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Critically evaluating surgical microscopes
To the Editor:
In both private practice and a large academic medical center, I’ve had the opportunity to critically evaluate microscopes for ophthalmic surgery. In my private practice and our ambulatory surgery center, we perform mostly cataract surgery, including challenging cases and premium IOLs. We need a great surgical microscope to help the surgeon keep the complication rate low and the efficiency high. At our large teaching hospital, we perform a wider range of surgeries, including retina, glaucoma and cornea cases, along with a large volume of dense cataracts. In this setting, we also need a great surgical microscope to help the surgeons-in-training visualize the anatomic details and provide better outcomes for the patients.
I’ve found the best way to compare different platforms is by understanding their technologies and optics and then taking them for “test drives” on multiple operating days. The surgery center or hospital will be making a considerable investment in the microscope, which will be in use for at least a decade and often much longer. Our goal is to choose the best microscope, not necessarily the least expensive one.
In comparing microscopes, we use many of the same criteria that professional photographers use to compare cameras, with the primary focus being the quality of the optics. The image quality and perception of detail for the surgeon depend on optical resolution, depth of field, light transmission and apochromatism. Photographers are right when they say that image quality is all about the glass.
Technologies that are important include optimization of the red reflex using coaxial illumination, comfortable ergonomics and integrated video. Options for the Zeiss Lumera include the Resight Fundus Imaging System to simplify retinal surgery and a true HD video system. If your center does not perform retinal surgery and you don’t have a need for HD video, then you can nearly drop the price of the Lumera in half compared with the heavily optioned model. Even with the most basic Lumera model, the surgeon benefits from the technologic advances as well as the superb optics for which Zeiss is famous.
After the surgeon’s own cumulative skill and experience, the microscope may well be the ophthalmic surgeon’s most valuable tool. I encourage you to test drive the new platforms and compare for yourself. — Uday Devgan, MD, FACS, FRCS (Glasg), Los Angeles
Disclosure: Dr. Devgan is a consultant to Carl Zeiss Meditec but has no direct financial interest in the products mentioned.