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Lenses for new resident

Discussion in 'Ophthalmology: Eye Physicians & Surgeons' started by goldfisch, 05.08.06.

  1. goldfisch

    goldfisch Junior Member

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    What is the "basic" set of lenses that all ophthalmology residents should have? Unfortunately, my program doesn't provide lenses.

    I am assuming: 20D or Panretinal 2.2, 28D, 78D, 90D, gonio lens.

    Which gonio is better: 3 vs. 4 mirror? Handle vs. no handle?

    Which brands are recommended? Are certain brands/models really "better?" or it really just depends on user experience level?

    Finally, any ideas regarding discounted prices / packages / deals ?

    I would appreciate any input (e.g. anectodal evidence) on the subject. Thanks everyone!

    goldfisch
  2. Redhawk

    Redhawk Fellow

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    My 2 cents.

    You should at least have a 20 and a 90 (or some equivalent of the two). As for a 28, it can be useful with getting a little wider view of the periphery, in poorly dilated pupils and with kids. I did end up buying a 28. I've never used a 78 or any other indirect lens to this point.

    I actually did just buy a gonio lens. Our clinic has one, so I didn't buy one for a while. A 4 mirror is the way to go. Whether you want a handle or not is personal preference. I used both and came to prefer the handle. Neither is really "better" than the other.

    Most people seem to use Volk lenses. Our program provided Ocular lenses, which seem to work fine for us, but if I were spending my own money I probably would have sprung for the Volk. I've heard some people say it doesn't matter. I've also heard people say that they didn't think it mattered until they switched - then they changed their minds.

    My basic advice is to get the basic lenses (20, 90 - or equivalent) first then take your time and practice with others - borrow them from people who bought them and find out whether it's really worth the investment of your money.
  3. drgregory

    drgregory Senior Member

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    id opt for a 78D if you are dilating most. a 2.2panret is a good BIO lens. i prefer a 3 mirror gonio lens. the 1.0 digital is an excellent high mag lens, but if you get this, id get a supervitreofundus also and skip the 78D. i have the supervit, 78Dvolk, 90D volk, 1.0digital, 20D volk, 2.2panret, and a 90D nikon at one office and i like all except the 90D nikon. its optics are terrible. if you plan on doing alot of GLC id for sure get the 78D or 1.0 digital, or even a 68D. hell, why not get em' all? :D
  4. PDT4CNV

    PDT4CNV Physician/Surgeon

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    For the indirect get either a 20D a Panretinal 2.2 or a 28D lens. There is no need to get more than one It is totally personal preference. I use a volk panretinal 2.2 and have found it to be a versatile lens for diagnostic purposes and for laser. I occasionally used a 30D lens when looking at newborns in ICUs for ROP checks, or when looking at trauma patients in Neuro ICU who could not be dilated.

    For the slitlamp there are many many lenses to choose from. I own a Volk 78D and a volk 90D lens. I use my 90D lens most of the time. I occasionally use my 78 when I need more mag for evaluating an abnormal disc or for macular edema.
    However, volk now has second generation lenses (super 66 and super field) and third generation lenses (digital wide field and digital 1.0 and digital high mag) which are supposed to be pretty good. I have heard good things about the digital lenses, especially regarding glare and optical image quality. Some of the residents at my program use the superfield and like it, one had the digital wide field and likes it.

    But, the volk 90D gives excellent field of view with decent mag. It can be used 95% of the time. It gives enough mag to see macular edema, and the field of view is good such that I can usually do a pretty good retinal exam up to the equator. You can also see through a smaller pupil with the 90D than the 78. And, it is cheaper.

    For goniolenses, it is personal preference. I own a volk G4 goniolaser lens. It gives the best view of any goniolens I have tried. It is a 4 mirror lens. 4 mirror is the way to go. It has no handle so it is a "sussman" style goniolens except that it has a flange. Volk does make it with a handle and without the flange (no fluid design). The flange is nice when doing laser, as it provides extra stability, but for diagnostic purposes the flangeless no fluid design is the best. With or without the handle is personal preference. I prefer no handle. Most of our glaucoma attendings however use the handle design. It is personal preference. I think without the handle is more stable on the eye.

    If you have money to spend, would consider a no fluid macular contact lens. Volk makes one. By the way, Volk lenses are the way to go. You do not have to buy them direct from Volk though. Can get discounted prices and even group discounts via Lombardt.
  5. eyedr

    eyedr Member

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    I worked with a retina surgeon who recommended a 60D and a 90D at the slit lamp as well as a wide field lens. Anyone have any opinions about purchasing a 60D instead of a 78D for examing the macula and optic nerve?

    He also used a 20D with the indirect most of the time but had a 28D for poorly dilated patients.
  6. retinasurgeon

    retinasurgeon VR surgeon

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    I have all (Volk), a 90D, 78D, 28D, 2.2 panretinal, and a 20D. I use the 78 most of the time with my slitlamp, after which I use my 2.2 pan retinal for a BIO

    I usually use the 28D when I do indirect laser for ROP or for post-op patients with a gas bubble, or indirect laser after an AFX. I usually use a 20D for buckle procedures, though a 28 D is suitable for smaller pupils.

    For the gonio, better get the Sussman or the Posner or the Zeiss type. It is better when you do indentation gonioscopy, and since it is 4 mirror, you don't have to rotate the lenses when you examine the angles. The three mirror ones have a bigger contact area compared to the three lenses aforementioned, so, it can give a false impression on indentation gonioscopy.

    And last thing, buy Volk. Quality is better, though Ocular Instruments have the glass type lenses, but they are more expensive compared to the same Volk lenses. The cheaper Ocular Instrument lenses are actually made of CR 39. (plastic)
  7. Visionary

    Visionary Medical Retinologist

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    You'll find a lot of opinions on lenses. Regardless of what you eventually choose, you will likely add to and/or change the lenses you buy. I'm a bit of a technophile and thus prefer to buy the latest and greatest. I went with all Volk to start.

    I chose the Digital Wide Field over the 90D, because of the much better field of view (124 deg vs. 89 deg) for equivalent mag. Some people say that you get distortion at the lens edge, but I've not found this to be a problem.

    I wanted a second slit lamp lens for higher mag evaluation of the nerve and macula. I chose the Super 66 over the 78D. The have equivalent field of view (96-97 deg), but the Super 66 has better mag (1.0 vs. 0.93). This is an amazing lens with great stereo views. You feel like you can crawl into the nerve cup, and you can pick up subtle macular changes.

    For the indirect lens, I chose the 2.2 PanRetinal. It's a happy medium between the 20D and 28D. It has less mag than the 20D (2.68 vs. 3.13), but a larger field of view than either the 20D or 28D (73 deg vs. 60 deg & 69 deg). The mag difference is not much of an issue, as this is a "big picture" lens anyway. The 2.2 also has good small pupil capability (especially if you use one of the new Keeler indirects).

    Finally, I wanted a gonio for myself (for calls and convenience). I chose the 4 mirror no fluid without a handle (just couldn't get used to the handled lenses). Definitely get a no fluid gonio, so you don't have to mess with Gonak (yuck!).

    I've been happy with all of these lenses, and I've found that some of the other residents (and attendings) have borrowed and/or bought them once they tried them.
  8. 7ontheline

    7ontheline Member

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    I love my Digital wide field, it's much better than a 90D. I don't agree with people who say you don't need a 78 or SUper 66 if you have a 90 - no matter how good you are you can see more with the higher mag. I have a 78, but have heard good things about the Super 66. I like the pan-retinal 2.2. I have a 20 but the 2.2 is pretty cool. Gonio lenses are pretty individual - I have big fingers and I love the handled 4-mirror. I think it's easier in people with deeper orbits. You definitely need a 20 or 2.2 (I think a 28 isn't as useful personally) and a 78 or super 66 - I think you can actually get away with not using a 90 or similar lens initially. You'll definitely need one later, but maybe not to start.
  9. Elephantitan

    Elephantitan Member

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    I'm curious of the handled gonio lens crowd: is it ever hard to get the lens on the eye since you don't have extra fingers right by the lids to help out the patients terrified of anything approaching their eyes? I have a volk 4 mirror w/o handle or gonak dependence and love it but sill rarely go find a 3 mirror needing gonak from clinic to help keep the lens in place on the extra squirrely pts. I would never buy one needing goop though.
  10. orbitsurgMD

    orbitsurgMD Senior Member

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    If I were buying a set of lenses, I would get a Volk PanRetinal 2.2 clear, a Volk 78D clear, an Ocular Instruments Sussman 4-mirror with a large ring (no handles) and either a Volk Digital Wide angle or a Volk Super Pupil XL. Really, that is all you will ever need. Goniosol 3 and 4-mirror lenses are something only rarely used and most resident clinics have them already.
  11. Ophtho24

    Ophtho24 Senior Member

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    On an away rotation a resident I was working with told me he knew a great web site to buy lenses at that was very affordable. They were all brand new lenses. Do any of you guys know what website he might have been talking about?
  12. PDT4CNV

    PDT4CNV Physician/Surgeon

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    Lombart Instrument company is where I and most of the residents at my program buy our lenses.

    The address is:
    http://www.lombartusa.com/

    If you call, they have even cheaper prices for those in training.
  13. IEye

    IEye Junior Member

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    I can seem to see as well with Nikon compared to Volk.

    For gonio, I like Sussmans but have a Zeiss (with handle). Try it before you buy. You probably need a basic set of lens that you will need to buy before you try it in residency. For that, consider a Volk 20, 78 or 90. Afterwards, start buying a lot of lenses. By the time you finish residency, consider having about 6 lenses, including 2 20's, one as a spare.
  14. eyedr

    eyedr Member

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    Can someone comment on their experience using a 60D lens at the slit lamp compared to a 78D for evaluating the macula and ON?
  15. retinasurgeon

    retinasurgeon VR surgeon

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    Better view for the macula and ON, as it is more magnified. a 78D is in between a 90 D (wider view) and a 60 D (higher mag). My glaucoma partner prefers it more.
  16. shiro1

    shiro1 Member

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    I generally use the 78 at the slit lamp, however, I have recently bought a 60 for glaucoma suspects. The reason comes from my desire not to do any calculations when looking at the optic nerve. With a 60 diopter lens you do not have to correct when estimating the size of the nerve or cup. You can adjust the size of the slit lamp light beam and directly measure the size of the optic nerve. I think you have to correct by 1.1 for a 78 and I don't remember the correction for 90. So, its nice to have it around.
  17. ping1050

    ping1050 Member

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    We get a choice of two lenses. Price is no object. These will be the first lenses for a starting resident. Have used these lenses only somewhat as a MSIII and MSIV, so don't have a great grasp on the DWF and Dig Hi Mag lenses, but it seems people here prefer them. Would prefer to get the nicest lenses possible since it's the only time we will have hosp. paying for lenses. Suggestions?

    VOLK LENSES:
    Lenses: 60d-90d
    Lenses: 20D - 40D, 2.2
    Super lenses
    G-Series 3 or 4 mirror
    4 mirror with handle
    Digital High Mag
    Digital Wide Field
    Digital ClearMag
    Digital ClearField
    3 mirror, uncoated

    OCULAR LENSES:
    3 Mirror Universal
    Posner or Sussman

    HAAG STREIT LENSES 81d

    HEINE 20d with case
  18. MDEYES

    MDEYES

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    DWF
    2.2 vs digital clear field
    volk 4 mirror lens
    Super 66 (optional)



  19. Visionary

    Visionary Medical Retinologist

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    If you are only getting two, go with the DWF and 2.2. They'll be the meat and potatoes of your lens set. See above for my take on lenses. I'm still using those same 4 lenses from residency, with the addition of a mini 30D. It's better for very small pupil indirect exams.
  20. ctmedman

    ctmedman

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    Which one to get....

    Volk G4 (4-mirror) Goniolaser or Volk G4 (4-mirror) high mag Goniolaser

    Only difference between the two is high mag. I'm not clear why you need high mag if you can increase mag on the slitlamp but maybe someone can chime in here. Is it clearer and easier to see with the high mag one?


    Thanks.
  21. Visionary

    Visionary Medical Retinologist

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    I use the G4 no flange. Never tried the high mag G4, so can't speak about it specifically. Can't imagine it would be needed. I just flip the mag on the Haag-Streit, and I can see what I need to with the regular G4. Sometimes higher mag carries more aberration and, therefore, worse image quality. Personally, I'd save the extra $30 and go with the regular G4.

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