Indirect BIO lens Vs Slit lamp non contact lens

[Luxman]

Helllo everybody!
I usually perform ophthalmoscopy with a SuperField non contact lens at the slit lamp and only from time to time with a BIO lens. Untill now I always had the impression to reach a greater amount of retinal periphery with the first method. Recently some doctors told me that one should be able to see more retinal periphery with BIO, contrary to what it's stated in the volk website and to my personal (for now limited) experience. What's the truth???
Thank you!

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[Ophtho24]

I agree that I get out further with my superfield than I can with a 20. I may get out a touch further with the 28. It takes more time to scour the retina with a superfield than the quick glances with the 20/28. I think the main thing is that you can depress with the 20 and see ora and peripheral retina by pushing it into your field of view. However, without depression I, like you, get out further at the slit lamp with my superfield (I don't use a 90 so maybe we can get out further with our superfields than others can with their 90s).

 

[Mirror Form]

With a 20D lens and depression you should be able to see out to the ora. My guess is that you probably get out farther with the superfield b/c that is what you're used to using. But in order to do a thorough retinal exam, depression is sometimes required. So it's best to get comfortable with the 20D.

 

[Luxman]

You are right, 20D with depression is known to be the most complete retinal exam. It's also true that I feel much more comfortable with my SF than with a 20D. Anyway in the Volk website they declare a 46°-60° field of view for the 20D versus a 95°-116° for the SuperField...

 

[snowbank]

Quick question for the posters here: with the non contact lens at the slit lamp - whichever one you're used to (either the 78 or 90 or super field or the new digital -- do you have the pt. look in all 4 quadrants? I felt I could also see peripherally IF I did this - but at the expense of time and seeing less pts.

Are you guys saying you can see more periphery with the pt looking straight ahead/or at your eye, or in the cardinal directions!?

 

[Visionary]

Quick question for the posters here: with the non contact lens at the slit lamp - whichever one you're used to (either the 78 or 90 or super field or the new digital -- do you have the pt. look in all 4 quadrants? I felt I could also see peripherally IF I did this - but at the expense of time and seeing less pts.

Are you guys saying you can see more periphery with the pt looking straight ahead/or at your eye, or in the cardinal directions!?

Echoing some of the prior posters, using the SL lens to view the periphery primarily is tedious and you can easily miss things. I use a Volk Digital Wide Field (DWF) to scan the macula and close to the midperiphery without needing the patient to change gaze. It has similar mag to the 90, but has a 50% greater field of view. I then use the BIO and a Volk 2.2 for the peripheral exam. If there's something I pick up with the 2.2 that I'd like a closer look at, I go back to the DWF and have the patient change gaze accordingly. Regarding scleral depression, I normally only depress patients that I suspect of having peripheral pathology (e.g., flashes/floaters). However, I've really only had a few retinal breaks that I've not been able to see with the 2.2 sans depression. It's a great lens for peripheral exams.

 

[MDEYES]

Echoing some of the prior posters, using the SL lens to view the periphery primarily is tedious and you can easily miss things. I use a Volk Digital Wide Field (DWF) to scan the macula and close to the midperiphery without needing the patient to change gaze. It has similar mag to the 90, but has a 50% greater field of view. I then use the BIO and a Volk 2.2 for the peripheral exam. If there's something I pick up with the 2.2 that I'd like a closer look at, I go back to the DWF and have the patient change gaze accordingly. Regarding scleral depression, I normally only depress patients that I suspect of having peripheral pathology (e.g., flashes/floaters). However, I've really only had a few retinal breaks that I've not been able to see with the 2.2 sans depression. It's a great lens for peripheral exams.

Hi visionary, great post. Do you mind to comment about the 20D vs 2.2 vs digital indirect lens? I have a 20D that I have used for the past 2 years but was thinking about upgrading.

thanks

 

[Visionary]

Hi visionary, great post. Do you mind to comment about the 20D vs 2.2 vs digital indirect lens? I have a 20D that I have used for the past 2 years but was thinking about upgrading.

thanks

Don't have experience with the digital BIO lenses, but I definitely prefer the 2.2 to the 20. The 2.2 has a 73 deg max field of view, compared to 60 deg for the 20. That's what gives you the better peripheral images. The mag is a little less (2.68 vs. 3.13), but it's a screening lens. If I want mag, I go back to the DWF, as I stated above. I've also found, as advertised by Volk, that the 2.2 can be used for small pupil (3 mm or so) exams. Takes a steady hand, but you just can't do that with a 20.

Looking at the digital clear field in comparison, the max field of view is about the same as the 2.2 (72 vs. 73 deg), but the mag is a little better (2.79 vs. 2.68). No mention of small pupil capability. At $321 vs. $252 list price, I'm not sure it would be worth the extra coin. Haven't actually used it though.

 

[MDEYES]

Don't have experience with the digital BIO lenses, but I definitely prefer the 2.2 to the 20. The 2.2 has a 73 deg max field of view, compared to 60 deg for the 20. That's what gives you the better peripheral images. The mag is a little less (2.68 vs. 3.13), but it's a screening lens. If I want mag, I go back to the DWF, as I stated above. I've also found, as advertised by Volk, that the 2.2 can be used for small pupil (3 mm or so) exams. Takes a steady hand, but you just can't do that with a 20.

Looking at the digital clear field in comparison, the max field of view is about the same as the 2.2 (72 vs. 73 deg), but the mag is a little better (2.79 vs. 2.68). No mention of small pupil capability. At $321 vs. $252 list price, I'm not sure it would be worth the extra coin. Haven't actually used it though.

What about examining post op retina patients, especially those with intra-ocular gas? will a 2.2 be good enough? I have read that the 30D lens is best for that, what about the 28D? My plan was initially to buy a 28D to complement my 20D but now I am a little confused.

So far I am happy with my SL lenses (digital wide field and super 66) and feel confortable with my 20D, but want to make sure I am not missing out on something better.

Thanks again

 

[Visionary]

What about examining post op retina patients, especially those with intra-ocular gas? will a 2.2 be good enough? I have read that the 30D lens is best for that, what about the 28D? My plan was initially to buy a 28D to complement my 20D but now I am a little confused.

So far I am happy with my SL lenses (digital wide field and super 66) and feel confortable with my 20D, but want to make sure I am not missing out on something better.

Thanks again

I also use a Super 66. Like it, but I'm honestly not sure it's that much better than a 78. As for post-op patients/small pupils, I would probably still go with a 28 or a 30, though you could manage with a 2.2. I actually have a mini 30 that I use for most small pupil exams. Was also good for peds. It's the ultimate screening lens (large field, but very low mag). I really feel the 2.2 is considerably better than the 20. You can get by with the 20, and many retina docs do, but you're helping yourself out a lot with the 2.2.

 

[MstaKing10]

Quick comment on the 2.2 vs digital BIO lens: I like both but for some reason have found the digital BIO to be a much nicer lens. The view to the periphery is very similar, but the image seems a bit clearer for some reason. A bit smaller lens too. Overall, may not be worth the price difference though.

Best rec is to find a colleague who will let you borrow some of these, use them and decide.

Would be curious to know what most think are the "mandatory" or minimum number/type of lenses needed for a comprehensive and/or retina doc?

 

[Visionary]

Quick comment on the 2.2 vs digital BIO lens: I like both but for some reason have found the digital BIO to be a much nicer lens. The view to the periphery is very similar, but the image seems a bit clearer for some reason. A bit smaller lens too. Overall, may not be worth the price difference though.

Best rec is to find a colleague who will let you borrow some of these, use them and decide.

Would be curious to know what most think are the "mandatory" or minimum number/type of lenses needed for a comprehensive and/or retina doc?

I would not be able to get by without my DWF (or 90), 2.2 (or 20), mini 30 (or 30 or 28), and gonio. That's four. I use the Super 66 (or 78) occasionally, but could likely do without it. Laser lenses are another topic.

 

[MR1]

For slit lamp exam, my question is why use the 90 unless undilated. I have a super 66 and the field of view is just as good as a 90 and the mag is much better. Other than small pupils I only use my 90 when looking in the periphery at the SL for more mag than a 2.2 or 20 gives.

 

[Visionary]

For slit lamp exam, my question is why use the 90 unless undilated. I have a super 66 and the field of view is just as good as a 90 and the mag is much better. Other than small pupils I only use my 90 when looking in the periphery at the SL for more mag than a 2.2 or 20 gives.

One thing to keep in mind is that higher mag also magnifies media opacities. If a patient has significant cataracts, PCO, or vitreous opacity the view with a 78 or Super 66 will be worse than with a 90 or DWF. For this reason, I prefer the DWF for screening. That way, I don't have to gauge pupil size or media opacity before choosing the lens. I only use the Super 66 if I really need the extra mag, which is not very often. Subtle macular findings are better seen with SD-OCT anyway.