Equipping an oculoplastic surgery office will depend largely on how you wish to tailor your practice. For instance, will you be delving into aesthetics largely, orbit, children, etc? Below is a basic guideline and buyers’ guide for how to put together an oculoplastics office. In this first segment, I will discuss equipment.
An oculoplastics office should be equipped with lanes similar to any basic ophthalmology office.
A projector is an obvious necessity for any ophthalmology practice. Below is a list of a few available units.
- Chart Projector CP-770: This remote controlled unit has a white LED that features an internal brightness control rheostat allowing you to adjust the brightness intensity of the projected image with an advanced internal circuitry that automatically compensates for any fluctuation in supply voltages. A new optics design for the condensing lens system produces a 30% increase in the overall projected image quality. It has an optical zoomer for a variable installation distance. There are 33 available charts including a wide variety of Snellen, illiterate E's, numbers and pediatric charts and 11 specialty charts and 2 ETDRS LogMar charts. To avoid patient memorization, 10 individual 20/20 lines are available on the CP-770, as well as additional 20/15 and 20/10 lines for the more discriminating refractive surgery patients.
- System Chart SC-1600 Pola/1600: The working distance can be pre-selected from 2.5 to 6m in increments of 50cm, accommodating any size examination room. Exclusively for the SC-1600 Pola, there is a state-of-the-art special LCD to polarize charts, which provides binocular assessment in a conventional way. There is also a "Night mode" to examine nighttime visual acuity under low light conditions. This unit can be synchronized and integrated with the NIDEK Smart Refractor. When synchronized, chart images adjustments are possible using the Smart Refractor control box.
- AP250 Auto Chart Projector: This is a remote-controlled, programmable, random-access, high-resolution, ophthalmic projector. It fits into almost any refracting environment and comes with a choice of mounting options. There are 33 different test charts or you can create a two user-defined chart sequence. There are masking controls that allow you to isolate horizontal and vertical lines or individual characters. You can also apply the red/green filter or polarization filter to any chart. Focusing controls enable you to sharply focus slides for projection distances of 10 to 26.5 feet. The unit has a 2000 hour long-life halogen bulb.
- LongLife Project-o-Chart: This is one of the most popular manual projectors among eye care professionals. The bulb lasts 10x longer than incandescent bulbs and comes with a quick-change socket design. Reichert has vectographic slides that create test situations that simulate normal binocular vision through the use of polarized iodine crystal characters in a binocularly viewed structure. This format facilitates fusion of the images cortically. They also provide the ability to conduct a wide variety of tests for both children and adults, including astigmatism tests, acuity tests, muscle balance tests, tests to determine malingering, stereopsis tests and fixation disparity tests with or without paracentral fusion lock.
Topcon Medical Systems
- ACP-8R Automatic Chart Projector: This system operates with a cordless remote controller allowing instant projection of the 30 test charts at a rate of 0.03 seconds per frame. The ACP-8 can offer 3x5 character charts with a 330 x 270 projection size. Masking functions include open 1, horizontal line 5, vertical line 8, single isolation 21 and red/green 1.
- MC-3 Mirror Chart Projector: This compact eye chart allows 5m examinations with an installation distance of 110cm. It has a thin depth of 26.7cm and mounts a 26cm x 34 cm low-reflection wide screen. Four types are available: 110cm, 70cm, 90cm and free installation distance. There are 30 charts and masking functions for horizontal and vertical lines, single isolation and red/green. It runs with a 12 volt 30 watt halogen lamp.
Chart projectors can range in price from $200 to $3000, depending on model and whether new or used.
My article last month was a buyers' guide to slit lamps. Please refer to this article for different manufactures and features of various slit lamps.
The exam chair: another obvious necessity for any medical professional. I prefer and recommend one that is hydraulically operated with a foot pedal. Below are a few.
Haag-Streit USA, Inc.
- 7000 Dual-Purpose Minor Procedure Table and Examination Chair with 7800 Instrument Stand: This chair is useful for a larger lane and excellent for an oculoplastic practice where a lot of minor procedures will be performed. It reclines to a near flat position and comes with an adjustable surgical headrest. This is a full articulating examination chair/minor procedure table with square base and dual controls for base and top functions by footswitch or membrane switches on both sides of the chair. There are programmable memory features for recline position and safety switch.
- FX920 Tilt Exam Chair with the 7900 Instrument Stand: This is a full power examination chair with dual controls for base and top tilt function by footswitch or membrane switches on both sides of the chair. There is a programmable memory tilt feature and safety switch to prevent small children from operating the chair by disabling side and footswitches.
- Encore Automatic Chair: This chair is controlled by either footswitch or backlit fingertip switches on both sides of the chair. The chair can recline to form a bed or any position desired. There is an optional pillow headrest for delicate surgical procedures. This chair can be interfaced with Marco’s Deluxe2 Stands to form a wheelchair-accessible system.
- Advantage Plus Chair & Stand: This chair manually reclines with pneumatic assist. It comes with a large positive locking headrest and footrest. Chair elevation can be controlled with the footswitch, from the stand control console or instrument arm. The chair rotates a full 360 degrees, 270 degrees at the lowest position. The stand comes with an overhead lamp, fully counterbalanced refractor arm and a lower instrument arm, which incorporates a vertical motion lock system for simple one-handed instrument positioning. The stand also has a multi-function control console, which controls all of your lane operations.
- Advantage Tilt Chair: This chair is good ideal for small lanes. It offers 360 degrees of rotation, a stop switch for transitional positioning and can be controlled via a footswitch, from the stand control console or from the lower instrument arm. It features one-handed patient inclination from upright and supine. The arm rests swing upward and it comes with a locking headrest and flip-up footrest.
Topcon Medical Systems
- OC-2100 Patient Chair: This chair features an 8" power elevation by means of a footswitch control. There is a high back to this chair, which means that the chair back and armrests are fixed. Optional features include a 15-degree tilt mechanism and footrest, locking rotation and sliding armrest.
- OC-2200 Patient Chair: This chair features single button folding armrests, manual recline with an ambidextrous handle and a full range-articulating headrest. It has a hydraulic low lift 9" stroke with a maximum seat height of 29" or hydraulic high lift 12.5" stroke with a maximum seat height of 35". There is an illuminated membrane switch control with an optional foot pedal control. It has contoured cushions with anti-viral upholstery.
- OC-2300 Ophthalmic Chair: This chair features a fully powered recline with 2 programmable memory positions. It also has foldable single button armrests and a one-hand articulating headrest. There is an illuminated membrane switch control on both chair sides as well as a single foot pedal control (dual available as optional accessory). It has contoured cushions with anti-viral upholstery.
- OC-2400 Ophthalmic Chair: This chair features a motorized tilt function, single button folding armrests and an illuminated membrane switch control. It features a hydraulic 9" lift stroke with a low seat height of 21.5” and a maximum seat height of 30.5". There are 2 user programmable memory positions and it comes with Flash Port Technology. This chair also has the contoured cushions with anti-viral upholstery.
These chairs start at lowest $600 up to $5000 used, so you can imagine the price for a new unit.
Refraction is not the most common element of an oculoplastic exam, but a phoropter is essential none-the-less. There are numerous units on the market, too many to discuss in this article, but I have highlighted a few below.
- Phoropter RT-300: The accessory knob is positioned next to the cylinder power/axis knob. Cylinder power is up to +6.00; sphere power from +16.75 to -19.00D.
- Phoropter RT-700: This is Marco's new refractor design with an internal illumination system adjustable for sphere, cylinder and axis measurements. The white prism, accessory and cross-cylinder scales provide easier recognition in dim lighting conditions. There is a functional "wing-grip" design and soft, smooth knurled knobs. The axis/cross-cylinder system is fully synchronized.
- Phoropter Ultramatic: This unit features a 28” reading rod and rotochart that gives you 12 sets of charts for tests out to the trifocal range. An auxiliary dial has 10 lenses and 2 open positions.
- Auto Phoropter RS: This instrument allows you to perform all known refraction functions and integrate your refractions system electronically with your practice. You can flip between old and new prescriptions with the touch of a button. This system features an ultraslim lens to prevent tunnel vision. Prism lenses slide in manually. There is automatic convergence and transition to binocular measurement when the near point rod is lowered and automatic removal of the ADD power when the near point rod is raised. Polarized lenses and Maddox cylinder are available, along with selectable default lens options for retinoscopy.
- Illuminated Phoropter Refracting Instrument: This phoropter has lighted dials to make it easier to perform refractions in the dark setting of the exam room. This unit features lighted sphere, cylinder power and cylinder axis scales. It utilizes cool-running, energy efficient LEDs that light only what you need to see without affecting the darkened refracting environment.
Prices for phoropters range widely from $1000 up to $10,000 and beyond.
Exam lamps help especially if you are going to incorporate aesthetics into your practice. You can get freestanding lamps on wheels for a little over $100, a lamp that attaches to your exam chair that can be controlled on a central control panel, or ceiling-mounted lamps that are adequate for surgical procedures and can cost around $5000. Welch Allyn Green makes freestanding lamps and wall mounted lamps. Burton makes ceiling mounted and floor lamps and can be found through the Philips website. Riester and Ritter make floor lamps.
These stools come with or without a backrest and can be adjusted with your hand or foot. For the clinic, I prefer the chairs that can be adjusted with a hand bar and that have a backrest for added comfort while speaking with your patients. Most will have a height adjustment ranging between 20 and 26". They should swivel and have ease of movement on all floor types. They come in a variety of upholstery colors and grades; hence vary widely in price ($80 to over $500). Many different companies manufacture them as well.
Of course, chairs for those who accompany the patients will be needed. Lightweight chairs are easier to move around when necessary. Those with armrests are more comfortable for the guests. You can get metal or wood, vinyl or leather. Some fabrics come as antimicrobial. The range of prices can be from as low as $50 up to $400. Boss chairs makes all types of chairs and physician rolling stools as well.