Diagnostic lenses

[SteelEyes]

I was wondering what set of lenses you would recommend to a recently matched ophthalmology resident? I'm hoping to use my intern year "educational money" to get a set.

I've used the 20D, 78D and 90D of course, but I noticed some residents prefer other lenses, such as the SuperPupil XL or the 'super 66 stereo fundus lens'.

I know the volk lenses are quite popular, but are there other brands to consider, i.e. nikon? Lastly, where does one buy these?

Thanks for all your help!

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[hsyed]

I was wondering what set of lenses you would recommend to a recently matched ophthalmology resident? I'm hoping to use my intern year "educational money" to get a set.

I've used the 20D, 78D and 90D of course, but I noticed some residents prefer other lenses, such as the SuperPupil XL or the 'super 66 stereo fundus lens'.

I know the volk lenses are quite popular, but are there other brands to consider, i.e. nikon? Lastly, where does one buy these?

Thanks for all your help!

Go to volk.com to buy lenses. If you call and let them know you are a resident, they will give you a decent discount on the lenses, as well as the case.

I am actually interested in seeing what type of lenses people recommend also, since I am in the process of buying lenses for residency. I have heard that the "superfield" lens is better than a 90D. I wanted people's opinions on that as well as how difficult it is to learn to use a superfield vs. 90D. I'd also appreciate comments on 20D vs. pan-retinal 2.2D.

Thanks!

 

[samdo]

Go to volk.com to buy lenses. If you call and let them know you are a resident, they will give you a decent discount on the lenses, as well as the case.

I am actually interested in seeing what type of lenses people recommend also, since I am in the process of buying lenses for residency. I have heard that the "superfield" lens is better than a 90D. I wanted people's opinions on that as well as how difficult it is to learn to use a superfield vs. 90D. I'd also appreciate comments on 20D vs. pan-retinal 2.2D.

Thanks!

For the indirect ophthalmoscope I use primarily the 30 diopter lens, it works well to give you a large field of view but you sacrifice a bit of stereopsis. It will also serve you well on your pediatric ophth. rotations for the smaller pupil kids. Think of this as the low mag "high altitude" view using a standard light microscope.

For looking at the nerve and the macula it is hard to beat a superfield which is a modification of a 90 that lets you get a decent view thru a small pupil. I have no experience with a super pupil 66 etc... most of these lenses sacrifice some field of view versus stereopsis versus pupil size. Question the companys and try to work with the same lens frequently because the view will be subtly different with each. For a super sharp stereo view of the disc you cant beat a 78 diopter.

Other lenses I like, 14 diopter lens works very well for high mag super stereo view using the indirect ophthalmoscope. You can get a better stereo view of the disc, macular or midperiphery but the field of view is very limited. think high power/mag on a light microscope. Only disadvantage is working distance, you have to hold the lens far away from the eye and it may take you awhile to get used to that. For hospital consults this lens is the go to lens at the bedside to get a sharp stereo disc or macula view when no slit lamp is available.

For gonioscopy , you can get a three mirror lens which has different degree tilt for each of the three mirrors. Nice points, you can see the angle and far retinal periphery without learning scleral depression, which will take some time to master and most residents never get the hang of. The center of the lens makes a nice fundus contact lens. i would probably get the smaller diameter possibly peds lens. You may have to experiment with this since in very deep set eyes you will not get a good coupled fit.

For the best view of the angle and one that you can use for angle and iris laser procedure. The magna view gonio lens provides SUPER stereo and fine detail of the angle structures. Disadvantage is contact lens type requires a coupling agent and you have only one mirror so some rotation and experienced is required but you get a great view of the angle and this view carrys over to when you are ready to perform some alt, slt, iridoplasty etc... This lens is really a luxury since the three mirror will give you lots of info that is similar.

There is a company called ocular instruments that sells these lenses. do a google search for them and you will see their catalog. call them and they will explain anything and everything. If you put together a group purchase you will get the best price. Also the shows ASCRS is in washington this month you can walk around the show floor getting quotes and working the floor to get your best price.

Dont forget looking into a nice quality indirect ophthalmoscope that can travel with you. Most of the units available to residents are beat up crap that limit your ability to see. A personal unit is like driving your own car that you can negotiate the corners the most precisely. its alignment, pd, head setting will be yours and you will treat it like it was made of glass. I bought one on the advice of one of my attendings and by using the same one and getting better and beter with indirect funduscopy, you may be able to eclipse some of your senior residents who havent the desire to learn this skill well.

Also dont buy any colored lenses for patient comfort etc... only clear ones.

Good luck.

Samdo

 

[JR]

Wow, thanks for such detailed description!

 

[samdo]

Wow, thanks for such detailed description!

JR you are welcome. Check this link. I just spoke with a fellow ophthalmologist who liked this lens. He likes it better than the standard superfield:

http://www.volk.com/ss-digitalwide.aspx

Are you a med student, resident, ophth?

Samdo

 

[samdo]

Wow, thanks for such detailed description!

Also picked up a keeler cordless batter operated indirect today. Little different than my old vantage but it is sweet to not have any cords. So fast for consults.

Samdo

 

[pianist]

Does anyone feel there is any significant quality difference between say volk/ocular instruments/nikon? especially ocular since they tend to be less expensive.

 

[ryangeraets]

Four most standard lenses are 78D (neuro-ophth and glaucoma for disk eval), 90D (good for more "big picture" view of posterior pole and for disk through small pupil), 20D (standard indirect lens), and 28D (larger field of view, better for kiddos).
This is pretty much what everyone else has already told you; however, I think that a better goiniolens than a Goldmann style is the Zeiss 4 mirror goniolens because you can do dynamic gonioscopy to see if an angle is scarred shut or wheter the iris is just in apposition. You can't do dynamic gonioscopy with a larger/flanged contact goniolens.
Just food for thought...
ryan

 

[orbitsurgMD]

Four most standard lenses are 78D (neuro-ophth and glaucoma for disk eval), 90D (good for more "big picture" view of posterior pole and for disk through small pupil), 20D (standard indirect lens), and 28D (larger field of view, better for kiddos).
This is pretty much what everyone else has already told you; however, I think that a better goiniolens than a Goldmann style is the Zeiss 4 mirror goniolens because you can do dynamic gonioscopy to see if an angle is scarred shut or wheter the iris is just in apposition. You can't do dynamic gonioscopy with a larger/flanged contact goniolens.
Just food for thought...
ryan

For indirect exams, the 20D or a Volk PanRetinal 2.2 is a good choice.
If you get the PanRetinal, you can also use that as a wide-angle lens. I don't recommend the 30D as a primary lens but see it as more of a specialty lens for indented exams and for very fast exams in uncooperative patients with clear media. Wide angle lenses are best used clear, you will have a harder time with illumination with wide-angle yellow lenses, IMHO.
I have both, clearer is better. The Nikons are equivalent to Volk. The OI glass lenses are too. Consider the Nikon 28D clear for a wide-angle as well.

For slit-lamp use, the choices are even greater. Volk's 78D is great for disc detail. The Super Pupil XL is one of my favorite lenses, geat for that quick look at the nerve during an interval exam, good enough to get a quick look at the fundus in sudden vision loss to get a jump on the problem before dilation and for narrow angles where you don't want to dilate. 90Ds are in a lot of clinics, kind of old-school, though. The Digital Wide Angle 1.0x is a nice alternative to a Super-Pupil that gets you a bigger field than a 90D.
I don't have a 66 or Super Fundus, but I tried them on a show demo and preferred the DWA. The Haag-Streit 81 is a flip-flop design that gives you a wide-angle one way and a 78D view on the other. I still prefer the Volk 78.

If you are buying a headlamp, the Heine 180 is it. You will never want another.

For gonio, the non-contact Ocular Instruments Sussman with the big ring. Accept no substitutes.

My $0.02.