Surgical Magnification
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Top Ten Questions
How much power of
magnification is best to use?Which should I choose
--- fixed telescopes (through-the-lens) or flip-ups?Will long-term daily use
of surgical magnification adversely affect my own vision?Should I wear my contact
lenses when I operate? If I start using
surgical telescopes for my surgeries now, what happens if I become dependent upon them?At what age should a
surgeon start using surgical magnification? Should young practitioners use surgical
telescopes, too?What happens if I add
surgical telescopes to progressive lenses?If I wear reading
glasses, does that need to be taken into account with my prescription? How long should I expect
to work with a set of telescopes before I’ll need to change or replace them?What is the best way to
disinfect or sterilize the telescopes between patients? If I use sterilized lift-tabs on
my flip-up telescopes between patients, is there any need to disinfect or sterilize the
rest of the telescopes?
The Experts Answer...
1. How much power of magnification is best to
use?
"The best choice for magnification is the amount of power which gives the user suitable magnification and image size without causing any loss to the image clarity. The more power you have, the larger the object appears. However, you will also invite more distortion and blur type effects. I usually recommend the minimum amount of magnification that lets the job get done clearly and comfortably." --- KE
"The LOWEST power permitting a comfortable and unstrained view of the operative field. Field of view, stability of the visible field and depth of field all decrease as power increases." --- CB
2. Which should I choose --- fixed telescopes (through-the-lens) or flip-ups?
"Through-the-lens provides more stable optics and fewer opportunities for distortion. However, with flip-up telescopes the carrier lens can be modified as the users' spectacle prescription changes (which is more important in younger surgeons, and as they become more presbyopic)." --- KE
"Whichever suits your needs best. There are trade-offs with both." --- CB
3. Will long-term daily use of surgical magnification adversely affect my own vision?
"Use of surgical magnification (or any optically ground lens, for that matter) will not adversely affect vision in the short or long term. Some people will initially experience some post-use blurring, eyestrain, or headache, but this should not persist for more than a few uses, while your visual and perceptual pathways adapt to the magnification change. If longer term problems persist, return to your prescribing doctor." --- KE
"Let's hope not - it has been used for the last 30 years by ophthalmologist, neurosurgeons, plastic and vascular surgeons! To date, there are no known adverse effects from any form of surgical magnification." --- CB
4. Should I wear my contact lenses when I operate?
"There is no reason contact lenses cannot be used during surgery. However, the eye must be protected at all times against foreign matter and splashes. If contacts are used, safety lenses (with or without telescopes) are mandatory. Careful consideration must be given to adequate cleaning and disinfection of contact lenses and this should be discussed with your prescribing doctor." --- KE
"Provided that you have adequate eye protection from body fluids and are comfortable in your lenses, there is no reason not to wear contact lenses while operating." --- CB
5. If I start using surgical telescopes for my surgeries now, what happens if I become dependent upon them?
" The eye and visual system will not become dependent on magnification. However, many practitioners find that the magnification enables them to do their work more comfortably and effectively. If this is the case.... why not use it?" --- KE
" Clear vision is habit forming, but no one becomes "dependent" on any form of optical correction in any other way!" --- CB
6. At what age should a surgeon start using surgical magnification? Should young practitioners use surgical telescopes, too?
"Surgical magnification can be used at any age and is now readily available to dentists and surgeons in training. If the magnification effect enables work to be done more comfortably and effectively, it is likely worthwhile to start early."--- KE
"As soon as possible." --- CB
7. What happens if I add surgical telescopes to progressive lenses?
"Surgical telescopes are designed to be used with distance prescriptions, and are usually mounted in the lower third of a lens. In the case of a progressive lens (on most bi/multifocals), the lower third is the portion with the reading correction. Most people find that the quality of the image is poorer and therefore prefer to leave the progressive out." --- KE
"Very important question. There is no intrinsic reason NOT to add surgical telescopes to progressive lenses, but the user should be very careful that the optician who makes the progressive lens and the surgical telescope supplier know precisely where the optical centers for near focus are located. Ideally, the telescopes would be aligned with the latter." --- CB
8. If I wear reading glasses, does that need to be taken into account with my prescription?
"This does not need to be taken into account. Distance prescription should be adequate, however you may need to remove your telescopes and put on your reading prescription, as needed. (If so, you might need to consider cross contamination issues.)" --- KE
"Yes. The telescope supplier should have a copy of the prescription to be used in conjunction with the telescopes. This prescription should clearly show the measurements for both DISTANCE and NEAR correction." --- CB
9. How long should I expect to work with a set of telescopes before I’ll need to change or replace them?
"The answer to this question will be a little different for every telescope user, and largely dictated by individual experience and needs." --- CB
"Manufacturers generally advertise their telescopes to be highly durable. Usage conditions can vary highly, but as a general rule a well used and well cared-for set of surgical telescopes might be expected to last eight or more years. It is a good idea to have the hinges (and any suspension mechanisms) tightened and adjusted, and the optical components cleaned annually. This may be done by a qualified optician or by having the telescope shipped back to the manufacturer. Prescriptions should also be checked periodically, preferably following an eye examination by a professional who is aware of the special considerations of surgical magnified vision." ---LR
10. What is the best way to disinfect or sterilize the telescopes between patients? If I use sterilized lift-tabs on my flip-up telescopes between patients, is there any need to disinfect or sterilize the rest of the telescopes?
"Recommendations for disinfection vary from telescope to telescope. Consult the manufacturer's instruction manual, or contact the manufacturer directly (see the Product Section of this Web Site). Oculars are not sealed against aqueous damage. Use of lift-tabs (available for most flip-up telescopes), while offering useful leverage for raising and lowering the telescopes, almost invariable results in peripheral contaminating contacts via head, hair, face, and/or surgical head barrier. The surgeon may assume that any contact with any parts of the surgical telescope is a violation of the sterility of the field." --- LR
"Is there any need to sterilize or disinfect telescopes at all? The surgical telescopes used in medical microsurgery are seldom if ever sterilized or disinfected, nor is other sensitive equipment if not a risk in the operative field. In order to protect telescope performance, the MINIMUM CLEANING AND DISINFECTION CONSISTENT WITH GOOD SURGICAL PRACTICE should be employed." --- CB
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