As a student or new grad optometrist, it can be overwhelming to make financial decisions about equipment in addition to managing student tuition, living costs, and considering future practice locations.
For many, it can be difficult to understand which tools are necessary or strongly recommended in practice. This guide provides an overview of the most common equipment and factors that might weigh into your purchasing decisions.
Essential optometry equipment
- Diagnostic kit: Includes your retinoscope, direct and indirect ophthalmoscope, and transilluminator (torchlight)
- Diagnostic lenses: Includes lenses held in conjunction with the indirect ophthalmoscope and slit lamp, as well as lenses for gonioscopy
- Other considerations: Trial frames and specialty equipment
Building your diagnostic kit
Retinoscope
The retinoscope is the main tool for determining refractive error in an objective manner, which is why it is so fundamental for pediatric eye exams. Some optometrists choose to use the retinoscope with the phoropter, while others prefer to use it in free space with trial lenses or retinoscopy racks.
For a refresher on retinoscopy essentials, check out Retinoscopy from A to Z—with Downloadable Cheat Sheet!
Transilluminator
The transilluminator or torchlight is used for pupil assessment (and generally recommended over handheld penlights as it provides stronger illumination).
Direct ophthalmoscope
The direct ophthalmoscope allows for more gross assessment of the anterior and posterior segments, where a slit lamp might not be available. All three tools share the same interchangeable handles and are purchased together in a set. Standard brands include Heine, Keeler, and Welch-Allyn.
In addition to these tools, you will also need to consider purchasing a binocular indirect ophthalmoscope (BIO), which allows for assessment of the peripheral retina and is typically used after a patient has been dilated. The BIO is typically sold separately from the rest of the handheld tools, and certain brands may provide a discount if you choose to purchase both their diagnostic kit and BIO.
Figure 1: Standard battery (Welch-Allyn, left) versus microSD to USB charging (Heine, right) attachment handles.
Figure 1: Courtesy of Jenny Lee, OD, FAAO.
Comparing diagnostic kit manufacturers
The best way to determine ease of use between brands is to make sure you get the chance to try each one—and there is no better time to do so than while you’re in optometry school!
Different distributors will carry different brands and therefore provide their own unique pricing; student discounts are often common while purchasing diagnostic kits, so it’s important to compare between brands. Distributors will typically offer a day for students to try various tools from each brand to see what feels best.
Welch Allyn, for example, carries an ophthalmic diagnostic set and also the PanOptic ophthalmoscope. The PanOptic can provide easier views when performing funduscopic examinations of young children due to a greater viewing area compared to a direct ophthalmoscope.
They also carry a spot retinoscope (with a spot light instead of a streak), which has applications in certain retinoscopy techniques. There is an option for USB-C charging or standard battery charging.
Figure 2: Welch-Allyn retinoscope, direct ophthalmoscope, and transilluminator.
Figure 2: Courtesy of Jenny Lee, OD, FAAO.
Heine also provides diagnostic kits with the option for charging via a USB port or the standard battery handle. For clinics with charging ports that are not compatible with Heine, it can be useful to rely on a universal USB charger instead, especially on the go.
Figure 3: Heine direct ophthalmoscope and retinoscope.
Figure 3: Courtesy of Jenny Lee, OD, FAAO.
Keeler has prices available on their website for various diagnostic kit tools, with ophthalmoscope heads starting at $310 USD, transilluminator heads at $123 USD, and retinoscope heads at $689 USD. Handles are approximately $400 USD each. They also provide a student brochure that provides an overview of the general equipment they offer.
Download the cheat sheet here!
Optometry Equipment Comparative Cheat Sheet
Use this cheat sheet to compare the pros and cons of different tools and equipment manufacturers to ensure you have the best options on hand to strengthen your clinical techniques.
Diagnostic lenses
There are several lenses that are used in the optometrist’s examination. Lenses are typically categorized as slit lamp lenses, BIO lenses, or gonioscopy lenses.
Volk Optical is one of the most common suppliers, with individual lens prices available on their website. Haag-Streit offers some options for gonioscopy lenses, and Ocular Instruments also carries various lenses available for purchase.
Slit lamp lenses
Newer slit lamp lenses on the market will generally advertise better and wider views than standard lenses, although there is no wrong choice to be made. Again, preference depends widely on the individual. Standard lenses include the 90D, 78D, and 60D lenses, where the higher the number, the less magnification is provided.
The 90D lens is widely used for undilated eye examinations and provides 0.76x image magnification with a 74° undilated field of view. It is an ideal training lens for students due to its ability to provide clear views for small, undilated pupils.1 On the other hand, the 78D and 60D are preferred by some for the increased magnification (0.93x and 1.15x, respectively) and can be useful for more detailed assessments of the optic nerve or finer abnormalities.
However, these lenses are generally recommended after the patient has been dilated. Between the 90D, 78D, and 60D, the 60D provides the greatest magnification, but the 78D provides the greatest field of view while having increased magnification over the 90D.
Figure 4: Comparison of size between a 90D and 78D lens.
Figure 4: Courtesy of Jenny Lee, OD, FAAO.
Some of the newer slit lamp lenses from Volk Optical include the Super Field and Digital Series Wide Field Lenses. The Super Field was released as a newer alternative to the 90D lens, providing an increased field of view (0.76x magnification and a 95° undilated field of view); however, it can be more difficult to use and manipulate due to its larger size compared to the 90D.
Meanwhile, the Wide Field lens is the “3rd generation” of the 90D lens, and offers 0.72x image magnification and a 103° undilated field of view. While both 90D lens alternatives are advertised for use with small pupils, some recommend that these lenses be used post-dilation instead due to concerns of glare for the patient with the wide field in particular.
There is no harm in starting off with the 90D lens and purchasing a Super Field or Wide Field lens once the basics of funduscopic examinations with the slit lamp have been mastered, although some prefer to dive right in to purchasing the 90D alternatives.
Figure 5: Size comparison between the Super Field and 90D lens.
Figure 5: Courtesy of Jenny Lee, OD, FAAO.
BIO lenses
The 20D from Volk Optical is the standard lens that is used with the BIO to allow for peripheral retinal views; however, some find that the PanRetinal 2.2 lens is useful, especially for its shorter working distance and wider field of view (at the cost of reduced magnification).
Figure 6: Comparison between the PanRetinal 2.2 and 20D lens.
Figure 6: Courtesy of Jenny Lee, OD, FAAO.
Gonioscopy lenses
Gonioscopy lenses are also recommended for evaluation of the anterior chamber angle when there are concerns of angle closure or recession.
The 3-mirror lens is recommended for students as it provides more stable views but often requires the application of Celluvisc or other viscous gel drops and needs to be rotated to view each quadrant. On the other hand, the 4-mirror lens allows for simultaneous viewing of all quadrants, but may be more difficult to manipulate.
Figures 7 and 8: Comparison of 3-mirror (left) and 4-mirror (right) gonioscopy lenses.
Figure 7: Courtesy of Jenny Lee, OD, FAAO.
Figure 8: Courtesy of Jenny Lee, OD, FAAO.
To review the basics of gonioscopy exams, check out Gonioscopy Tips: Understanding Anatomical Landmarks and Their Significance!
Tight on time? Download the cheat sheet to reference!
Miscellaneous and preliminary testing equipment
While the diagnostic kit and lenses comprise the largest financial purchases as an optometry student, it is worthwhile considering miscellaneous and preliminary testing equipment. There is no pressure to purchase some of these tools early, as with continued experience and practice, they can be purchased as needed throughout your optometry career.
Trial lenses and trial frames are sold by a wide variety of distributors. Trial frames can vary significantly in price from as low as $50 USD to above $1000, but are exceedingly useful to ensure a patient is happy with a prescription before it is finalized, particularly with low vision patients or those with additional support needs.
For instance, the Good-Lite Universal Adult Trial Frame is priced at $140 USD. Oculus sells a trial frame that advertises dermatologist-recommended safe materials and provides a comfortable fit for the patient, unlike typical metal-based trial frames, which can weigh down on the patient’s face.
Figure 9: Example of a standard metal-based trial frame.
Figure 9: Courtesy of Jenny Lee, OD, FAAO.
Consider the benefits of having a trial lens holder that can be easily held overtop the patient’s face in the exam lane. Bernell and Good-lite offer a Trial Lens Holder with 8 Wells; this can also be useful to hold over the patient’s habitual prescription to demonstrate prescription changes or reading prescriptions.
Figure 10: Image of the Good-Lite 8-well adjustable trial lens holder.
Figure 10: Courtesy of Jenny Lee, OD, FAAO.
In addition, more specialized equipment can help those who are interested in providing more thorough assessments, such as contact lens fitting, binocular vision assessments, or low vision assessments. For the prospective optometrist, it is recommended to stick with the equipment provided by the clinic to get a better sense of what might be realistically used in practice.
Bernell generally provides optometric equipment geared towards binocular vision and vision therapy, but some of these products, such as fixation sticks, can be incredibly useful in the pediatric eye exam.
In addition, it is useful to have your own Random Dot Stereopsis Test on hand to assess depth perception, as keeping consistent with the same test can make it easier to remember patient results in the examination room.
Key takeaways
- Take advantage of student pricing while also refraining from purchasing too much or unnecessary equipment.
- Some equipment can be easier to use while in the learning stage, and can always be supplemented later.
- Always try out different brands available at your school’s optometry clinic before making a purchasing decision!
- Distributors should advise you of warranty policies with regard to all equipment purchases.
- Making guided decisions about optometry equipment purchases can help with examination efficiency and clinical decision-making.
In conclusion
There is no right or wrong answer when it comes to selecting optometric equipment, but taking the time to research and try out different options can greatly boost your own confidence and bolster your clinical techniques.
