Loupes

[blu]

I'm in the market for loupes, and have done a search of the forums for info. However, I am looking for some current opinions from surgeons. A lot of the posts are on the dentistry forums.

First of all, I'm wondering why just about every surgeon I know owns Design for Vision. Are their optics so superior over everyone else's? I would like to find a pair of sports frames, rather than the traditional military issue black frames, and DFV doesn't seem to offer them.

Other names I've heard include Orascoptic, for example, which is directed toward the dentistry crowd. As much as doctors snub their noses at dentists, they do do more intricate work a lot of times. So could their loupes actually be better? (They also earn a helluvalot more money because of insurance reimbursements, from what I hear, so they can probably afford better loupes).

Any thoughts? Thanks.

---

Members don't see this ad.

 

[surg]

Loupes are a personal thing. There is no substitute for trying them on and seeing what feels and looks the best to you. I have Surgical Acuity (the medical arm of Orascoptic) loupes and love them. (I have 2.5x TTL if it matters). I also have friends that have DFV's and love them equally as much as I love mine (BTW, I'm pretty sure that DFV now makes a metal frame instead of just the black frames). I even have friends that have Surgitel flip downs and love those.

For my intern class, I called all 3 brands' reps and arranged for them to come on the same night (and brought dinner) and all the various surgical interns and even a number of upper levels and attendings came and tried on all the competing brands one after another. I think the 3 reps ended up selling ~30 loupes in ~3 hrs so everyone went home happy (and we all got a discount).

 

[Winged Scapula]

My program required that you have them by R2 - mostly for Peds Surg as the attendings frankly won't let you operate on the teeniest ones without them. It was paid for the categoricals so we ordered them early spring of intern year.

DFV are marketed the most, so the observation that most people have them is likely a function of that, rather than any real superiority of their optics. They do have a wire frame style in addition to the "Buddy Holly" style but frankly I found them both so geeky looking that it didn't make any difference and I figured the latter would hold up better than the wire frames.

Check the Plastics forum - there was a discussion a ways back about loupes there; these guys need the best optics for their microvascular work.

 

[tussy]

I never bought a pair during my residency and never really needed them. Peds surg with premies was probably the only place they would have been useful, however, i doubt i would have gotten to do any of those cases when i was a PGY2 on my peds rotation anyway; loupes or not. For everything else in general surgery i got by just fine with my natural god-given eyeballs.

So, if your program isn't paying, and doesn't require them, then don't bother wasting the money.

 

[ESU_MD]

you certainly need loupes. i only wish I had gotten them sooner- like day 1 of intern year. now that i am used to them, i wear them for every case except laparoscopic cases. even if the attending makes fun of me. i cant see without them

it would be tough to wear loupes as a junior though if your attending doesnt. i dont reccomend that

as for type- designs for visions. thick black frames, 2.5x is great for general. any thing else besides the thick frames is for the 80hr workweek lovers. the only thing that sucks is my neck may be shot by the time I can adjust the table !

and flip-downs, well.....

 

[Pilot Doc]

I never bought a pair during my residency and never really needed them. ...
So, if your program isn't paying, and doesn't require them, then don't bother wasting the money.

Isn't vascular surgery a separate specialty in Canada? i.e. you never had to do an anastamosis with 6-0 prolene.

 

[Pilot Doc]

Another general trick to keep in mind is that if your program
1) doesn't pay for loupes
2) does offer a health care reimbursement account, AND
3) you wear glasses normally,

then you can buy them using #2 and get them tax free.

 

[Winged Scapula]

Would loupes be tax deductible as a resident if you did have to pay for them?

Just wondering...

 

[surg]

Assuming that you are training at a program that gets you a lot of vascular or transplant experience, you will find that having loupes really helps for the small anastamoses unless you have amazing vision or are just that good. I also wear my loupes for pancreatic anastamoses on all but the biggest ducts and often for radical necks and parathyroid/thyroid surgery, but certainly this is not really necessary for many people.

As to when, I'd say, get them at least a few months before you would need them in case you find out you don't like them. Try doing some things at home with them before taking them to the OR. For the first few cases you will find them annoying, but after a while you won't remember how you did the case without them.

KC- loupes may be tax deductible as an unreimbursed employee expense (Form 2106 I think), I would think, however, to take that deduction you need to be itemizing your taxes (on schedule A) and they are subject to the 2%AGI rule (you only can deduct the amount over 2% of your adjusted gross income). On the other hand if you are moonlighting, you may be able to deduct them (or at least a portion of them) on your schedule C as a business expense if you bought them and use them for your moonlighting job. This has the advantage of decreasing the income directly and is not subject to the 2% issue. Requisite disclaimer: Not a tax professional. It's free advice and worth even less than you paid for it. For real advice consult a real tax professional.

 

[Dr. V]

Yeah, I think they would be deductable as well. My tax guy said everything I bought for residency, be it books, PDA, Computer, mileage, etc could be deducted.

Of course he could be wrong as I haven't taken him up on it due to the fact that itimization would not have helped me last year. This year it will and I plan on taking him a shoebox full of reciepts Hopefully he is correct and it helps me next year.

 

[Winged Scapula]

KC- loupes may be tax deductible as an unreimbursed employee expense (Form 2106 I think), I would think, however, to take that deduction you need to be itemizing your taxes (on schedule A) and they are subject to the 2%AGI rule (you only can deduct the amount over 2% of your adjusted gross income). On the other hand if you are moonlighting, you may be able to deduct them (or at least a portion of them) on your schedule C as a business expense if you bought them and use them for your moonlighting job. This has the advantage of decreasing the income directly and is not subject to the 2% issue. Requisite disclaimer: Not a tax professional. It's free advice and worth even less than you paid for it. For real advice consult a real tax professional.

Thanks for the detailed information. I didn't ask for me, as my loupes were paid for by my residency program and I haven't used them since I was Chief on Vascular, but figured others reading this thread might want to consider deducting them, if it was allowed. Mine are getting dusty on my dresser!

 

[toofache32]

I bought a pair of DFV loupes in dental school and loved them. Now I'm an oral surgery resident and my focal distance is different now that I work standing up. The DFV rep came to the hospital and re-measured me, took my loupes, and mailed them back in 2 weeks adjusted to my new measurements....for free. They have good customer service, but I suppose the other brands are probably similar.

 

[Guile]

Would loupes be tax deductible as a resident if you did have to pay for them?

Just wondering...

I have an accountant in the family. Hands down, yes they are tax-deductible.

Shoot, even the depreciation of your computer, PDA, etc is deductible. That's why it's worth it to have a GOOD accountant.

 

[njbmd]

First of all, I'm wondering why just about every surgeon I know owns Design for Vision. Are their optics so superior over everyone else's? I would like to find a pair of sports frames, rather than the traditional military issue black frames, and DFV doesn't seem to offer them.

Other names I've heard include Orascoptic, for example, which is directed toward the dentistry crowd. As much as doctors snub their noses at dentists, they do do more intricate work a lot of times. So could their loupes actually be better? (They also earn a helluvalot more money because of insurance reimbursements, from what I hear, so they can probably afford better loupes).

Any thoughts? Thanks.

My program buys our loupes and works with Design for Vision. Since I was not about to say "No" to them purchasing my loupes and spending a few hundred of my dollars, I am wearing Design For Vision. The rep came and fitted all of us during orientation week when we were PGY-1s. My program also purchased headlamps for us too. Again, I wear and use what was free. I have had no problems with my loupes or headlamp. Since we use Designs for Vision, they are upgrading (extended field of vision and increased magnification) my loupes (I am going into vascular surgery) at no cost to me.

When I am in practice, I might change brands or go to something else but for now, these work and the price was definitely right.

 

[Guile]

My program buys our loupes and works with Design for Vision. Since I was not about to say "No" to them purchasing my loupes and spending a few hundred of my dollars, I am wearing Design For Vision. The rep came and fitted all of us during orientation week when we were PGY-1s. My program also purchased headlamps for us too. Again, I wear and use what was free. I have had no problems with my loupes or headlamp. Since we use Designs for Vision, they are upgrading (extended field of vision and increased magnification) my loupes (I am going into vascular surgery) at no cost to me.

When I am in practice, I might change brands or go to something else but for now, these work and the price was definitely right.

You're not going to keep the 2.5x ones and get a separate pair with increased magnification? I know some CT guys who still have their 2.5x from residency, and they wear them for valve cases because they don't need the increased magnification.

 

[tussy]

Isn't vascular surgery a separate specialty in Canada? i.e. you never had to do an anastamosis with 6-0 prolene.

Still had to do 6 months of vascular. I did do anastomosis with 6-0 prolene and just got a bit of eye-strain. Also would have been nice for those pancreatic anastmosis. But, i'm not doing either of those things now that i'm done my residency and i wasn't about to buy an expensive pair of loupes for just those rotations when i was able to get by without. No residents in my program bought them except the ones that knew they were going into vascular or peds surg.

 

[Bill59]

Designs for Vision offers a titanium frame, but they usually don't recommend that for the higher mag because they aren't as sturdy. But an associate got the titanium anyway because they're lighter and he hasn't had any problems. If they don't offer, ask about a discount for residents.

I wanted a mirror sunglass type lens (like State Troopers) but they weren't very helpful with that.

Oh yea, technically they're called surgical telescopes. Loupes are those little things jewelers use.

 

[Winged Scapula]

Designs for Vision offers a titanium frame, but they usually don't recommend that for the higher mag because they aren't as sturdy. But an associate got the titanium anyway because they're lighter and he hasn't had any problems. If they don't offer, ask about a discount for residents.

I wanted a mirror sunglass type lens (like State Troopers) but they weren't very helpful with that.

Oh yea, technically they're called surgical telescopes. Loupes are those little things jewelers use.

Do you know ANYONE who actually calls them surgical telescopes? It may be technically correct, but frankly loupes are the commonly used phrase by residents and practicing surgeons alike.

 

[Pilot Doc]

i wasn't about to buy an expensive pair of loupes for just those rotations when i was able to get by without. No residents in my program bought them except the ones that knew they were going into vascular or peds surg.

Fascinating. maybe an american/canadian cultural difference, but at the two programs I've been associated with EVERYONE bought loupes and the attendings (and probably most other residents) would have thought you a weak and uncommitted dilletante to do anything otherwise.

 

[Skylizard]

surgical Loupes/telescopes, etc...

My impression from what I have seen.... granted, limited impression:

Generally "major" university PGY1 possibly PGY2 residents are often not allowed to perform finer portions of procedures i.e. vasc anastomosis and/or pede surgery procedures.

Much community programs on the other hand may allow more junior residents earlier operative responsibilities and experience....

Thus surgical Loupes/telescopes are useful PGY1 & 2 in community based programs.... just my experience/impressions/and/or opinion.

I know at my community program, PGY1 & 2 do in fact participate in vascular procedures beyond amps and do in fact participate in pediatric surgery. The primary resident service is a PGY1 & 2 & a PA for pediatric surgery where I train.

I deducted mine on my taxes.

 

[toofache32]

Fascinating. maybe an american/canadian cultural difference, but at the two programs I've been associated with EVERYONE bought loupes and the attendings (and probably most other residents) would have thought you a weak and uncommitted dilletante to do anything otherwise.

Geez, gimme a break. This is also the typical gorilla attitude of the general surgeons at my institution. As if everything you do is a marker of your character, moral fiber and worth as a surgeon.....or lack thereof.

 

[Blade28]

We were all required to order our loupes in time for our PGY-2 vascular rotations. They weren't required for the PGY-1 peds surg rotations.

I found them especially helpful in CT surg as well.

Every resident here has the DFV (black frame) ones - we get a slight discount from them.

 

[maxheadroom]

In plastics we urge our interns to get them pretty quickly. I think that for your first couple of months of face call it makes a huge difference to sew up lacs with loupes -- I just felt like I had a better appreciation for the repair. I don't use them for that kind of stuff nearly as much these days. I use mine daily for hand surgery and harvesting flaps, though. DFV 2.5, Buddy Holly style.

 

[SocialistMD]

Surgical Acuity just came out with wrap-around sport frame loupes made of carbon fiber. They look pretty silly, but I'm sure there will be at least one person in my program who will buy them.

 

[Guile]

I had a question and didn't think it warranted its own thread. I've noticed a lot of older attendings using what appear to be old pairs of loupes. (As in it looked like they might have had them since residency.) Do they have to get the lenses or magnification changed once presbyopia inevitably sets in, or is the field far enough away that your eyes don't have to accommodate that much?

 

[Skylizard]

I had a question and didn't think it warranted its own thread. I've noticed a lot of older attendings using what appear to be old pairs of loupes. (As in it looked like they might have had them since residency.) Do they have to get the lenses or magnification changed once presbyopia inevitably sets in, or is the field far enough away that your eyes don't have to accommodate that much?

Depending on the degree of change with age... yes, you would likely have to have your loupes/telescopes adjusted... there will be an expense associated with this.

 

[FliteSurgn]

I never bought loupes either. Our program didn't require it, but most other residents did buy them. I found that my 20/10 vision worked just fine for all intricate procedures. It helps when only half your vascular and pediatric attending surgeons wear loupes. You don't feel as pressured.

Nonetheless, I did end up getting some DFV Buddy Hollys. When I was in the Air Farce, they were begging for things to spend money on. One of my fellow general surgeons (who was going to go into plastics at the completion of his surgery stint in the military) actually got them to buy him two different sets of loupes.

I wore them for one parathyroidectomy and didn't like them. I was too accustomed to seeing the anatomy without the magnification. It made an easy case into a much harder one. I wore them for assisting during a couple of thyroidectomies and came to the same conclusion. Anyway, now that I'm in private practice they sit and gather dust. Wait, I did wear them once in the clinic because someone came in with a tiny sliver of glass in their finger that I needed to fish out.

 

[Winged Scapula]

I think that if you are used to wearing loupes, it becomes much easier but if you don't use them regularly they are hard to use:

they're heavy and can often precipitate headaches
the movement between mag and normal view can precip headaches and vertigo
they limit your field

I don't use them anymore because I don't have to in my field, but I found that since our attendings DID wear them and expected us to do so as well, that I much preferred them after awhile.

 

[Bill59]

Do you know ANYONE who actually calls them surgical telescopes?

The tech support guy from Designs for Visions who corrects me when I call them loupes.

 

[Winged Scapula]

The tech support guy from Designs for Visions who corrects me when I call them loupes.

Ok, well he's a nerd who doesn't even use the product.

 

[Blade28]

I never bought loupes either. Our program didn't require it, but most other residents did buy them. I found that my 20/10 vision worked just fine for all intricate procedures. It helps when only half your vascular and pediatric attending surgeons wear loupes.

That's impressive! I have 20/12 vision, but still find my loupes helpful when using fine suture like 7-0 Prolene, 6-0 PTFE, etc.

 

[Docgeorge]

I've been doing a lot of work with one of the vascualr surgeons (I eventually want to do VS)here...and he encouraged me to get a set of Loupes like his 3.5 EF DFV. I've had them for about a month now, and I cant imagine doing anything with-out them. I see a lot of stuff now that I did'nt even know was going on in the incisions. I love the damn things although I do have to put up with the occasional "wtf is a 4th year med studet doing with loupes".