One of the most important ophthalmic surgical tools is the operating microscope. This instrument, which enables eye surgeons to perform delicate anterior and posterior segment procedures, has evolved over the last few decades into a highly sophisticated device. The top of the line surgical scopes are now computerized machines that offer superb optics, enhanced illumination, high definition video recording, wireless footswitch control and touchscreen customization. Some are even key parts of integrated systems that allow seamless patient data transfer between examination equipment and intraoperative instruments. With the importance of this piece of equipment in mind, it is important to find the right microscope for your practice. To help you understand your options, here is an overview of some of the available surgical microscopes:
Leica Microsystems
Leica Microscystems M844
The M800 series consists of 3 different microscopes that offer OttoFlex technology for enhanced red reflex, dual illumination systems with both LED and halogen lights, ergonomic design for surgeon comfort, wireless footswitches, rotatable beamsplitters, controls and interfaces designed for easy use and logical workflow, and personalized preferences.
M844: This is the company’s premium class ophthalmic surgical microscope designed for posterior and high-end anterior segment surgery. It contains APO OptiChrome optics, direct halogen double beam stereo illumination, and OttoFlex II technology to provide superior clarity, contrast, and color images, and red reflex stability and brightness at safer light levels. It also features QuadZoom technology, a double wing assistant bridge, and HD recording.
M822: Featuring Coaxial OttoFlex technology and combined LED and halogen illumination, this microscope provides a large diameter, enhanced, stable red reflex to help clinicians perform precise and efficient cataract surgery.
M820: This is a high performance ophthalmic microscope primarily for anterior segment surgery. Its APO OptiChrome optics and direct halogen illumination result in natural color, outstanding depth of field, and stable red reflex.
Carl Zeiss Meditec
Carl Zeiss Meditec OPMI Lumera 700
OPMI Lumera 700: This top-of-the-line surgical microscope has a number of advanced features. It contains Stereo Coaxial Illumination (SCI) technology for better visualization of anatomic details and a brighter, more stable red reflex. The Superlux Eye xenon illumination provides a natural color view while the HaMode filter enables the surgeon to quickly change to a halogen light source. The assistant microscope is designed with no light loss for the main surgeon, and a zoom function that can be synchronized with the main surgeon or controlled independently. Additional features include the RESIGHT 700 fundus viewing system for posterior segment surgery, an integrated full HD or SD video recorder, magnetic brake for easy positioning, and customizable touch screen controls.
The Lumera also is part of an integrated system called the Zeiss Cataract Suite. The system is comprised of the IOLMaster 500, Callisto eye, and OPMI Lumera 700. Information obtained from the Callisto device is uploaded to the microscope so incision, capsulorhexis and astigmatism alignment information is displayed directly in the surgeon’s eyepiece.
Alcon
Alcon LuxOR LX3
LuxOR LX3: This state-of-the-art ophthalmic microscope offers an expanded visual field, larger and stable red reflex, excellent visual detail, touch screen video control, and customized settings. It contains ILLUMIN-I technology to provide a consistent, 6 times larger, high-quality, stable red reflex zone regardless of pupil size, centration, eye tilt or patient movement. There is an increased focal length between the lens and the patient’s eye, which gives a greater depth of focus for better visualization, detail, and contrast with less focus adjustment. The Q-VUE optical head is a 3D stereo assistant scope with an independent light path that does not reduce light from the surgeons’ optical pathway, features an independent magnification changer, and swivels 180 degrees for convenient positioning. AMP technology delivers more light to the surgeon during retinal procedures.
The LuxOR also is a component of Alcon’s integrated system. The Cataract Refractive Suite connects an imaging/measurement device (Verion Image Guided System) with the Centurion phaco machine, LenSx femtosecond cataract laser, and Luxor operating microscope. Patient data obtained with Verion’s Digital Marker is stored on a USB memory stick and transferred to the operating room system, where the microscope retrieves the data and presents image-guided overlays visible through the surgeon’s ocular. Specifically, the Verion captures a preoperative reference image of the patient’s eye and maps iris landmarks and blood vessels. A second image captured in the operating room is then analyzed to precisely and accurately align the eye. Overlays projected in the microscope ocular identify the pupillary axis, visual axis, geometric center of the cornea, and axis of astigmatism to help the surgeon position the capsulorhexis, IOL, and astigmatic correction. The Verion also contains IOL calculation formulas (Holladay, Holladay II, SRK/T, and Hoffer Q). Therefore, future capabilities may include data analysis for IOL optimization.
For the past few years I have been operating with the Leica M844 and Zeiss Lumera. Both these microscopes provide exquisite detail, depth of focus, and superb red reflex. When I upgraded to these systems, the improvement over the older generation scopes was immediately obvious. The advanced optics are almost too good because during my first cases with each scope, I was distracted by seeing tear film debris and vitreous floaters.
If you have not had the opportunity to operate with these modern microscopes you may want to trial one and consider upgrading your current equipment.