Do I really need it?

I have been wearing magnifying loupes for most of my career now, having first purchased a pair of Orascoptic 2.6x a few years after graduation 20 years ago. I wear loupes for virtually every procedure, about the only time I don’t use them is for denture work. I now routinely use 4.8x loupes and light source, this gives me excellent vision to be able to diagnose and treat my patients to a consistently high standard.

 

 

The routine use of loupes improves both the vision and the posture of the clinician. Dentistry has changed a lot since I qualified, the techniques and materials have moved on. While progress has improved clinical outcomes and aesthetics, the

downside particularly with adhesive dentistry, is that attention detail is a must. Even a tiny gap with a matrix band at the base of a class II box can lead to fluid leakage and the premature failure of a restoration. The ability to see the smallest of details has never been so important. There is no doubt that magnification has become more popular as clinical techniques have become more demanding. In addition the working distance encourages a much improved posture with no need to bend over to get closer to the patient. There is evidence to support the view that the use of magnification reduces and, in some cases, eliminates chronic neck and back pain.

 

 

The disadvantages of wearing loupes are largely perceived rather than actual. I am yet to meet a practitioner who cannot wear loupes, however a period of adaptation is required; in my own case this was a matter of hours, with some it is a few days or even weeks. Some dentists feel that wearing loupes will somehow harm or weaken the eyes, but there is no evidence to support. The investment in magnification can be significant but with all the advantages the initial outlay is soon forgotten.

 

 

Once you make the decision to purchase a pair of loupes then there are a number of factors to consider, and it is essential to deal with a company that provides good service as they will be able to guide you through the process of selecting the

right setup for you. Factors to consider when purchasing loupes are:

•  Clarity. This is also known as the resolution and is the capability to visualise small structures, and is established by the quality of the optical design and the use of precision lenses. As with most things you get what you pay for. Cheaper loupes, made with inferior materials cannot deliver the highest quality image.
•  Power. Magnification power is the size of the image produced by the loupe compared to the naked eye. Different manufacturers offer a range of powers, the entry level is generally about 2.5x power, rising to 3.5x, 4.5x, and even 6x. Although you might think that the more magnification power the better, there is a trade off with field width and depth of field.
•  Field width. This is the maximum area that can be seen when viewed through the loupes. When starting out with loupes a wide field of view is appreciated as it is easier to adjust from the naked eye to the magnified image. In general the higher the magnification power the smaller the field width.
•  Depth of field. Field depth is the range of focus delivered by the loupe. When you lean backwards and forward while wearing the loupe you will find the magnified image will go in and out of focus, this range when the image is in focus is the depth of field. It is dependent upon a number of factors, but the design of the loupe and the magnification power are particularly important. As the magnification power increases then the depth of field decreases.
•  Optical system. There are essentially two types of system, the Galilean and the Prismatic. The Galilean type of loupe tends to be limited to 3.5 power or less, the image quality is good and they are the lowest in cost and weight. The Prismatic type allows higher magnifications with improved field of view and depth of field for the magnification power, the main disadvantages are that they are heavier and more expensive. However the world of loupes is always changing and the image quality and magnification power of the Galilean type is improving to match that of the Prismatic type.
•  Flip-up or through the lens. The loupes can either be mounted onto a spectacle frame (flip-up) or embedded in the lens of the spectacle (through the lens). The flip-up type has the advantage that the loupe can flipped out of the way, without removing the frame, so that notes can be written up or a conversation can be had with a patient. The through the lens type are more expensive and cannot be flipped out of the way, however they are neater and lighter. The through the lens type require precise measurement and fitting otherwise eyestrain is inevitable when worn for more than 30 minutes.
•  Dedicated light source. This is a halogen or LED light source which attaches to the spectacle frame and provides bright illumination along the same axis as the loupe. My view would be that the light source at lower magnifications such as 2.6 is a good addition, however at higher magnification such as 4.8 it becomes essential. When performing molar root canal treatment I would never want to be without a dedicated light source again.

 

When teaching I often use the phrase “you don’t know what you don’t know”, when it comes to visualisation in operative dentistry I like the phrase “you can’t see what you can’t you see”. Dentists who tell me that their eyesight is fine so they don’t need magnification are missing the point, they can only see what they can, not what they can’t. So in answer to the question of whether or not you need magnification, my answer would be most certainly yes.