EyeWorld Asia-Pacific September 2017 Issue

the broad blades we use for the primary incision. The detail with this style of illumination is still ex- ceptional, and since the depth of field is better than with a focused beam, I find that my need to focus up or down is minimized,” Dr. Cionni said. As for magnification for mak- ing the capsulorhexis, Dr. Garg uses 16–20x magnification, zoom- ing in enough for focused visuali- zation, and 8–10x magnification for nuclear fragment removal, which he finds gives enough per- spective to show what is going on inside the eye. Dr. Wade’s general preference is to use whatever magnification allows him to see the majority of the area exposed by the speculum. Dr. Cionni said he performs most of his surgery under low magnification to increase depth of field and minimize the need for focus adjustments. “In general, I like to have the magnification at a level that allows me to see the entire eye including some of the sclera all in one field. This allows me to monitor all as- pects of what I’m doing. At times, I will increase the zoom in order to appreciate even finer details, for instance, while polishing the posterior capsule,” he said. Dr. Wade offered similar thoughts regarding decreased magnification for increased depth of field. In addition, he said, reduc- ing aperture will increase depth of field, but at the cost of light transmission. “Some microscopes have a ‘depth of field’ setting that op- timizes the aperture to balance depth of field and illumination,” Dr. Wade said, referencing Oph- thalmic Microsurgery: Principles, Techniques, and Applications. 2 Dr. Garg pointed out that de- creased field size can lead to ocular fatigue, and operative time could be increased due to frequent ad- justments. “Make sure to zoom out enough to keep enough perspec- tive,” he advised. Dr. Garg said it’s important to know the functionality of your microscope. “Current scopes have more buttons/functionalities than traditional scopes—make sure to use them to your advantage,” he said. As a final pearl, both Dr. Garg and Dr. Wade mentioned the physician’s posture and ocular position. “As ophthalmologists, many of our instruments are prone to poor ergonomic use,” Dr. Wade said. “Take your time to make sure the bed height, chair height, foot pedal location, and microscope oculars are all in ergonomically comfortable positions.” Dr. Cionni said that he has started using ocular warmers to prevent fogging. “I used to get fogging fre- quently and since using these devices have never had an ocular fog up while operating,” he said. The warmers he uses are from Mastel Precision (Rapid City, South Dakota). EWAP References 1. Cionni RJ, et al. Evaluating red reflex and surgeon preference between nearly-collimated and focused beam microscope illumination systems. Transl Vis Sci Technol . 2015;4:7. 2. Garg S and Steinert RF. Ophthalmic Microsurgery: Principles, Techniques, and Applications . SLACK Incorporated. 2014. Editors’ note: Dr. Cionni has fi- nancial interests with Alcon (Fort Worth, Texas). Dr. Garg has financial interests with Carl Zeiss Meditec. Dr. Wade has no financial interests related to his comments. Contact information Cionni: rcionni@theeyeinstitute.com Garg: gargs@uci.edu Wade: wadem@uci.edu Microscope settings – from page 39 OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 ' Fax +852 2987 1090 www.oculus.de ' info@oculus.hk OCULUS Pentacam ® Now available in the basic software of all Pentacam® models! Keratoconus progression can now be easily detected taking every single parameter into account, including the evaluation of the posterior cornea and the corneal thickness at its thinnest spot. www.pentacam.com NEW! Belin ABCD Progression Display Keratoconus Progression Now Included! Please note: The availability of the products and features may differ in your country. Specifications and design are subject to change. Please contact your local distributor for details. 40 EWAP CATARACT/IOL September 2017