Ophthalmic lenses to buy

[EyeGuruOrg]

Volk Ophthalmic Lens Review - EyeGuru

I just wanted to share a review of Volk lenses for beginning residents who are in the market for new lenses. I felt like there wasn't enough info about lenses when I was first buying and wish I knew what factors to look for. Just my 2c

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[hello lady!]

Volk Ophthalmic Lens Review - EyeGuru

I just wanted to share a review of Volk lenses for beginning residents who are in the market for new lenses. I felt like there wasn't enough info about lenses when I was first buying and wish I knew what factors to look for. Just my 2c

The dimming of the image with the Digital Clearfield lens cannot be stressed enough. My indirect can't be bright enough with that lens. I would recommend against it.

 

[MullerCell]

As a resident, I used to obsess about all the different lenses and bought way more than needed. The reality is, your ability to examine the posterior segment has nothing to do with the lens you use (assuming you have a normal functioning, clear volk lens). Buy a 90 and 20 and then a 28 if you want for kids and seeing through gas filled eyes. With proper technique, practice, and a scleral depressor, that is all you will ever need.

 

[EyeGuruOrg]

Thanks, that's probably true haha. I used to obsess about lenses and was always wondering if I made the best choice. I guess it eventually its just another daily tool, like wondering if you're using the best pen.

For the brightness, don't you think the 28D is pretty dim also? I would guess its a function of taking the same light and spreading it out over a bigger field of view

 

[DrZeke]

I don't think the 28D is dim but it's less magnified and sometimes that bothers me when I compared it to the 20.


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[long]

I have a 20 and and 90. I've tried pretty much every lens out there during residency, finding lenses laying around the clinic and using them for a while to get a feel for them. Maybe it's just because it's what I started out on, but I've always come back to the 90 and the 20.


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[DrZeke]

I don't love the 90 for macular pathology. I have a 90, 78 and 20 and the 78 gives me the best stereopsis.


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[ocularis]

I think the main questions I have are,

1. Love the 78, haven't had much experience with the Super 66. Super 66 or 78? What's the verdict?

2. You go as far as saying a digital wide field negates need for a 90, I haven't heard that one before! How can we rate a digital wide field vs 90 vs a super field? I heard the digital wide field has a high learning curve on it. I personally feel the 90 gets you a better view centrally than the peripheral field lenses, but a super field is great for a peripheral exam. Super field vs digital wide field??

 

[EyeGuruOrg]

Hey, I'll try to answer these the best I can having tried everyone of these lenses though only having used extensively (as my own lenses) the 90D and digital wide field.

1. The mag is pretty similar - basically it gets you "better mag than the 90" and to me didn't make/break the choice. They're both the same sized lens too. Only thing is if you really care about 1:1 optic nerve measurements, 66 would be the way to go.

2. Digital wide field - I'm biased I do like this lens a lot. It's almost as high mag as a 90 centrally and has the farthest view peripherally to get a pretty good peripheral retinal exam at the slit lamp. It's got more glare, but not a high learning curve and wouldn't break you as a new ophthalmology resident if you bought this lens. Ultimately, nothings as comfortable to use as a 90 since its so small and easy to hold with a good working distance. Can't comment too much about the super field but Volk told me that's the lens they recommend new residents buy FWIW.

 

[Brathmore]

SUPERPUPIL vs. SUPER VITREOFUNDUS

Has anyone actually used the Volk superpupil and/or the Volk super vitreofundus? I'm torn between which one to buy after looking at the specs. In my resident clinic, no one has either (a little sad). From the specs, it looks like the tradeoff is between a slightly larger size vs. getting through a slightly smaller pupil.

On undilated pupils, does the superpupil really give a much better view than the 90? Is the image too small? Could you get by without dilating patients?

On undilated pupils, is there a big difference between the superpupil and vitreoufundus practically? The specs say superpupil is for pupils 1-2mm, and vitreoufundus for 3-4 mm. But what's it like in practice? I'm a PGY3, and I *can* get looks at the nerve with a 90 through an undilated pupil, but I'd be thrilled to get a much larger field of view.

 

[DrZeke]

I can't comment on the differences between these lenses, but I just wanted to make a comment, because I've noticed a few times a lot of people want to see pathology through an undilated pupil. I think for that no complaint patient that was dilated recently - a quick glance at the nerve is fine for practice sake.

But, if you're ever concerned about pathology just dilate. Even with all these fancy lenses the stereo is always better when there are no pupillary constraints. There are often pressures on us to be fast or get through clinic and sometimes when unsupervised you can get away with doing whatever you want. We've all been there, I think.

My best advice is: Just do what's best for the patient, even if you sometimes have that one person breathing down your neck to be done quicker... you will sleep better at night.


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[MstaKing10]

90 and 20 is all I use (I have old Nikon lenses they don't make anymore, super high quality) Rarely a 78 if it's in the office. I have a few digital lenses collecting dust. Nothing beats the quality and versatility of these lenses.

Good luck defending a missed tear, detachment, retinitis or the like in a patient because you used a fancy lens and opted not to dilate.

 

[Brathmore]

I received my Volk Super VitreoFundus today. I cannot praise it enough. In my opinion, it is hands down a superior lens to the traditional 90 for most general clinic uses. I have no ties to Volk, but I can say that if you really want what's best for your patients, or if you don't want to 2nd guess whether you missed a peripheral issue, you should strongly consider buying this lens.

- At any given time, a slit beam with the SVF covers 33% more retina real estate than the 90 diopter. The cost of this is minification by the same amount. In this sense, the tradeoff is similar to the relationship of the 20 and the 28. HOWEVER, at the slit lamp, you can get extra detail if you need it be adjusting your 10X mag to 16X or beyond, thus equaling the mag of the 90 if so desired. You can also just pull out another lens (90, 78, etc.) if you want to zero in on a spot.

- The field of view is awesome. There is no question whatsoever that you can get farther out with the SVF than with the 90, or even the Superfield or Digital lenses. There are things you can see with this that are unavailable to people relying on a 90, 78, etc.

- I'm already loving the small pupil capabilities. It's just easier to get a view of the nerve and beyond. Compared to the 90, it gives me a wonderful stereoscopic view of the nerve in an undilated pupil. I can't explain why - perhaps because you hold it closer to the patient's eye?

- I have not noticed glare issues. It seems a clearer view than the 90, although my 90 is an old resident clinic lens, whereas this is brand new.

- I have not yet noticed the purported disadvantage of the shorter working distance, although I have had to clean the lens already (and I rarely need to clean my 90).

It's ironic that we eye doctors think nothing of having patients spend tens of thousands of dollars to improve or preserve their visual field, yet when a superior technology like this comes around - which essentially increases your field of view by at least 33% so that you can do your best to help patients - some eye doctors dismiss it out of hand. I think it will come to a point where lenses like these are the standard of care, and doctors not using them will have to explain why.

 

[MstaKing10]

Lens sounds great. Question: do you perform indirect ophthalmoscopy and/or scleral depression and if so how does it compare to this wide field lens? And if you are concerned about peripheral pathology would you feel comfortable only using that lens and forgoing indirect/scleral depressed exam?

 

[EyeGuruOrg]

I received my Volk Super VitreoFundus today. I cannot praise it enough. In my opinion, it is hands down a superior lens to the traditional 90 for most general clinic uses. I have no ties to Volk, but I can say that if you really want what's best for your patients, or if you don't want to 2nd guess whether you missed a peripheral issue, you should strongly consider buying this lens.

- At any given time, a slit beam with the SVF covers 33% more retina real estate than the 90 diopter. The cost of this is minification by the same amount. In this sense, the tradeoff is similar to the relationship of the 20 and the 28. HOWEVER, at the slit lamp, you can get extra detail if you need it be adjusting your 10X mag to 16X or beyond, thus equaling the mag of the 90 if so desired. You can also just pull out another lens (90, 78, etc.) if you want to zero in on a spot.

- The field of view is awesome. There is no question whatsoever that you can get farther out with the SVF than with the 90, or even the Superfield or Digital lenses. There are things you can see with this that are unavailable to people relying on a 90, 78, etc.

- I'm already loving the small pupil capabilities. It's just easier to get a view of the nerve and beyond. Compared to the 90, it gives me a wonderful stereoscopic view of the nerve in an undilated pupil. I can't explain why - perhaps because you hold it closer to the patient's eye?

- I have not noticed glare issues. It seems a clearer view than the 90, although my 90 is an old resident clinic lens, whereas this is brand new.

- I have not yet noticed the purported disadvantage of the shorter working distance, although I have had to clean the lens already (and I rarely need to clean my 90).

It's ironic that we eye doctors think nothing of having patients spend tens of thousands of dollars to improve or preserve their visual field, yet when a superior technology like this comes around - which essentially increases your field of view by at least 33% so that you can do your best to help patients - some eye doctors dismiss it out of hand. I think it will come to a point where lenses like these are the standard of care, and doctors not using them will have to explain why.

Interesting about the vitreofundus. That's kind of what I felt about the Digital Widefield. For diabetics especially, I can scan the entire posterior pole with the patient looking in primary, very convenient. I know an attending retina specialist that uses it exclusively (almost) for peripheral viewing to rule out RT/RD. I think his point is that nothing replaces a scleral depressed exam but having extra mag allows you to pick up more details than BIO.

 

[pianist]

I'm a retina surgeon in practice for a few years now.

I think starting out, a 20D, macular lens, and then digital wide field is a great combination.

The DWF is great for peripheral viewing with higher magnification. it is like a newer superview, which also is a great lens. With practice, you can pretty much see as far out in the periphery as with the indirect, save for scleral depression. It takes years to become proficient with indirect ophthalmoscopy, and it is often easier to see small breaks in the far periphery with the DWF than with BIO until you're pretty good with the indirect. (scleral depression tips btw: lie the patient completely flat, don't need to press hard, and if you can't see your indentation, you're probably looking too anterior)

The digital wide field is not so great for macular viewing because of less magnification and glare. There's no cheating physics: magnification is always a trade off with field of view. A basic 60D or 78D is great for the macula and allows great stereopsis. They're also cheaper than something fancier like the Super66, or digital high mag. Subtle macular pathology is difficult to see with a widefield lens. Macular viewing is a lost art with OCT, but things like CME are much easier to see with a high mag lens with better stereopsis.

Maybe they are new lenses, but I don't know anybody who has purchased a vitreofundus or superpupil, and have never heard of them being commonly used. I think the standard of care is how good your exam is, not what lens you used.

A standard 20D is all you need for the indirect. I too have a Nikon, and also think its the best. There's something about the optics or coating, I don't know, but nothing beats the view with the Nikon. I had a panretinal 2.2, but much prefer the Nikon 20. You can occasionally find them on Ebay, and grab one if you do. Don't buy a 28D unless you're going into retina and looking at gas filled eyes frequently.

Having said all that, I would get a 20D, DWF, and 60D if buying 3 lenses. If I was going to buy 2 lenses, I would get the Super66 and a 20D.

At the Fellows Forum for 2nd year retina fellows, Volk gives you a free DWF.

 

[someguyinMI]

Volk Ophthalmic Lens Review - EyeGuru

I just wanted to share a review of Volk lenses for beginning residents who are in the market for new lenses. I felt like there wasn't enough info about lenses when I was first buying and wish I knew what factors to look for. Just my 2c

Excellent site and blog. Thank you. I will soon add it to my resource site for med students interested in opthalmology, pre-ophtho.com.