RETINA RETROFIT Find out how to select the right retina accessories for your ophthalmic microscope.

Adapting your ophthalmic microscope to vitreoretinal surgery typically involves outfitting it with a wide-angle viewing system. Your surgeons look into the eye through the small opening of the pupil, but the retina lines the entire inner surface of the eye. A special panoramic lens gives surgeons the widest view possible, letting them see defects and injuries on the periphery.

Traditionally, this view was obtained through a lens placed directly on the eye and held steady by an assistant or sewn in. Some surgeons still prefer these contact lenses, but most now opt for non-contact devices that attach to the microscope's optics and flip down into its line of sight. Not only do these devices avoid corneal stress and allow eye rotation for fuller views, they also don't require specially trained assistants to hold them in place. Most manufacturers' wide-angle viewers also incorporate inverters to flip the mirror-image the lenses deliver into correct orientation.

Selecting the right retina accessories for your ophthalmic microscope depends partly on your physicians' preferences: The devices they've trained on and are used to are influential factors indeed. Ease of attachment and portability is another draw, particularly if a facility's physician-owners are performing retina cases at more than one location.

Another important consideration is whether the device is compatible with your manufacturer's microscope, and whether the scope is ceiling- or floor-mounted. Because the devices attach to the bottom of the scope, they tend to add a few inches of length to the equipment. While a ceiling-mounted scope can be easily elevated, floor stands may have height and balance limits, and the OR table can only lower so far. Depending on your surgeons' heights, these mechanical arrangements can also have an impact on ergonomic safety. I've heard many eye surgeons blame aching backs on inconveniently articulated equipment. Some manufacturers' wide-angle viewers feature integrated inverters that don't add much length to the unit. That's a step toward perfecting the human-machine interface, so your surgeons can operate comfortably.

Carl Zeiss Meditec
Resight Fundus Viewing System
meditec.zeiss.com
(925) 557-4100
Pricing: Resight 500, $26,800. Resight 700, $28,680.
FYI: Zeiss's Resight, when used with the company's Invertertube binoculars, eliminates stack-height issues, extra foot pedals and the need to adjust the focus with every lens switch. Its folding design lets surgeons flip it into place single-handedly, without assistance, while maintaining focus. Single-piece glass aspheric lenses reduce optical distortion across the field of view. The Resight 500 is manually focused. The 700 model, when used with the company's OPMI Lumera T or 700 microscopes, enables hands-free, motorized focusing via the scope's foot pedal; and, when used with the Invertertube, automatic inversion of the main, assistant and video images.

Haag-Streit Surgical
EIBOS 2
haag-streit-usa.com
(800) 787-5426
Pricing: not disclosed
FYI: The EIBOS 2 non-contact, wide-angle fundus system by Haag-Streit Surgical (the new brand name for M??ller-Wedel equipment) delivers retinal observation with clarity and detail, high-quality optics and innovative ergonomics. The patented optical system eliminates the need to invert the image or reconfigure the microscope with an inverter. Internal focusing provides a focal range from the retina through the upper vitreous body. The unit is mounted onto a spring-loaded extension for safety and has been engineered for workflow efficiency. EIBOS 2 is compatible with Haag-Streit microscopes as well as other manufacturers' equipment.

Insight Instruments
Super View Wide Angle Viewing System
insightinstruments.com
(800) 255-8354
Pricing: not disclosed
FYI: Insight's Super View system includes the quickly and easily installed wide-angle module, which delivers a non-contact, 130?? field of view through the operating microscope; and the inverter, which automatically corrects the inverted image produced by the wide-angle module whenever it is positioned for use. The Super View system is compatible with all major microscope models, designed to reduce stack height and weight, and operates without foot pedals or cords. Because it doesn't interfere with the normal beam path of the microscope, it can remain in place even when it is not required for vitreoretinal surgery.

Leica Microsystems
Leica RUV800
leica-microsystems.com
(800) 248-0123
Pricing: not disclosed
FYI: Mounted beneath a Leica microscope's optics, the Retinal Upright Viewing system features an integrated inverter to give the surgeon, assistant and video camera an upright image of the panoramic view, all at once without the expense of individual inverters, for easier, safer surgical insertion and positioning. The integrated inverter doesn't add height to the microscope stack, improving ergonomics and surgeon comfort while avoiding obstruction to the field. The system employs a 132-diopter XLView loupe for wide-angle views and a 90-diopter loupe for higher magnification. The unit's AgProtect nano-silver-coated surface provides antibacterial protection.

Oculus Surgical
BIOM Ready
oculussurgical.com
(855) 734-2466
Pricing: $179
FYI: From the inventors of non-contact, wide-angle viewing comes the first single-use, wide-angle viewing system for vitreoretinal surgery. Oculus Surgical's BIOM Ready balances flexibility and high optical quality. The system incorporates the new BIOM HD Disposable Lens to provide a 130?? field of view with high resolution on the periphery and a deep field for quality stereopsis during wide-angle or high-magnification viewing, reducing the need for a contact lens. Ready for use without sterilization downtime and compatible with a range of surgical microscopes, it is easily connected and removed for use.

Optronics
Microcast HD Pro-Lite Surgical Microscope Camera
optronics.com
(800) 796-8909
Pricing: $12,500 to $19,500
FYI: Compatible with leading brands of surgical microscopes, the Microcast HD Pro-Lite 3CCD camera is able to deliver live and recorded video of retina surgery in 1080p high definition. High-speed shuttering and proprietary image processing algorithms ensure quality imaging, while programmable setting and a simple interface make the camera easy to use. Video adapters are available, including the Quintus, which features horizontal and vertical centering control, iris control for depth of field, fine focus control and image orientation clutch, as well as optics precision-corrected for color and light transmission.

Volk
Merlin Surgical System
volk.com
(440) 942-6161
Pricing: $30,170, or $19,345 without re-inverter.
FYI: Volk's Merlin Surgical System synchronizes the retina viewing system with the microscope and re-inverter to eliminate the need for a foot pedal or microscope height adjustments when the surgeon must switch between corneal and retinal views. Once it is swung out of the surgical field, Merlin allows unimpeded access to the site. Three autoclaveable, high-index glass lenses provide quality posterior-pole and pan-retinal images. A small profile lens allows dexterous instrument manipulation while also maintaining the view.