Lenses

[maz56]

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I need to buy my lenses before I start in a few weeks. Would appreciate your input.
I can buy the basics (90, 20) or go all out and buy the high-end models (digital wide, panretinal 2.2, G4 gonio). Regarding the later option...does the digital wide combine the function of the 90 and 60? does the panretinal 2.2 replace the 20 and 30? Or is it better to get the 90, 60, 20, 30 and a gonio?

So here are the options...
- 90,20
- 90, 60, 20, 30, gonio
- digital wide, panretinal 2.2, gonio

Thanks for the input.

 

[JMK2005]

This old thread may be useful...

http://forums.studentdoctor.net/showthread.php?t=280636&highlight=volk+lenses

 

[brendang]

i would recommend against the 78... you can see everything you need with a 90 and the resolution of a 78 is inferior. i would recommend a 28 or a 30 over a 20 or 2.2 (wider field of view and able to see through small pupils)... ultimately, i'm not a big fan of magnification. as one wise pathologist has told my class, "magnification makes what you don't know bigger..."

 

[Free Radicle]

What are digital lenses?

 

[rubensan]

as one wise pathologist has told my class, "magnification makes what you don't know bigger..."

very true!

 

[rubensan]

What are digital lenses?

it's a rather expensive lens that gives you great stereo. they are useful (but by no means mandatory) for viewing CSME (clinically significant macular edema).

 

[JL_Nightwing]

our residency gave us a 90, 2.2, 4-mirror Sussman (large or small ring)
then most residents bought a 28 and a 66 (vs. 60 or 78)

a 1.0 mag lens (60 or 66) can be helpful for evaluating optic nerve head size by slit beam height
I think the large ring gonio is easier to hold at first
Starting with the basics is fine. I didn't feel there was a huge advantage to the digital lenses for the price.

Personally, I just carry a 90, 28, and 4 mirror small gonio in a 3x4 box

you can ask the local Volk and Ocular Instrument reps to bring all their lenses to demo (most people seem to find Volk slightly superior), be sure to get the glass type lenses

 

[V05]

I started residency with 78D and 20D and found them adequate for most exams.

78D gives a good balance between magnification and field of view. I also find that I can get through most pupils without much difficulty (therefore, I don't think a 90D is necessary). I have tried some digital high mags but I didn't find them to be worthwhile enough to replace my existing lenses. For traditional lenses, I do not think you can have just a 90D or 60D- you should have both or the 78D.

For the peripheral retina, I purchased a 28D lens in additional to my 20D. I use both of them routinely- the 28D gives you a wider view and is helpful in small pupils and/or looking at and lasering the far periphery. I use the 20D for most of my routine exams because it is easier to identify the lesions with a higher magnification.

For gonioscopy, I prefer a small base gonioscope such as the Posner because I can use it for compression gonioscopy to break acute angle closure attacks. A wide based gonioscope like the Sussman are easier to use, especially for beginners, for routine gonioscopy.

I cannot comment on the panretinal 2.2- I have never tried it.

 

[FlyingDoc]

This is what I use:

Pan Ret 2.2 for most everything except really small pupils. Then I switch to my 28. I tried the Digital Clear field too... it gave a view like the 2.2, but for about $100 more -- so I returned it.
With the 2.2, you get a wider field than a 20, and only with a small sacrifice in image mag. I routinely have no trouble seeing out to the ora with it. And it is great for PRP. I've done over 100 PRPs with it now and it is far superior to using a 20. The only downside to the 2.2 is that it is heavier and slightly bigger than the 20. So it is sometimes harder to get a view in a deep orbit or in a patient with a large nose (but by having the patient turn their head a bit you can always get the view you need).

As far as slit lamp lenses go -- I learned on a 90 and 78, but I am a big fan of the Super 66. I use this lens almost exclusively (except for small pupils or patients who are big squeezers -- then I switch to my Super Field lens). The 66 is great because you get 1.0x mag (good for measuring the optic nerve, lesions in the fundus, etc), plus it gives you great stereo.

If you want to be technical about it, check out these tables (compiled from the Volk website) about field of view/dynamic field of view, image mag, laser mag, working distance
and you can get a good idea of what lenses you want for what purpose.

For Indirect Use:

PanRet 56/73, 2.68, 0.37, 44mm
20D 46/60, 3.08, 0.32, 50mm
Digital ClearField 55/72, 2.79, 0.36, 37mm
28D 53/69, 2.27, 0.44, 33mm

The PanRet gives you more field (56/73) than the 20 (46/60) and the 28 (53/69), with a mag (2.58) in between the 20 and 28.

For Slit Lamp Use:

SuperField 95/116, 0.76, 1.3, 7mm
DigitalWF 103/124, 0.72, 1.39, 4-5mm
90D 74/89, 0.76, 1.32, 7mm
Super66 80/96, 1.0, 1.0, 11mm
78D 81/97, 0.93, 1.08, 8mm

Last point, I would consider the working distance into your purchase equation. I personally did not like the short working distance, like 4-5 mm, of the Digital Wide Field or the SuperVitreoFunus lenses because you're basically up on your patient's eyeball. Lashes constantly rub your lenses and you end up needing to clean them more often.

In summary: get the Pan Ret 2.2 and the Super 66, you won't be let down.

This is a brief "super geek" analysis of why I chose the lenses I did.

 

[dk23]

What if you had to choose between the following three. The first two give you 1.0x mag. Is 1.0x mag that much more convenient for measuring lesions that you would do without 1.3x mag? If 1.0x mag IS important, are the digital benefits worth the smaller field compared to the Super 66? Thank you.

Super 66
80°/96° 1.0x 11mm

Digital 1.0x
60°/72° 1.0x 12mm

Digital high Mag
57°/70° 1.30x 13mm

 

[rubensan]

do you have to choose right away? if not, why not try out some of your seniors' lenses? the differences that you have listed are slight. all 3 would serve you well. i can tell you why i like the digital 1.0x better than the super 66, but someone else may tell you that the digital lenses are over-rated. others hate the fact that the working distance is much less. i started residency with a 90D and 2.2. i then purchased the other lenses that i liked once i felt that they were necessary.

What if you had to choose between the following three. The first two give you 1.0x mag. Is 1.0x mag that much more convenient for measuring lesions that you would do without 1.3x mag? If 1.0x mag IS important, are the digital benefits worth the smaller field compared to the Super 66? Thank you.

Super 66
80°/96° 1.0x 11mm

Digital 1.0x
60°/72° 1.0x 12mm

Digital high Mag
57°/70° 1.30x 13mm

 

[OMD]

Many companies will also let you borrow a lens for a month or so before you buy. I did this before purchasing a second slit lamp lens and wished I had done it before buying any of them.

 

[ryangeraets]

To be honest with you, any of the above lenses will suffice. They all have their SUBTLE differences, but with time you will become proficient with any of them. The only time you will notice any significant difference between them is after you have examined thousands of patients, and by then you should be able to switch between lenses without much difficulty and know each lens's nuances and differences in magnification for measuring the sizes of lesions.

The long and short of it is this: as a first year, your examination will not be made or broken by the lens you are using (78 vs 90 or 20 vs 28), it will be made or broken by your persistence (or lack thereof), and your konwledge of what you need to look for during your exam given a particular patient's problem or complaint.

 

[4424]

do most people prefer the large or the small ringed ocular sussman gonioscope? is there any adv/disad besides preference? thank you!

 

[FlyingDoc]

do most people prefer the large or the small ringed ocular sussman gonioscope? is there any adv/disad besides preference? thank you!

I use the small ring sussman. No problems with it for me. My program gave it to me, so I really had no choice.

 

[Free Radicle]

Took my first call last night and would agree for the first timer a 28 gives you a much easier view. Thanks for the advice. Used both 90 and 78 (senior resident's) and found 90 to be easier to get a steroscopic view with. Just my 2 cents.

 

[Visionary]

After comparing specs on a number of lenses, I ended up starting with a Digital Wide Field, a Super 66, and a 2.2 Pan Retinal. The DWF came out a month before I bought it, so I paid the technophile tax.

Having used these lenses for the past 2 years, I've not been disappointed. The DWF has mag equivalent to the 90D, with 50% greater field of view and similar small pupil capabilities. The Super 66 has better mag and, I think, better stereoptic view than the 78D. The 2.2 Pan Retinal has less mag than the 20D, but considerably better field of view. It is, after all, a "big picture" lens. You can see out to the ora in well-dilated eyes without scleral depression!

I've convinced some of my peers to pick up these lenses, once they've tried them.

I've since added a G-4, large ring, handle-less gonio. Have found it rather handy, both in the clinic and on call. I also now carry a mini 30D for infant exams and small pupil (e.g., post-op, quick call) exams.

All of these fit in the large Volk box, which fits nicely in my lab coat.

For the true technophile retina dogs, like myself, consider picking up the Keeler Spectra Plus on the new sport frame, as well. It's remarkably affordable, as BIOs go (~$1200), and rather unobtrusive. I wear it in clinic, even while at the slit lamp (you'll understand why I wear it in clinic in a moment). It's also the ONLY BIO (spectacle-mounted or otherwise) to use an LED light source. This provides a cooler color temperature, yielding a much clearer image. I've seen things with it that I've not been able to see with any other BIO. I believe that LEDs are the wave of the future. I've already convinced one of my retina attendings to pick one up. Other nice perks: increased battery life (I haven't recharged my pack in over 5 months of daily use on call AND in clinic!), no bulb replacement, and people look at you like "what the $%#^ is that?!".

My 2 cents. 😎