off of LG Electronics in 1998, Huvitz distributes the HOM-700 scope exclusively through Coburn Technologies. Its high-resolution optical system provides sharp, crisp, 3D visualization even in low-illumination situations, says the company. An optimized red reflex and finely adjustable motorized zoom enable surgical precision, while a foot pedal provides hands-free control. All microscope functions are also easily accessible through an HD touchscreen user interface that stores patient data and surgeons' programmable microscope settings while also facilitating video recording of surgery. The 10x21 mm visual field of the eyepiece assists in avoiding eyestrain, while an optional ergonomically designed observation tube offers a 5 ? to 35 ? tilt for comfortable viewing and fewer fatigued necks during long procedures.

Hi-R NEO 900

Haag-Streit USA
Hi-R NEO 900
(800) 787-5426
Pricing: not disclosed
FYI: Adaptable to both anterior and posterior segment surgeries, the Hi-R NEO 900's large stereoscopic base of 25 mm delivers high-quality 3D depth perception, says the company. Haag-Streit's C.RED red reflex enhancer technology allows surgeons to adjust the angle of illumination to accommodate the anatomy of different patients and obtain consistent, stable and bright retroillumination. A small window, ergonomically positioned above the main binoculars, lets the surgeon quickly monitor the status of the microscope without looking away from the operative site. Motorized focus, zoom and X-Y coupling, along with fine and coarse inclination adjustments, and the option of either electromagnetic or friction brake floor stands, add to the equipment's efficiency.

Leica M822 Ophthalmology Microscope

Leica Microsystems
Leica M822 Ophthalmology Microscope
(800) 248-0123
Pricing: not disclosed
FYI: In Leica's M822 microscope, a combination of LED and halogen illumination lets surgeons adjust the optimum light balance, at the lowest possible light intensity, in order to achieve a brilliant, stable and natural red reflex, says the company. Its ergonomic design ensures a comfortable working position, while intuitive controls enable efficient workflow and a wide range of binoculars offers surgeons an individual fit. The long-lasting LED illumination reduces operating costs and results in fewer disruptions and downtime due to lamp changes. The system's open architecture makes it possible to capture surgery in high-definition with video recording accessories or to perform posterior segment surgery with vitreoretinal accessories.

Carl Zeiss Meditec

OPMI Lumera 700
OPMI Lumera 700
(800) 442-4020
Pricing: $140,000 to $425,000
FYI: The OPMI Lumera 700 features Zeiss's proprietary Stereo Coaxial Illumination for a highly stable, high-contrast red reflex to clarify anatomy and increase detail recognition, says the company. Xenon illumination delivers whiter, more natural light, and the platform is compatible with high-definition video and recording. The ceiling-mounted scope not only frees up floor space but also, assisted by a motorized lift function, provides flexible positioning. A wireless foot control, programmable to the surgeon's preferences, eliminates cord clutter underfoot. The OPMI Lumera 700's modular design enables the integration of Zeiss's other ophthalmic visualization innovations, including the Callisto Eye intraoperative toric alignment system, the Resight non-contact fundus viewing system for posterior segment surgeries, and the ReScan 700 real-time intraoperative optical coherence tomography unit.