Is it worth buying your own indirect?

[Cdnophthalresident]

Hi guys,

I'm a canadian resident here just starting out. I did a search and it seems like most american residents do buy their own binocular indirect ophthalmoscope, whereas it's more the fellows here in Canada that buy their own. Most residents use the program's or the call bag.

If I wanted learn (and practice) a good scleral depressed exam, would it be worth the investment to get one for myself? Do you guys find you learn better having your own personal tool? I am interested at this time on doing a retina fellowship potentially down the road. I find that some of the on-call ones can be pretty beat up.
Thanks so much!

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[LightBox]

I don't think it's worth it to buy your own. They are really expensive. But if you must buy one, form a LLC and then buy one through the LLC. Then you can depreciate the indirect so you pay less in overall taxes.

 

[MstaKing10]

I don't think it's worth it to buy your own. They are really expensive. But if you must buy one, form a LLC and then buy one through the LLC. Then you can depreciate the indirect so you pay less in overall taxes.

Unless they are moonlighting and generating a fairly significant income on their 1099 then likely it's not worth forming an LLC. Probably on a resident salary the standard deduction will suffice and be better than itemized deductions, especially with new tax code. Of course the OP is Canadian so not sure what tax law is there.

To answer the original question, buying your own indirect is rarely necessary. They are available in most clinics and on call bags. Having your own doesn't really help you become better at scleral depression, only practice does. Becoming good with various different indirects will likely improve your exam skills and make you more versatile which comes in handy if you join a practice with multiple offices or the like. I wouldn't buy it.

 

[Cdnophthalresident]

Thanks so much guys for the input! I don't think then I'll get it...it is pretty expensive actually, around $2200 for Keeler Vantage.
Other than my lenses and loupes, any particular other equipment you think would be worth the investment?

 

[LightBox]

If I was a resident again, I wouldn't buy expensive loupes either especially if you have no intention of going into plastics or peds. Definitely overkill.

I would just get a 78D or 90D lens, goniolens, and a 20 or 28D lens. That's it. Don't most program provide these for their residents?

 

[Cdnophthalresident]

If I was a resident again, I wouldn't buy expensive loupes either especially if you have no intention of going into plastics or peds. Definitely overkill.

I would just get a 78D or 90D lens, goniolens, and a 20 or 28D lens. That's it. Don't most program provide these for their residents?

Sadly we have to get our own lenses, as well as loupes as well (at least for our canadian program).

 

[DrZeke]

Not mine...

 

[Equality]

If you decide to go into oculoplastics or pediatrics, it's a good idea to get custom-made loupes before graduating from residency so secure the "resident discount." Fellows don't get this discount!

 

[Cdnophthalresident]

Yup got myself a nice pair of TTL loupes!

 

[increscence]

It depends on your program. All of your clinics should have an indirect in every exam room, but you still need an indirect to do floor and ER consults. If you have access to a portable indirect (i.e., not mounted to the slit lamp tower) for all these settings, and you can borrow it from clinic after-hours, then you're good. Some of my coresidents bought their own indirects, but I just can't justify the cost.

You do need lenses. Not all programs provide these. As others mentioned, you need 1) a 90 or 78 (doesn't matter which), 2) a 20 or 28, and 3) a 4-mirror gonio (handle or not, doesn't matter. Also consider a Sussman instead of the traditional Volk - I find the Sussman easier to hold on the eye when patients squeeze their eyelids).

You need a handheld eye chart for bedside consults, as well as +2.50 readers. I got a chart that has distance on one side and near on the other.

A quality pen light with a focused beam of light (doesn't have to be a full-blown muscle lamp) is really helpful. Cell phones are totally inappropriate for pupil exams (yes, people actually do this).

You need a copy of the Wills Manual or other solid on-call guide.

Things you might consider later on in residency, but shouldn't buy right away:
- Scleral depressor - You can get by with a Q-tip.
- Desmarres retractor - They're cheap, and they do help with trauma consults, but you can improvise one at the bedside with a paperclip. I've only had to do this 2-3 times in residency. I personally don't want to deal with lugging around the extra equipment.
- Jewelers - Because the ones in clinic are often bent and defective. You can get one for like $30 with the resident discount at the major conferences.
- Extra lenses, like a 3-mirror or a 66
- Loupes. The $60 non-custom loupes from Amazon look dorky, but they absolutely work. Don't drop $1500 on custom Designs for Vision loupes until you decide that you're doing plastics or peds.


Another thing you might consider is some instruments to practice suturing at home - needle driver, 0.12s, tiers (tying forceps), Westcott or Vannas. It takes time to learn how to work under loupes/the microscope. I'd sooner put money toward instruments than toward an indirect.

 

[Cdnophthalresident]

Thanks so much! it's amazing how much great advice you guys have.
I didn't think about the surgical instruments, and that's definitely something that I want to work on. I'll see if my program will let me borrow/use some instruments to work with and continue working hard. I have already bought the loupes but it'll be worthwhile to keep practicing on suturing material. Would you say suturing foam would be a good start?

 

[skarim]

Regarding loupes, oculus has some Easyloupes that are like $300-400 dollars or so and are excellent. I use them for scleral buckles. Super expensive loupes I think are unnecessary.