Best Brand of Surgical Loupes

[4ophtho]

Anyone have any recommendations for loupes for oculoplastics procedures?

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[EyeDoctor23]

Designs for Vision are the gold standard for a reason. They have a rep that will come and measure you so that your loupes will be custom built with your interpupillary distance, working distance, and nose fit. They also have a lifetime warranty. I have loved mine. My chairman has had the same pair for 25 years.

A few residents in my program have bought MedLite loupes and have liked those as well. About 1/4 the cost. Less customizable. Get the largest available working distance that they offer -- 21" I think -- anything smaller and you'll be craning your neck and/or blocking the attending's view.

 

[JayZBlue]

Agree with EyeDoc, everyone raves about their Designs for Vision loops.

Non-customized ones, like Keeler, would be better for reselling it after residency, if you want that option.

 

[digitalsideburn]

I'm an oculoplastics fellow and operate A LOT. I will go against the grain here- I had a pair of Designs for Vision loupes for 1 month and they just weren't that great. They let me return them as I was unsatisfied. I then tried Surgitel and I love them. They blow away the designs for vision loupes for these reasons: 1) MUCH wider range of working distance. Really incredible difference here- almost double of Designs for Vision. 2) Oakley, not Nike frames. 3) Better case. All this for $100 extra (At resident/fellow prices).

If you're a resident and looking for cheap, versatile loupes you can't go wrong with these (I used them for 3 years and did hundreds of plastics cases with them). ~$230 with shipping.

http://www.loupedirect.com/sgf20.html

Working distance is key for neck/back health. In general, pick a longer working distance than you think you'll need to keep your neck/back straight.

 

[orbitsurgMD]

Anyone have any recommendations for loupes for oculoplastics procedures?

There are a lot of choices available. I don't think there is going to be a "best" brand generally, and with loupes there are tradeoffs between brands on matters like weight, optics design, selection of magnification, customize-ability, options for spectacle correction, type of mount and options for lighting. And cost.

In my residency, I used a pair of spectacle-mount, flip-up galilean loupes, 2.5x, Keeler, and they were fine. I sold them after residency. In fellowship, I got a pair of Designs For Vision 3.5x roof prism loupes, and I still have them. They have been re-glazed at least once. I also have a pair of Zeiss 4.3x roofs and have a pair of 4.5x DFV roofs I use for orbit cases and DCRs, along with their double LED headlamp, which is head-mounted.

What you may find useful as a resident, assisting as well as doing some cases as a primary surgeon may not be what you need or prefer when you are doing all of your cases yourself. What you may prefer for sitting cases might not have the working distance or magnification you need for standing cases. What might work with overhead lighting might not work so well with a headlamp. What might work well when you are 30 years old might not work as well when you are 42.

DFV are sturdy. They are highly customized to your PD and wearing prescription, if you need one. Despite the fact that they are spectacle loupes, they are well balanced and do not pull, even though they have a metal (aluminum) frame (the Yeoman, Buddy Holly style). So there's that. DFV makes very sturdy, very bright LED light sources. I consider that a plus and use a headlamp for the majority of my cases.

Of the loupes I own, the Zeiss ones have the best optics. Brightest, clearest edge-to-edge, widest field. They are head-mounted. The ones I have pre-dated good LED lamps, so it has an after-market LED by a company in California called Sheer Vision. By now, that company probably has a better LEDs. The one I have is adequate but not as good as DFV.

Keeler makes nice loupes and a decent compromise between quality and weight and versatility. They are not through-the-lens mounted like DFVs. You can remove them from the spectacle mount and swap for a different optic if your needs change later or if you find yourself wanting different optics for different kinds of cases. They have LED lighting options, but not as robust or as bright as DFV. Their frame is a sport-style, if that matters. The one downside is if you require a spectacle, the ocular is difficult to bring as close to your eye as a DFV through the lens mounted ocular. That can matter because the eye relief is not that long in Keeler loupes--part of the design tradeoff they make to keep the size and weight of their telescopes to a minimum--and so even a couple of extra millimeters can result in vignetting, which gives a dark fuzzy edge to your field. Overall, Keeler optics are very good--they use Schott glass lenses, like Zeiss--but I think people who don't need spectacles will find them easier to use.

Heine makes decent loupes as well. I think they are similar in optical quality to Keeler, but they have done a bit better on the eye relief allowance. Very good optics and they have at least one LED light option.

As far as head positioning to avoid fatigue, only one company I am aware of, Pentax, has created a design to allow a surgeon to keep a neutral head position while working in a field below the head, using a prism design.

In general, the taller you are, the longer the working distance you will need and the higher the magnification you will need to obtain a similar working field. Same for doing standing versus sitting cases.

 

[orbitsurgMD]

Most of the suppliers that make the flip-up type of loupes have options for a prescription lens to be put into the frame, either in the lens itself or in a temple-less insert that clips onto the nose bridge. Those offer removable, adjustable/replaceable optics which is nice if you want to upgrade from a less-expensive Galilean optic (the cone-shaped ones, no internal prisms) to the more expensive higher-mag Keplerian prism units. Keeler, Heine, Surgitel and others do this. Some companies offer both through-the-lens and flip-up designs. Some of the through-the-lens mounted models have prescription lenses both in the objective of the telescope and in the carrier lens (DFV), others cement a prescription lens into the objective but do not use a prescription lens in the carrier.