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Surgery has progressed from simple wound debridement to repairs of the smallest tissues. Before, injured blood vessels and nerves can no longer be repaired. The only recourse was to cut the damaged blood vessel and cauterize the ends to prevent hemorrhage. Damaged nerves were left to either heal or die on their own. With the advent of microsurgery, more health conditions are better treated, including the smallest tears in the cornea or muscle fibers. These surgical procedures are made possible by the introduction of microsurgical instruments. 

What are instruments used in microsurgery?

Microsurgical instruments are specially designed surgical tools to allow the manipulation and surgical intervention of very small bodily tissues. These include microscopic tears along muscle fibers, common among athletes, tears along mucus membranes, and repair of damaged blood vessels and nerves. These instruments are better at accessing and grasping smaller body tissues. They have a more slender design to allow ease of access through layers of larger tissues. They provide better maneuverability to allow surgeons to perform the necessary procedures.

These microsurgical instruments are generally much the same with general surgery instruments. The difference is in the size and shape. Microsurgical instruments need to have long handles to allow surgeons to have better grip as the instruments are inserted into deep body layers. The tips are slimmer than general instruments because they are inserted in tiny spaces to access the microscopic structures.

What are the basic microsurgical instruments?

All surgeries require the same basic types of instruments. Microsurgery does, too. To perform microscopic surgical procedures on tiny body tissues, surgeons need to have basic tools. A few are added to the list depending on the requirements of each surgical case. Basic microsurgical instruments include microscope, forceps, vascular clamps and dilators, cutting tools, and sutures.

A microscope is indispensable. It allows the magnification of tiny body structures. Better visualization allows for better and more successful surgical procedure on these tiny tissues. Without microscopes, the surgeon will have nearly impossible chance to perform the small but crucial surgical procedure.

Forceps are the basic microsurgical instruments that allow for the handling of tissues. Larger tissues can be lifted away from the surgical site for better examination of underlying tissues and more room for procedures. They can be used to grasp ends of tissues while being cut or sewn back. Forceps can also be used to grasp the sutures. An important type of forceps is the micro mosquito.

Vascular clamps and dilators are also important microsurgical instruments. They are used to clamp “bleeders”, or damaged blood vessels. They can be used to temporary impede blood flow to prevent blood from spurting. Vessel dilators are used for temporarily enlarging the lumen of blood vessels that are being sutured back together.

Surgeries are traumatic procedures. It involves cutting of tissues and tissue layers. In microsurgery, the cutters can be a very small surgical scissor with a slim tip for precision or a very fine blade. Sutures and needles are also important for repair, reanastomose and for closing up wounds. Sutures in microsurgical instruments have smaller gauge to effectively close up wounds without much damage to the tissues.

Anterior segment

Posterior segment

Diamond knives

Cannulas

IOLs and OVDs

Lens Injection-systems

Scissors are essential surgical instruments. They are useful in cutting organs open, or removing diseased or abnormal tissues. Scissors used depend on the nature of the surgery and the location of the organ to be cut. A special type of surgical scissors is the tenotomy scissors. One of the tenotomy scissors is Stevens scissors.

Recognizing this special surgical scissors type

Tenotomy scissors have a very long handle, with very small and thin blades. Standard blades can be straight or curved. It depends on the needs and preference of the surgeon performing the procedure. Stainless steel is commonly used for its non-rusting and durability features. 

The tips of tenotomy scissors blades can be blunt or sharp or a combination. The blunt tipped blades are used for blunt dissecting procedures, which usually involve mucus membranes. The sharp tipped ones are used for more delicate dissections, which require smaller and more accurate cuts.

The tenotomy scissors is especially designed to allow the scissors to cut tissues in tight and constricted areas. The long handles let the surgeon to have ample grip and adequate control of the scissors as it is maneuvered into tight spaces, body cavities or among delicate tissues. The sharp, slender and small blades allow precision cutting of body tissues. It also allows for access and probing into small areas.

What are the uses of tenotomy scissors?

Tenotomy scissors are mainly used in delicate surgical procedures. They are especially used in ophthalmic and neurosurgery. The small and sharp blades allows for precision cutting of the sensitive and delicate tissues in the eye region and of the small nerves.

Surgeries that involve the eyelids, lips and even the brain use tenotomy scissors as the main cutting instruments. Surgical dissections that require accurate cutting and tissue transplants that need a precisely defined area also use this type of surgical scissors. 

Nerves in the brain and tissues in the eye area are very delicate. Cutting through them require small precise incisions. A slight injury to nearby tissues that are otherwise healthy can cause irreversible damage. The damage can worsen the existing disease condition or give rise to new health problems. Nerves and the eye area are in tight, constrained cavities or body areas, which has very minimal areas where the surgeon can maneuver and manipulate the delicate tissues. Hence, each cut need to be adequately controlled and very defined. Using tenotomy scissors can adequately satisfy the surgical requirements in these areas.

Some tenotomy scissors are made to be extra sharp for cutting small bones and cartilage, like in the nasal cavities. The small scissors are easily able to fit into the small nasal openings, and can reach far back into the cavities, depending on where the dissection or cut is to be made. They can also be used to cut through tendons. The narrow blades are easily inserted into the muscle groups. The blades can make a precise cut into the deeper muscle areas, small enough to suit the requirements of the surgery.

Examples of tenotomy scissors

Sterilization is a very important process in surgery. It is a method of killing all possible contaminants like microorganisms in instruments. The contaminants are living organisms, which includes spores that may have been harbored by a particular instrument. All instruments that come in direct contact with the body surface and tissues need to be sterilized before use. Sterilization can be achieved using physical and chemical means and are best done by placing the instruments on sterilization trays.

What are the types of sterilization?

Sterilization can be achieved with steam, gas, heat and chemicals. Autoclaving is one of the most basic and commonly used sterilization techniques. Reusable instruments are cleaned and dried, then lined on sterilization trays. The tray is covered with cloth and then placed in an autoclave for steam to kill all the microorganisms. Gas sterilization uses ethylene oxide to sterilize the equipments. This method is used for instruments that are heat sensitive like those made with plastic materials.

Why sterilize surgical equipment using sterilization trays?

Surgical instruments are used inside body cavities. The surgical site is very much exposed to the environment, with a very high risk for infection. Manipulation of the body tissues using the surgical instruments is a huge source of possible introduction of microorganism. That is why all instruments and materials that come directly in contact with the surgical site should be free from microorganisms. Sterilization also helps in reducing the possibility of cross contamination. This is a risk when equipments used in one patient is reused for another. There are lots of equipments that can be reused, and are too costly and impractical to discard after a single use. Such items include metal equipments like forceps and scissors. These items are cleaned, dried and placed on various types of sterilization trays for sterilization.

Sterilization trays help make the process a lot simpler. Instruments are lined up along the trays to keep them in place during the sterilization process. The instruments should not be touching each other, to allow heat, gas or steam to freely circulate between them. In the market, there are several types of sterilization trays. Micro instruments sterilization trays are best for small and difficult to track instruments like tiny probe tips. There are perforated trays that allow steam to penetrate the instruments and circulate within the trays. Some sterilization trays are made of high quality, medical grade plastic for convenience and economic purposes. There are see-through trays that allow for easy visibility of the instruments. The most common ones are made of stainless steel. These trays are extremely durable and can withstand the harshest conditions. It is best used for autoclave and gas sterilization techniques.

There is also the standard perforated instrument trays best used for autoclave and cold sterilization. Cold sterilization is soaking instruments in chemical sterilisants. This type is best for instruments called “sharps”, whose sharpness can deteriorated when subjected to extreme heat. Instruments to be soaked in chemicals should still be thoroughly cleaned and dried before soaking. Time of soaking the instruments depend on the instrument type, amount of possible contamination and the type of soaking solution.

Examples of sterilization trays

Capsulorhexis is the surgical removal of the lens capsule affected by cataract. Removing the lenses is a delicate procedure. The incision along the lens capsule needs to be deep enough to allow the entry of forceps to grab the lens and remove it. Creating an incision should be shallow enough to avoid injuring the iris. Removing the lens affected by cataract carries a risk of creating slits on other eye structures, which can cause another problem. The instruments for capsulorhexis should be small enough to be inserted into the thin layers of the eyes but can adequately grasp the lens. The capsulorhexis forceps does just that. 

What are the features of the capsulorhexis forceps?

The capsulorhexis forceps looks like an ordinary pair of tweezers. It is 4.7 inches (119 mm) long. It has an ultra fine tip, which is mildly sharpened. This tip can be used to puncture the side of the lens capsule, creating a small incision. The jaws of the forceps are slim enough to allow the surgeon to maneuver within the lens capsule. The shaft of the forceps has a 2.5 mm and 5.0 mm marks. These measures help to determine the radius and diameter of the capsulorhexis as the incision is being made. It is equipped with an iris stop feature, to prevent injuring the iris while the surgeon grasps the lens within the capsule. The handle has a cross action design, which creates a perfect alignment of the tips. This handle design reduces wound gape and consequent loss of viscoelasticity after the procedure. 

How to use the capsulorhexis forceps

To remove the lens affected with cataract, the surgeon gently punctures the side of the lens capsule with the capsulorhexis forceps. It creates a micro incision for the removal of the affected lens. From this, the forceps are gently inserted into the lens capsule. The markings on the shaft of the forceps guide the surgeon in measuring the depth of the puncture and the radius of the lens. The slim and ultra fine tip of the forceps allows the surgeon to insert the capsulorhexis forceps and maneuver it within the capsule. The surgeon gently separates the lens from the capsule. The lens is firmly but gently grasped then pulled through the small incision on the capsule. The small incision made with this special type of forceps reduces the amount of viscous fluid that may seep out of the wound. Wound healing also occurs much faster from the smaller wound.

Capsulorhexis can result to injury of the iris. The injury may occur during the creation of the puncture wound or while the forceps are maneuvered within the lens capsule. To prevent it from happening, the capsulorhexis forceps has a gentle bend on its slim jaws and has an iris stop feature. The jaws are slim and pliable to enable ease of movement within the eye’s anterior chamber. The jaws have a platform to ensure a firm grasp of the lens. The entire forceps is lightweight with good spring action to reduce hand fatigue.

Example of Capsulorhexis Forceps

Cataract is one of the common eye conditions that require invasive surgery. It is the increased opacity of the lens of the eyes. Common symptoms include seeing halos around lights, cloudy or blurred vision with sensitivity to glare and light. Cataracts are treated through ophthalmic surgery. The affected lens is removed and replaced with an artificial one, called an intraocular lens. This type of surgery uses a special set of cataract surgery instruments.

What are cataract surgery instruments?

Cataract surgery requires a standard set of cataract surgical instruments due to the delicate nature of the eyes. General instruments may be too large and coarse for use in this surgical procedure, which may do more damage than good. Here a list of the common cataract surgery instruments:

• Castroviejo Caliper:
  

  This used to measure size of the incision.

• Colibri forceps:
  

  These fine and smooth forceps have special 0.12 1x2 teeth. They are used for holding cornea.

• Capsulorhexis forceps:
  

  These fine sharp-tipped forceps are used to make a continuous curvilinear incision on the anterior capsule of the lens.

• Capsulotomy forceps:
  

  These forceps are use to create and incision in the anterior capsule of the lens during cataract surgery.

• Formed irrigating cystotome:
  

  Irrigating cystotome  is designed for  capsulorhexis, intercapsular/endocapsular and can-opener capsulotomy  techniques. Formed cystotome  conforms to the  convexity of the  lens providing easier access to the  anterior  capsule. Reduces potential of corneal touch. Formed sharp  tip  cystotome  for  creating an opening into the  anterior  capsule, nucleus dislocating or other intraocular applications. Capsulorhexis cystotome has a special tip which provides more control of the flap when performing continuous curvilinear capsulotomies.

• Hydrodissectors:
  

  A range of cannulas with tips designed to deliver fluids  to facilitate the  separation of the  cortex from the  nucleus and capsule.

• Viscoelastic cannulas:
  

  For injecting viscoelastic to all meridians of the anterior chamber and to coat intraocular lens. This range of cannulas has smooth rounded tips for the safe introduction of viscoelastic.

• Diamond Knife:
  

  The angled phaco knife is used this is a micro surgical knife used in making sclerocorneal tunnels in small incision type of cataract surgery. Can be used clear cornea blades and trapezoid self-diving blades. 

• Side-port blade:
  

  This is used in making a sclerocorneal side port or a secondary tunnel in small incision cataract surgery.

• Universal straight side-port knife:
  

  This is used in making a sclerocorneal side port or a secondary tunnel in small incision cataract surgery. 

• Knife for Micro Incision Coaxial Surgery (MICS):
  

  Designed to make micro incision.

• Nucleus removing forceps:
  

  This is an instrument used to force out the lens in extracapsular type of cataract extraction. Designed to remove fragments of the nucleus through a small incision. Ususally it has two rows of delicate teeth on jaws.

• Prechopper:
  

  Prechopper is a special cross-action forceps for dividing a nucleus by the phaco prechop technique. Nowadays Combo Prechoppers are the most popular prechoppers, as they can be used for all kinds of cataract. 

• Sinsky's hook:
  

  This is an intraocular lens dialer. It has an angulated round hook with a handle used in inserting an intraocular lens.

• Irrigation/Aspiration handpieces

• These special handpieces can be used for bimanual I/A (Irrigation handpiece and Aspiration handpiece) and Coaxial I/A (Irrigaton/Aspiration handpiece). Irrigation/Aspiration handpieces are used to maintain the intraocular pressure and to remove the residual cortex after phacoemulsification. 

Why perform cataract surgeries?

Cataract increases the opacity of the lenses of the eyes. The result is gradual and progressive impairment of vision. If left untreated, cataract can cause loss of vision. Cataract surgeries vary in types, depending on the patient’s condition and preferences. For each type, additional cataract surgery instruments are used to suit the needs.

Chalazion is a cystic growth in the eyes. It is also called Meibomian cyst, conjunctival granuloma, or tarsal cyst. The cyst usually grows on the upper or lower eyelid. It may be firm or soft and fluid-filled. It is caused by an inflammatory reaction or obstruction of the oil glands on the eyelids. The mainstay of treatment is through surgical excision and drainage of the chalazion. This procedure uses a special instrument, the chalazion forceps. 

A chalazion forceps is a self-retaining type of thumb forceps that has discoid ends. One arm has a flattened plate at its end, which is round and solid. The other arm has a matching ring that fits into the opposite arm’s solid plate. There is an adjustable screw at the middle of the plates, which can be tightened until it has a firm and fine grip to the cyst or lesion. 

The tip is specially designed to grasp a cyst perfectly. The design allows the chalazion forceps to be safely inserted into a tiny incision. There are no rough edges that may scratch or injure the delicate membranes as it passes through. Unlike other thumb forceps, the chalazion forceps can be safely inserted and withdrawn without the risk of tissue damage. It is primarily used to remove a chalazion, hence the name. The special design also allows surgeons to use this forceps for prevention of bleeding during chalazion removal. The slim fit design does not require a large incision inorder to remove lesions. This forceps can also be used for the isolation and removal of lesions (such as a mucocele) located on the lips and cheeks.

The surgical removal of chalazion is a minor type of surgery and the patient can go home and perform regular activities right after. A local anesthetic is applied to the eyelids. A small incision is made, usually at the topmost portion of the chalazion. Then, the chalazion forceps is carefully inserted. The plates are gently squeezed together until a firm hold is established on the cyst. The hold is maintained while the other hand adjusts the screw to the desired grasp. When the desired stability and amount of grip is obtained, the surgeon slowly withdraws the forceps from the incision. Any exudates like plasma and small amounts of accumulated blood can be manually expressed by applying gentle pressure around the site of the chalazion. Any residue is normally reabsorbed by the system as part of the healing process. The procedure usually takes about 15 minutes.

The chalazion forceps allows the surgeon to make a small incision, unless the chalazion is a very large one. Because of this, there is no need for suturing after the cyst has been removed. Applying pressure over the incision is usually enough to stop the minimal bleeding. Healing of the wound is left to occur naturally, without any stitches. Usually, healing does not leave any scars and occurs in about 4 to 5 days.

Surgery has progressed from simple wound debridement to repairs of the smallest tissues. Before, injured blood vessels and nerves can no longer be repaired. The only recourse was to cut the damaged blood vessel and cauterize the ends to prevent hemorrhage. Damaged nerves were left to either heal or die on their own. With the advent of microsurgery, more health conditions are better treated, including the smallest tears in the cornea or muscle fibers. These surgical procedures are made possible by the introduction of microsurgical instruments.

Microsurgical instruments are specially designed surgical tools to allow the manipulation and surgical intervention of very small bodily tissues. These include microscopic tears along muscle fibers, common among athletes, tears along mucus membranes, and repair of damaged blood vessels and nerves. These instruments are better at accessing and grasping smaller body tissues. They have a more slender design to allow ease of access through layers of larger tissues. They provide better maneuverability to allow surgeons to perform the necessary procedures.

These microsurgical instruments are generally much the same with general surgery instruments. The difference is in the size and shape. Microsurgical instruments need to have long handles to allow surgeons to have better grip as the instruments are inserted into deep body layers. The tips are slimmer than general instruments because they are inserted in tiny spaces to access the microscopic structures.

All surgeries require the same basic types of instruments. Microsurgery does, too. To perform microscopic surgical procedures on tiny body tissues, surgeons need to have basic tools. A few are added to the list depending on the requirements of each surgical case. Basic microsurgical instruments include microscope, forceps, vascular clamps and dilators, cutting tools, and sutures.

A microscope is indispensable. It allows the magnification of tiny body structures. Better visualization allows for better and more successful surgical procedure on these tiny tissues. Without microscopes, the surgeon will have nearly impossible chance to perform the small but crucial surgical procedure.

Forceps are the basic microsurgical instruments that allow for the handling of tissues. Larger tissues can be lifted away from the surgical site for better examination of underlying tissues and more room for procedures. They can be used to grasp ends of tissues while being cut or sewn back. Forceps can also be used to grasp the sutures. An important type of forceps is the micro mosquito.

Vascular clamps and dilators are also important microsurgical instruments. They are used to clamp “bleeders”, or damaged blood vessels. They can be used to temporary impede blood flow to prevent blood from spurting. Vessel dilators are used for temporarily enlarging the lumen of blood vessels that are being sutured back together.

Surgeries are traumatic procedures. It involves cutting of tissues and tissue layers. In microsurgery, the cutters can be a very small surgical scissor with a slim tip for precision or a very fine blade. Sutures and needles are also important for repair, reanastomose and for closing up wounds. Sutures in microsurgical instruments have smaller gauge to effectively close up wounds without much damage to the tissues.

The ophthalmologist and the required instruments form an important team
To achieve better results in ophthalmic surgery, it is often indispensable to have appropriate surgical instruments. An ample level of surgical experience results in the knowledge that the instruments can assist in and facilitate certain steps during ocular surgery. One of the most commonly used instruments are the forceps for capsulorrhexis.

As a surgeon, one looks for the following:
1.- Instruments that pass through increasingly smaller incisions with the goal of minimizing post-operative astigmatism
2.- A pair of forceps that can hold the crystalline capsule firmly
3.- A clear view of the capsule while we have the capsule within the forceps
4.- Instruments that allow us to save on the use of another instrument within the eye
5.- The toothed plate facilitates the grip of the capsule at all times
6.- Instruments that have the appropriate length and curvature, among other requirements

This has obliged companies to develop the instruments which comply with our expectations and which allow us to conduct the same steps within the eye, but through increasingly smaller incisions.

Rumex International Co. has an investigation, design, development and production team by which I was contacted merely a few months ago. That was the moment that I had the pleasure of trying the modified forceps of Kawai and started to use them in my surgical procedures.

After having conducted some 500 surgeries, I can mention the following:

1.- Thanks to their 23g diameter in the body and their 25g diameter on the tip, you can use them for whichever size of incision, which is why they can easily be used in openings of up to 1 mm

2.- The great opening of the forceps allows them to grab the capsule easily

3.- They are so fine at the tip that they make it possible for us to see perfectly what we are doing below the forceps during capsulorrhexis

4.- You save on the use of cystotome and one can start capsulorrhexis without the cystotome. When you enter, I only recommend doing it with the forceps of an angle of 90 degrees with respect to the level of capsulorhexis; so that the apices of the cystotome do not damage the tunnel floor or the corneal tissue, as we often do when using forceps that include cystotome

5.- The toothed plate facilitates the grip of the capsule at all times

6.- I found two ways of conducting capsulorrhexis thanks to its fineness and the thinness of its tip

a)Directly making an incision on the lens capsule with the tips closed, tearing it towards any side.

b)Making a preseptal dissection. In other words, puncturing the lens capsule and opening the forceps to tear it. This is what I finally prefer

7.- I recommend supporting it with the other hand in a way that the index finger serves as a support for the forceps, the reason being that, as the forceps are very thin, it is difficult to control them at first, especially in incisions bigger than 1 mm.

8.- I think that the curvature of the forceps is appropriate, given that it makes it possible for us to handle them in a comfortable manner and that they allow us to reach the lens capsule even in highly myopic eyes. Furthermore, it proves out to be very useful when we are working through incisions of 1 mm, given that this curvature gives us the possibility not to stress the wound by not crashing into the lateral borders when intending to reach the lens capsule during capsulorrhexis.

9.- To increase the service life of the forceps, I recommend to always clean them at the end of the surgical day with the device that the forceps include, which is specifically used for that purpose.

Links on the web on the modified forceps of Kawai

https://www.youtube.com/channel/UC1wrcDFtKPBW3Qyhocy2h0Q

Eye surgery is an accumulation of small, well-conducted steps.  In order to advance in this kind of surgery, we need to train ourselves for many years, managing to dominate our instruments, to have confidence and safety so that these steps allow us to go onto the next ones.

Since the year 1995, I have been using the 1.00 mm width diamond knives of the company Rumex to conduct my cataract surgeries, cornea transplants and trabeculectomy. 90% of my incisions are sclerocorneal as I think that different works published on endophthalmitis and corneal incisions versus scleral ones produce a rate of 0.05% of endophthalmitis for scleral incisions and 0.29% for corneal ones.

Initially, I was using the Universal Straight Side Port Diamond Knife with 1.00 mm trifaced blade of Rumex (6-10/6-053). However, currently, I am very comfortable with the ones with trapezoid self-diving blades like 6-10/052 or 6-10/6-070, which have an excellent end with an edge and this allows me to make the incision with safety and confidence to have it valvulated. The cost of surgery has decreased remarkably as the instruments can last years with the proper care.

To enlarge the sclerocorneal wounds, I use a scalpel of surgical steel according to the size of the wound that I need to make, currently making it as small as 2.0 mm.

The versatality of the scalpel also allows me to use it in trabeculectomy, the procedure of cutting the scleral lid, which needs to be as soft and precise as possible. 

With the use of the 1-mm Rumex diamond, we can control the depth and cut carefully to later make the entry into the chamber and conduct trabeculectomy with Punch.

These diamonds also allow me to make and complete the cut in the trepanation of the cornea. I choose to use them due to the edge they have, which does not require any pressure at that moment as any pressure could lead to damage in the adjacent structures, such as the crystalline and the iris.

I also use a diamond scalpel to make my accuate incisions to lower astigmatism.
For those patients that have 1.0 dp to 2.50 dp of astigmatism and cannot pay the cost of toric lens implants, I make relaxing incisions according to the nomogram of Dr Nichamin from Pennsylvania (USA). The preset scalpels offer the possibility of using them at required depth that range from 600 microns (the pre-set LRI knife 6-600S/6-0531 is the one I use) to 500, 350 or with the free mode.

This means that I can use it for other surgeries, such as with marking the scleral lid in trabeculectomy, or using it for valvulated scleral incisions (350 microns).
I use SKY, which provides help for the wound so that the wound does not go deeper. And in the free mode, it can be used as a paracentesis or incision scalpel.
In short, my relationship with Rumex is mainly based on its excellent scalpels that have accompanied me since my first surgeries.

Watch micro incision cuts with Rumex diamond knives video:

Dr. Pablo Luis Daponte Mr. Daponte is the owner of Centro Integral de Salud Visual Daponte, Buenos Aires Argentina  and university teacher. He is the President of Argentine Council of Ophthalmology, an institution that brings together all the societies and departments of ophthalmology in Argentine and it has 3500 ophthalmologist members.

Mr. Daponte is a specialist in anterior segment surgery, he does cataract surgeries, cornea transplants, insertion of lenses for high myopia (Artisan and ICL), valvulae. He has been working with Rumex diamond knives for twenty years and buys our scalpels every year. Using Rumex diamond knives Dr. Pablo Luis Daponte have conducted around 40.000 surgeries.

What makes an ophthalmological practice successful? Some may say the quality of the professionals at work, others may point to the use of advanced technologies, while others would argue that strong patient-client relationships are what makes or breaks a practice. We agree that each of these factors contribute to success, but would add that an effective ophthalmological practice is also one that always takes time to pay attention to the little things, such as keeping a well-stocked office. 

Maintaining an office that's always stocked with quality ophthalmic tools, such as vitreo cannulas, eye forceps, scissors, needle holders, corneal transplant instruments and other items, is essential for providing patients with consistent, high-quality service. Tools like disposable vitreo cannulas and various types of eye forceps are needed for a wide variety of common eye procedures, from chalazion removal to retinal surgery. What's more, these procedures may sometimes require the use of a specific variation of a tool, a necessity which may only be brought to an ophthalmologist's attention immediately prior to or before a surgery. For example, after closer evaluation, a patient's retinal surgery would be best performed with a larger millimeter cannula than what is currently in stock; such a situation is when keeping an office well-stocked or purchasing a vitreoretinal set, complete with a large variety of cannulas, proves essential.

An ophthalmological office that's well-stocked is also one that has tools on hand for any type of procedure, not just those that are most common or those scheduled for the upcoming week. The reality is that an ophthalmologist's office may be required to perform unexpected emergency procedures at a moment's notice, such as a preventing a retinal detachment or treating a damaging eye laceration. In extreme cases, letting supplies dwindle or forgetting to re-order a niche tool could severely impact a patient's eye health.

The good news is that re-stocking ophthalmic tools doesn't have to be accompanied by steep costs. Most common ophthalmic tools and microsurgery instruments can be found at competitive prices; for example, at Rumex, because we're a manufacturer, the cost of our tools is 10-20% lower than those offered by reseller companies. In other words, practitioners can save significantly over the course of time when purchasing from a manufacturer. We make ordering supplies much easier as tools can be delivered to an ophthalmological practice within a matter of days; at Rumex, we ship out of European and U.S. locations to ensure quick delivery and will even waive shipping fees depending on the cost of a purchase order.

For more information on eye surgery instruments for keeping your practice supplied, browse Rumex products online.

As an ophthalmologist, you know that your credibility as a medical professional depends upon more than just your knowledge and skill set. Like any professional in a service field, you're also evaluated on your ability to make ethical decisions. While we may typically think of ethics as involving doctor-patient confidentiality, an ethical ophthalmology practice is also one that consistently relies on the best surgical tools and equipment available.

Why does a commitment to quality surgical tools matter? The truth is that even the most talented, insightful ophthalmologists disserve their patients and, quite frankly, act unethically, when surgical tools and equipment are outdated, in need of repairs, or ill-suited to the specific surgery at hand. There's no amount of experience or skill that can make up for an instrument that features manufacturer defects with the potential to botch an operation. Given the intricate, delicate nature of eye surgeries, whether a limbal relaxing incision that relies on the precision of a toric marker, or an intraocular lens implant following cataract removal, one defective or inadequately-built tool can outright ruin a surgery.

Not all ophthalmological instruments are created with the same care and attention to quality as those manufactured by Rumex. When ophthalmologists neglect to ensure that the instruments they use on hundreds of patients are guaranteed by manufacturers to perform as expected, they run the risk of damaging their reputation as a respected physician or worse, incurring damage to a patient's eye. As an ophthalmologist at the head of your practice, it's ultimately your responsibility to ensure that every aspect of your operations, from patient consultations to the use of eye instruments, is carried out in an ethical manner.

How can ophthalmologists accurately identify well-made surgical instruments that will ensure patients undergo surgery that's truly safe?

• - Instruments are well-made when constructed with high-quality materials, such as non-corrosive stainless steel and titanium, both of which are guaranteed to provide durability and longevity.
• - Ophthalmologists should look for tools from manufacturers that have consulted with leaders in the field of ophthalmology. Companies that don't seek out the expertise of professionals lack the type of key insight that could lead to improvements in design and production.
• - Reliable manufacturers implement strict quality control standards that, at minimum, meet FDA criteria. At Rumex, our commitment to exceptional quality control allows us to make a 100% percent guarantee that our instruments are free of manufacturing defects and will offer exceptional performance for the duration of their use.
• - Ophthalmologists should seek instruments that feature innovations. Surgical tools made with unique, advanced features, such as ergonomic handles, indicate that a manufacturer intimately understands the industry.

Learn more about what makes for high-quality eye instruments to ensure your practice continues to operate ethically by visiting Rumex online. 

You may have noticed an influx in patients at your ophthalmology practice over the course of the last year; wait times may have increased in length, more surgeries may be scheduled, and new patients are likely arriving at a faster pace. That's because the number of individuals seeking ophthalmology services is increasing nationwide.

The growing popularity of corrective eye procedures is one reason for this increase. Eye procedures once considered to be major operations, like the LASIK or PRK eye surgeries, are now seen as safe and viable options for individuals with poor vision. More than 12 million people have had LASIK eye surgery alone since 2002. Ophthalmologists are also witnessing an increase in younger cataract patients, which is likely the result of better detection methods and a host of environmental factors that contribute to overall poor health.

Additionally, as the baby boomer population ages, more will be in need of procedures to treat cataracts, macular degeneration, retinal detachment, and other eye conditions common among the elderly. In fact, for the next 20 years, 3 million baby boomers will enter the Medicare system each year; this will undoubtedly mean more patients for eye care professionals.  The introduction of the Patient Protection and Affordable Care Act has already resulted in significant increases in Medicaid procedures performed in 2014 and 2015.

So as your ophthalmology practice prepares to treat an increasing number of patients, how can you ensure quality service continues?

A Supported Staff

As your practice expands, you'll need to ensure that your staff is prepared to meet new demands. Focus staff meetings on new strategies for scheduling, patient accommodation and staffing, and actively listen to what your team has to say about how they're managing increased levels of patients. Be sure to hire more staff as needed to avoid stretching your current staff too thin.

Exceptional Technology and Instruments

It's important to maintain the latest technologies and instruments in a practice to ensure that procedures are conducted as smoothly and efficiently as possible. Investment in these items will yield valuable pay-offs to both patients and ophthalmologists. Regularly assess your inventory of tenotomy scissors, vitreoretinal forceps, toric markers and other surgical tools to ensure that they're in top condition, and consider if newer models would make your surgeries more effective. Keeping an eye out for advanced technologies will also help increase the efficiency of your practice, and in turn, help you treat more patients.

Patient Feedback

Regularly ask patients to conduct a satisfaction survey to provide feedback of their experience at your office. Are wait times too long? Are doctors and staff as attentive, organized, and accommodating as they've always been? Were there any issues with scheduling or payment processing? How your patients feel about their experience in the coming years can be an indication that it's time to expand your practice, hold off on accepting new patients, or continue in the same manner.

How satisfied are patients of your ophthalmology practice? The answer to this question is an important one, and will continue to be so in the coming years. Despite what we know about expected increases in the number of ophthalmology patients, ophthalmologists won't be able to benefit from this influx without continuing to improve patient satisfaction. Why? Patient satisfaction plays a significant role in the success of healthcare practices, even when demand for services is high; in fact, word-of-mouth remains the primary way individuals choose a healthcare professional. Additionally, according to Forbes.com, an increasing number of businesses and insurance companies are interested in metrics concerning patient satisfaction, with some even proposing that a percentage of physician pay be based on patient satisfaction scores. While these aren't widely-implemented ideas as of yet, they do underscore the continued importance of patient satisfaction.

So how can your ophthalmology practice find simple ways to better satisfy patients?

Emphasize Quality Consultations

Today's patient is arguably more concerned with their health than ever before, and with easy access to an abundance of information on eye health and specific eye procedures, expect patients to attend consultations with more detailed and informed questions. While some procedures may be urgent, and therefore leave patients little time to "shop around" for the best ophthalmologist, common procedures like corrective lens surgery and cataract removal afford patients the time to conduct research and attend multiple consultations.

What will set your consultation apart from others is demonstrating your breadth of knowledge in a way that's clear and easy-to-understand, discussing alternative treatments, and being honest if you feel a procedure is not the best course of action for a patient. 

Leverage Advanced Technologies and Instruments

Equipping your practice with advanced technologies and high-quality microsurgery instruments like vitreoretinal scissors and eye forceps can result in higher patient satisfaction for two reasons. First, better technologies and instruments reduce the chance of error during a patient's procedure; second, these cutting-edge technologies and tools often make procedures more expedient. This allows ophthalmologists to treat patients faster (increasing their satisfaction), and in turn see more patients (reducing patient wait times). 

Be Personable and Polite

While this may seem an obvious word of advice, there are ways to better communicate your sincerity to patients. Patient satisfaction is not just about the end result of a procedure; it's about how a patient feels while in your office, and it can sometimes be difficult for ophthalmologists to maintain a consistent level of courteousness and cheerfulness given the fast-paced nature of the job. To avoid coming off as brusque or indifferent to patients—even though you may just be tired or stressed—take care to: 

• - Address patients by name.
• - Make strong eye contact and greet patients with a handshake.
• - Ask if patients have any questions.
• - Offer to supply patients with additional resources.
• - Listen. Refrain from interrupting patients when they're expressing questions or concerns.
• - Always end an appointment with a friendly farewell.