Enhancing Microsurgical Assistant Experience with Bifocal Safety Glasses: A Low-Cost Alternative to Surgical Loupes.

Abstract

The standard flap harvest is performed under loupe dissection. It is not infrequently that a medical student or physician assistant participates in the role of first or second assist. Such scenarios have impressed upon us the observation that these surgical assistants seldom use loupes or any other form of visual magnification. The reasons for this are likely multifaceted and may be related to cost as well as perceived opinions of colleagues. The benefit of encouraging optical aid use among surgical assistants encompasses an augmented surgical and learning experience. The aforementioned barriers, however, prohibit the use of loupes. We have found bifocal safety glasses to be an adequate alternative (Fig. 1). As compared to Galilean or prismatic loupes, which utilize multiple lenses and can magnify up to eight times without distortion (in the case of prismatic loupes), single-lens magnifiers can magnify up to 1.5 times without distortion or significant loss of working distance. Although this level of magnification is not acceptable for the primary surgeon, the added benefit of single-lens magnification is certainly superior to total lack of magnification typically utilized by nonresident surgical assistants.Fig. 1.: Standard bifocal safety glasses with +1.00 diopter strength.Bifocal safety glasses need to be selected in order to allow for maximal magnification at the optimal working distance. With this in mind, we recommend lower-powered magnifiers (i.e., diopters between +0.75 and +1.50 diopters), as these allow for crisp magnification and accommodation without causing eye fatigue. It is important to note the conversion of diopter to magnification is described by the equation m = d/4 + 1, therefore a +1.00 diopter would result in m = ¼ + 1 = 1.25× magnification. As compared to surgical loupes, bifocal safety glasses have the added benefit of being lightweight. The detrimental effect of loupes on cervical spine health has been well documented in surgeons of all levels and across multiple specialties; surgeons with severe cervical spine pain can use bifocal safety glasses as an alternative to loupes in cases where high-power magnification is not needed.1,2 In addition, single-lens magnifiers are not cost-prohibitive. They can be purchased for less than $15, which is markedly less than the typical price of loupes.3 The design of bifocals is discreet, as they resemble safety glasses typically worn in the operating room, and this mitigates any worry about eliciting negative opinions from colleagues. Bifocal safety glasses are a cost-conscious, comfortable, and inconspicuous optical aid that should be utilized by microsurgical assistants when loupes are not available. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.