A surgical microscope is one of the most vital—and costly—pieces of equipment in an ophthalmic ASC, making upgrade decisions both clinically and financially significant. Although modern microscopes have long delivered excellent visualization, advances in digital overlays and imaging integration now offer new opportunities to enhance precision and efficiency in cataract surgery. In this interview, Michael Patterson, DO, shares his practical approach to determining when it’s truly time to invest in a new microscope, what features matter most, and how to balance performance with cost.
OASC: How do you know that it’s time to start considering a microscope upgrade?
Michael Patterson, DO: My opinion will be quite different than most people’s. To me, it’s a last-ditch effort. Your microscope is important, but for the last 20 years, modern microscopes have been very good, with just incremental improvements. However, if you don’t have one with imaging technologies in your clinic, you’re probably not offering the best you possibly could for the patient. If you don’t have digital imaging overlays from your microscope, it’s time to consider buying one that does.
OASC: What are the most important features and capabilities that you should prioritize for a microscope?
Dr. Patterson: Digital overlays are the most important feature of a microscope in modern cataract surgery. All of them have the ability to tilt the microscope. Some of them do so more easily than others. Some people want heads-up surgery. Those are all personal preferences. However, when you’re talking about patient care and what drives outcomes, there’s nothing more important than accuracy. And the most accurate outcomes are those that come from the clinic and go directly into your microscope, especially for things like toric lenses. If you don’t have that, you can still do surgery, but you’re missing out on things you could do for your patient.If you’re using toric lenses and you don’t have overlay and you don’t have digital marking, then you’re having to waste a lot of staff time and your own time going out and marking patients in the preoperative care unit. It’s been shown repeatedly that for toric lenses, digital marking is more accurate.1,2 It’s much more efficient to use a microscope that has digital marking than for you to go out, mark the patient, lay them back in the bed, go to surgery, and then find your marks have spread everywhere. Ideally, you’re not having to do any of that—it all goes into your microscope, and you can see it clear as day.
OASC: As far as the financial aspect, how do you weigh what you want from the microscope against the financial investment?
Dr. Patterson: That’s going to be a personal decision for every single surgeon. It really depends on what you need. There are microscopes that are phenomenal for under $100,000, and there are also some that are amazing for over half a million dollars. You have to weigh the needs of your practice. You should have your pros and cons written down, because you don’t get a reimbursement for your microscope. You know you want what’s good for patients, but there’s also a limit to what you can do financially. You can have the fanciest microscope in the world, but you won’t get reimbursed for that. That’s important for people to think about and remember.
OASC: And when you’re calling for demos, what’s most important to consider during that period?
Dr. Patterson: Priority one is going to be, does it give you the best view in the OR? Do you get the best imaging and best view of the eye, the best red reflex for patient safety? The next thing is, what’s the cost for your practice and what’s the acquisition cost? Here’s the thing to think about when you buy microscopes: many of the old microscopes in the 1970s and 1980s, which were very good, are still in use. I use them on mission trips. When a bulb goes out, it takes 1 minute and about $10 to put a new bulb in. With the new microscopes, the bulb may cost $2,000. You have to know the upfront cost as well as the ancillary cost to this microscope. For instance, if you’re using one with digital imaging, what do you do when that doesn’t work anymore? What’s the cost of the computer upgrade? It’s like buying a hybrid car. What do you do when the battery goes out? How much is the cost of that battery? Those are very important things that people often don’t think about. What’s the lifespan of this bulb, and what’s the cost of this bulb, and how many of those can we afford to keep on hand? Fortunately, they don’t burn out that often, but they do have a lifespan of a certain number of hours.
OASC: If not planning for all contingencies is a common mistake that an ASC might make when purchasing a microscope, are there any others, and how might an ASC avoid them?
Dr. Patterson: Yes, if you’re using one that’s connected to your Wi-Fi you need to make sure that you have redundancy should your internet go down and it’s relaying information from a computer into the microscope. You can install it hardwired as well. You just want to make sure there’s ease of operation, because eventually it’s not going to work. That’s just the bottom line and you need to have backup plans.
OASC: What is your backup plan?
Dr. Patterson: We have a full battery backup so that if our power goes out, we have a generator, but we also have a battery backup to that microscope. So there’s no way that goes down. We have a secondary switch that we can flip if our internet goes down; we can flip into another [network] immediately while we’re operating. It requires somebody to do it manually, but at least you can keep going.
OASC: Is there anything else that I missed that’s important for this conversation?
Dr. Patterson: To me, the decision about a microscope is very simple. We’d love to have a 180-foot yacht, but the reality is we don’t need a 180-foot yacht. So you have to decide, can you live with the 42-foot yacht?
References
1. Elhofi AH, Helaly HA. Comparison between digital and manual marking for toric intraocular lenses: a randomized trial. Medicine (Baltimore). 2015;94(38):e1618. doi:10.1097/MD.00000000000016182.
2. Webers VSC, Bauer NJC, Visser N, Berendschot TTJM, van den Biggelaar FJHM, Nuijts RMMA. Image-guided system versus manual marking for toric intraocular lens alignment in cataract surgery. J Cataract Refract Surg. 2017;43(6):781-788. doi:10.1016/j.jcrs.2017.03.041