Lenses

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ophtho_applicant15 said:
My family wants to give me a set of lenses for medical school graduation. Does anyone have any experience with the Digital Lens set from Volk (http://www.volk.com/index.php/volk-...s/volk-lens-sets/volk-digital-lens-set.html)? Or have any other suggestions?
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I used to borrow my co-resident's digital lenses in the past and never really noticed a difference (thought I wasnt really paying attention). I'd just get a 90, and 20 and a gonio. I have a 78 that I never use. If you can find yourself a used Nikon 20 lens (they dont make them anymore), get the used Nikon. They are far better than the Volk lenses.
 
I use a Nikon 20, a Volk 90 and a Volk 60. I really like the basic 60 lens over the super 66, although that's personal preference only. I also have a Nikon 28 and a 6 mirror gonio lens (4 mirror is fine too). A 90 is excellent for wide viewing at the slit-lamp or undilated fundus exams. The 60 gives good mag of the optic nerve and detailed views of the periphery in well dilated eyes. I also have a Volk 20 mm fundus contact lens. Nobody really uses those anymore for eval of DME since OCT is so available, but the view is outstanding compared to non-contact methods.
 
ophtho_applicant15 said:
My family wants to give me a set of lenses for medical school graduation. Does anyone have any experience with the Digital Lens set from Volk (http://www.volk.com/index.php/volk-...s/volk-lens-sets/volk-digital-lens-set.html)? Or have any other suggestions?
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Several of my classmates and retina people have the digital widefield. If you learn on something different like that you won't know any different. But, probably using someone else's 90 if you don't have your lenses will be weird after learning on it.

I think in terms of interchangeability and learning, starting with 90 and 20 ( and maybe a 78) and a 4 mirror gonio lens is a good idea. I plan on eventually buying another lens depending on my subspecialty....
 
The old stand by lenses are the 90 and 20. They'll be good for most anything. That said, I think the Digital Wide Field is the best slit lamp lens ever. When I'm at one of our satellites, I miss it. I'm also a fan of the 2.2 for indirect ophthalmoscopy. Good small pupil capability and some of the best peripheral views you can get. Most pathology I can pick up without significant scleral depression. It's noticeably better than a 20. I have three other lenses in my case that I use to varying degrees: Volk 4-mirror gonio, mini 30, and Super 66. The latter is the least used. It's similar to a 78. Just don't need that much mag. I just use the DWF and up the SL mag.
 
90 and 20 are the go to lenses for me, though I periodically like to use the DCF indirect BIO lens that gives great views of the periphery in small pupils. I have a DWF slit lamp lens and a 78 that gets little use (I don't like all the mag). I have a volk 4 mirror gonio lens that I use frequently to round out the collection.
 
I really want a DWF. I've heard great things.
 
the digital wide field is great for the periphery. Not so great for the macula. You will miss a lot of fine macular pathology with the digital widefield because of less stereopsis, less magnification and increased glare. I use the digital widefield, Nikon 20, and a 60D. 60D is kind of old school, a great lens for macular viewing, and not as expensive or bulky as the super 66.
 
Never had issues with macular evaluation with the DWF, and I've been using it for over 8 years. Equivalent mag to the 90, plus you can tilt with it on a Haag. Never have noticed glare issues either. When I want more mag, I have the Super 66, but 60 would serve that purpose. Of course, the SD-OCT sees more than I could even with a contact lens.
 
Agree with the digital wide field being a good lens to see a little further out into the periphery. The only downside is that it gets dirty easily as you have to hold it close to the patient's lashes.

Any preferences on scleral depressors? I know the Schocket is the most popular type. But I've heard of others as well, such as the Josephberg-Besser which is supposed to be more comfortable for the patient. (and I still have no idea what the bulb on the other end of the Schocket scleral depressor is supposed to be used for?)

Has anyone used any good macula BIO lenses for closely examining the macula with the indirect in elderly or bed bound patients who can't get into the slit lamp?
 
I think that experience definitely makes a difference, and with time more subtle findings can be seen with a lens like the DWF. I'm not as experienced as Visionary. I fairly recently finished retina fellowship, and I know that with my own exam, I definitely see macular edema better with a 60D than the DWF, when comparing to OCT. Try both and test yourself compared to OCT to see if you notice a difference. A contact lens sees even more, I also have a 3 mirror gonio but never pull it out.

For residents, I think it's a great habit to really look at the macula with a high mag lens and test yourself against the OCT. It's easy to get complacent and just look at the OCT. As a fellow and attending that has participated in the training of residents, I've seen how residents can have trouble making out subtle macular findings. I think if you can afford it, a high mag lens just gives you extra help.
 
For high mag BIO lenses, the Digital High Mag is probably what you want. Equivalent old school lens would be the 15 D.
 
I think the bulb end on the Schocket is for getting deeper behind the globe (under the lids), which is probably just for the OR. Never used that end.
 
I use my 78 all the time for undilated exams on short glaucoma returns. Sometimes all you're looking at is the nerve head, people don't want to be dilated every time, and it saves time in busy resident clinic to not have to wait on dilation. You just wanted to recheck the visual field, IOP, and nerve. Also sometimes people just refuse dilation. Some people claim that the 90 is the best for undilated pupils, but optically that doesn't make sense to me and clinically I find it much easier to view the nerve and often much of the macula in undilated patients with the 78.
 
I use a Nikon 20. I think it is much better than the Volk 20, especially when using for indirect laser. You can tilt the lens and get laser out to the ora without depression which is nice for PRP and lasering breaks. As a resident I bought most of the different macular lenses, but have really only used a 90 since fellowship. I've never felt like it doesn't provide enough mag. I would definitely buy a 28 for use on peds, undilated pupils, and if you do retina it is essentially for seeing into gas filled eyes, doing laser through gas if you need to add post-op, or placing laser in a pneumatic patient after injecting a gas bubble.
 
Another plug for the Nikon 20D. They pop up occasionally on ebay. Great view and I find it has less reflections/glare than the Volk 20D and especially the 2.2.
 
Nikon 20D and Super 66 most of the time. DFW gets oiled up way too much
 
Does anyone have experience with the Superfield NC lens by Volk? I was interested in the digital wide field, but many people are commenting that the 4-5 mm working distance creates build-up from the eyelashes. At least based on the specs from the website, it seems like the Superfield could be a good balance between increased field of view while keeping the same mag and same working distance.

1) Superfield (95/116 degrees, .76 mag, 7 mm working distance)
2) Digital wide field (103/124 degrees, .72 mag, 4-5 mm working distance)
3) Regular 90 diopter (74/89 degrees, 0.76 mag, 7 mm working distance)
 
The Superfield is also very good for peripheral viewing, pretty much just as good as the DWF.
 
I'm trying to decide between a 78D and 60D lens. From what I have read, both are used for higher magnification of the macula or optic disc. Since 60D has higher magnification, how is it not superior to the 78?

I'm also trying to decide between the 90D and DWF lenses. From what I have read, the main advantage of the 90D is the ability to see through small pupils. Is this true? And how often do you run into the situation of needing to examine though small pupils?
 
peter2013 said:
I'm trying to decide between a 78D and 60D lens. From what I have read, both are used for higher magnification of the macula or optic disc. Since 60D has higher magnification, how is it not superior to the 78?

I'm also trying to decide between the 90D and DWF lenses. From what I have read, the main advantage of the 90D is the ability to see through small pupils. Is this true? And how often do you run into the situation of needing to examine though small pupils?
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Have you looked at the Super 66? I like being able to measure things on the slit lamp without needing a conversion. It's right between the two.

We examine the optic nerve of all glaucoma patients through an undilated pupil. Once you get the hang of it it doesn't matter what lens you use.
 
I wasn't aware of this convenience for the Super 66. I'll take a closer look at that lens. Thanks!
 
eye love lamp said:
We examine the optic nerve of all glaucoma patients through an undilated pupil. Once you get the hang of it it doesn't matter what lens you use.
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To establish CDR? really? Without stereopsis? Or just to check on it periodically. In my program we do DFE on our glaucoma patients yearly to get a nice look at the nerve with two eyes. I can see the nerve in a small pupil but I may not get the same CDR.
 
the tradeoff between the 60D and 78D is magnification for field of view. There wouldn't be much point in getting both a 90D and a 78D, they are too similar. The DWF and 60D/Super66 makes a nice combination.

the digital wide field is excellent for an undiluted pupil.
 
A 20D and 90D are the classic lenses that most clinics carry, and are all that you need
+/- 28D if thinking about retina or peds.

The Super66 is a nice lens that is similar to a 78D, but you shouldn't get these over a 90D (or DWF) since you will need to do many nondilated exams in comp/cornea/glaucoma.
I personally don't like the DWF because the working distance is very close and the lenses get really dirty after every exam with patients' lashes/blepharitis
I like the 20D over the fancier panretinal (too big, nose gets in the way) and "digital" lenses (the coating comes off quickly and you get more glare)

Fancier lenses are fine, but that's not what makes a good ophthalmologist
 
So if you have a 90 and willing to get another one would you get a 78, a super66 or DWF?
 
Mokaccino said:
So if you have a 90 and willing to get another one would you get a 78, a super66 or DWF?
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I actually have both a 78 and a 90 and sometimes when looking at macular pathology or fine detail on the disc I use the 78. I had no clue and just bought both...

I can see into an undulated pupil with 78 and 90, neither gives me great stereopsis when undilated.
 
Mokaccino said:
So if you have a 90 and willing to get another one would you get a 78, a super66 or DWF?
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I would get either the 78 or Super66 (personally Super66 > 78; I like both lenses though). I think a DWF would be redundant.

Depends how big the undilated pupil is: 90 will be better at giving you stereo than 78. It helps to keep the slit beam small. FYI for new patients you'll be dilating most of them, and for non-retina followups it's less essential to have the perfect stereoptic view every visit, so I think it's still good to have a lens that can see through undilated pupils.
 
DrZeke said:
To establish CDR? really? Without stereopsis? Or just to check on it periodically. In my program we do DFE on our glaucoma patients yearly to get a nice look at the nerve with two eyes. I can see the nerve in a small pupil but I may not get the same CDR.
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Well everyone in glaucoma has a DFE annually, we check the nerve every visit. Even if you can't get stereo, if you identify a disc hemorrhage it could potentially alter your management.
 
JayZBlue said:
A 20D and 90D are the classic lenses that most clinics carry, and are all that you need
+/- 28D if thinking about retina or peds.

The Super66 is a nice lens that is similar to a 78D, but you shouldn't get these over a 90D (or DWF) since you will need to do many nondilated exams in comp/cornea/glaucoma.
I personally don't like the DWF because the working distance is very close and the lenses get really dirty after every exam with patients' lashes/blepharitis
I like the 20D over the fancier panretinal (too big, nose gets in the way) and "digital" lenses (the coating comes off quickly and you get more glare)

Fancier lenses are fine, but that's not what makes a good ophthalmologist
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I agree. 20 D has always been my favorite. The digital lenses give a dimmer image than the 2.2 or 20.

Instead of the 28 I bought a 30 (large ring, not the small ring) and really like it. It gives you a little extra angle for a negligible decrease in magnification.
 
JayZBlue said:
A 20D and 90D are the classic lenses that most clinics carry, and are all that you need
+/- 28D if thinking about retina or peds.

The Super66 is a nice lens that is similar to a 78D, but you shouldn't get these over a 90D (or DWF) since you will need to do many nondilated exams in comp/cornea/glaucoma.
I personally don't like the DWF because the working distance is very close and the lenses get really dirty after every exam with patients' lashes/blepharitis
I like the 20D over the fancier panretinal (too big, nose gets in the way) and "digital" lenses (the coating comes off quickly and you get more glare)

Fancier lenses are fine, but that's not what makes a good ophthalmologist
Click to expand...

I haven't read about the coating coming off of the digital lenses. Has anyone else experienced this issue?

And is the nose getting in the way of the panretinal a deal breaker?
 
peter2013 said:
I haven't read about the coating coming off of the digital lenses. Has anyone else experienced this issue?

And is the nose getting in the way of the panretinal a deal breaker?
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I started residency last fall and I got a panretinal 2.2, DWF, super 66, and a 4-mirror gonio (with a large ring, big man hands here). I also would recommend getting the Josephberg-Besser scleral depressor. Love all of them and would highly recommend this set to a starting resident.

Only a handful of times this year I've not been able to do an exam with the 2.2 because of somoene's nose being in the way. In these 2-3 cases, I just borrowed someone's 20.
 
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