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Searching for loupes?

June 1, 2018
Anne Guignon, RDH, points out that loupes are considered the standard of care in dental hygiene. Find out what you should look for—and what to avoid—when shopping for your first pair.

What to consider when shopping for a pair

Exactly 21 years ago, I was measured for my first pair of loupes by a wonderful person named Betty Waldheim at the Star of the South dental meeting. It might seem strange that I remember her name, but the encounter is forever etched in my mind. Loupes were not my only purchase that day; I also signed on the dotted line for an ergonomic chair with arms.

The decision to purchase loupes and a chair was scary, but my body was aching, and I was worried my 26-year career might end any day. It was an enormous purchase, but I was desperate for relief. It took me about a week to acclimate to the seating system and another week to feel fully comfortable using loupes. The following year, I purchased my first headlight.

Both doctors I worked with used loupes. No one questioned why they relied on magnification, but the other dental hygienists, assistants, and even some patients laughed when they saw me using different equipment. My neck, shoulders, and back gradually started feeling better, so I ignored the teasing. Betty had measured me correctly, and I had purchased premium, custom equipment—which allowed me to extend my clinical career for another 18 years.

Much has changed since my first foray into the world of magnification and illumination. Back then, only a handful of companies manufactured magnification loupes. Most were in the US, and a few were based in Europe. Today, magnification and illumination are considered the standard of care by many. Many schools either require or strongly encourage students to use loupes, and a growing number of established clinicians are now purchasing their first pair, while many seasoned users are upgrading for the second or even the third time.

Despite the popularity of loupes, confusion still exists. Those who have not adopted magnification often think loupes are unnecessary until one begins to experience visual changes around age 40. Nothing could be further from the truth. If you are old enough to stick a sharp instrument into someone’s mouth, you are old enough to be using magnification. The key benefit is gaining an erect, nonstressful posture, and the bonus is fabulous visual acuity.

Furthermore, companies are vying for our attention and dollars. As with all commodities, there are dramatic differences between products and companies. Today’s consumer needs to be able to cut through all the noise.

If you are old enough to stick a sharp instrument into someone’s mouth, you are old enough to be using magnification.

Magnification strength

Most clinicians start with 2.5x loupes, a level that allows users to view the entire oral cavity, a comfortable starting point for many clinicians. Others either start with a higher power or increase the strength when they get measured for their next pair. The quality of the glass used in the oculars determines the clarity—the higher the quality, the better the resolution, which results in crisp, defined edges on small objects. Low-grade optics will not provide a consistent and clear image from edge to edge. Lack of consistency and poor resolution can lead to eye fatigue. The strength of the ocular has a direct effect on both the width and depth of field of the image one sees through the ocular. As the strength increases, the image size enlarges, and the field width and depth decrease. Regarding ocular strength, there are no industry-wide standards, so one company’s 2.5x ocular might be quite different from another’s. It is wise to trust your personal experience.

For years, magnification loupes were made with one specific power per pair. There are now two unique options for clinicians who desire multiple power levels housed in one frame. The first multipower option was introduced three years ago. The system provides the clinician with three different levels of magnification in a single ocular. Simply rotate the ocular in or out to change the ocular power. The most recent innovation takes a different approach. It uses one frame, fabricated with a special housing to support a magnification ocular. Strength-specific oculars from 2.5x to 5.5x are available. The interchangeable oculars are held in magnetically, and the frame contains each clinician’s personal fabrication requirements. This new concept allows clinicians to use one frame and swap out ocular strengths as needed. Clinicians who alternate between glasses and contact lenses can also benefit from this concept. Imagine having one or two pairs of oculars that can be installed into a frame that is set for the days you’re wearing contacts or into another frame that is set for the days you want to wear glasses. It is all about accommodation, flexibility, and clinician needs.

Frame options and magnification systems

Years ago, there were very few frame options. Most were heavy, masculine-looking, and offered very few adjustment options. This is no longer the case. Companies that fabricate loupes have been listening. Manufacturers that carry high-quality loupes are constantly looking for frames that withstand the rigors of the clinical setting, can accommodate precise measurement requirements, and are adjustable to different facial profiles. Today’s first-time users are often drawn to a frame that either looks fashionable or carries a recognizable brand name, but the key is finding a frame that fits your face correctly, supports your optical needs, and is durable enough to be worn day in and day out for many years.

There are three different basic frame styles: through-the-lens (TTL), flip-up or front-lens-mounted (FLM), and a hybrid style that features a TTL ocular mounted in a carrier lens that can be flipped up. Oculars in a custom TTL system are mounted in the carrier lens according to a user’s specific measurements. The oculars in an FLM system are attached to a framework that is mounted to the top of a frame. Some users notice a weight difference on their nose when using an FLM system. TTL systems are the most popular and allow the largest volume of light because the ocular is closer to the eye, but the design of an FLM system has the potential to create the steepest declination angle, a feature important to some.

Over time, any pair of loupes will need maintenance, and it is wise to take maintenance requirements into consideration when selecting a frame. When a prescription change is necessary, most TTL systems need to be serviced at the factory, while prescription changes in an FLM system can be handled at a local level and installed in the lens in the frame. Several companies offer TTL systems that contain a special slot that holds a removable prescription lens.

Today’s frames are fabricated using titanium, carbon composite, aluminum, nylon, or plastic. Each material has advantages and disadvantages. Plastic frames are the most lightweight, but the material is rigid, and most plastic frames do not accommodate modifications or adjustments for head size, the shape of the nose bridge, or ear height discrepancies. Nylon frames are a new lightweight and customizable option. Titanium and carbon composite frames are very durable but not heavy, and it’s easy to bend the temple arms and front of the frame to customize the fit. More and more frames feature adjustable nose pads, allowing the user to fit the frame to the size and shape of the user’s nose bridge, and some nose pads can be positioned to increase the distance from the ocular for those with long eyelashes.

Getting measured for custom loupes

Loupes are a medical device and should be fitted specifically for each user. Custom magnification loupes offer two benefits. Loupes that fit correctly allow the clinician to sit erectly, minimizing neck and shoulder strain. Second, enhanced visual acuity translates to improved clinical outcomes.

Specific measurements that ensure correct neck and trunk posture must be taken. This can be done during a continuing education program or a conference, but the most ideal setting is in your actual clinical environment. This way, the measurements account for the treatment room layout and how one sits or stands while working.

Getting accurate measurements is easy, but they need to be taken by an experienced sales representative. Custom products are fabricated so your eyes are looking through the exact optical center of the oculars with your head in a relaxed, upright position, so while the measurements are being taken, you’ll sit in a relaxed, erect position with your ears in line with your shoulders.

A custom pair of loupes takes into consideration working distance, pupillary distance, convergence point, and declination angle.

• An accurate working distance is the distance from one’s eye to the patient’s maxillary cuspid. It is important to have the upper arm close to the body and the forearm parallel to the floor.

• An accurate declination angle allows the wearer to never flex the neck more than 20 degrees from neutral.

• The pupillary distance measures how far apart your eyes are positioned, and the convergence point creates a single, uniform image.

All of these measurements ensure your loupes are properly manufactured.

Adjusting to your new loupes

Most clinicians remember how excited they felt when their new loupes were delivered. Loupes are a big purchase and have the capacity to help you extend your clinical career. Initially, it is tempting to try to wear the loupes immediately for the full day, but if you are on your first pair, understand there is a learning curve. Wearing magnification is a new skill to learn. It is wise to gradually adjust to using loupes. Grasp the frame with both hands when you put your loupes on and take them off to reduce strain on the frame hinges and reduce flexion on lightweight sport frames. Make sure the nose pads are comfortable and that the temple arms fit comfortably on your head and over your ears. Snugging up the head strap counterbalances the weight and ensures the frame stays in position as you reposition your head.

Here are two big tips: (1) Train yourself to look through the oculars without moving your head. When you need to glance at something across the room, look over the oculars and keep your head still. Motion sickness is the biggest issue to overcome for most clinicians, and keeping the head still is the key. (2) Start with wearing them for a short time frame and gradually increase the wearing time as you become more comfortable with the magnification. Many clinicians develop their proficiency by wearing the loupes while doing crafts or needlework during their off time. This creates a learning environment that is free of the clinical demands.

Caring for your loupes

Establishing a care routine for your loupes is important. The temple arms are attached with tiny screws that can loosen over time, putting unnecessary stress on the frame. Eventually they can pop out. Typically this happens at the worst possible time, so make it a habit to tighten the screws once a month. If a screw falls out, make sure the replacement screw has a thread pattern that fits your particular frame. Don’t expect a local optical shop to bail you out. Installing the wrong type of screw can permanently damage the frame.

Cleaning and disinfecting your loupes is easy, but there are some important guidelines to follow. Never immerse your loupes in any liquid. Instead, spray them with water or a very mild soapy solution to dislodge debris. Always use a soft cloth, such as one made from microfiber. Paper towels and facial tissues are made from wood and will scratch both the oculars and the carrier lenses. Alcohol-based sanitizing wipes are also a good choice, but make sure the wipe uses nothing stronger than 70% alcohol. Anything stronger can deteriorate the glue that holds the ocular in the carrier lens. Once the glue is compromised, the ocular will lack the proper support. If an ocular dislodges, do not attempt to reglue it into the frame. Oculars are set at very precise points during manufacturing, and it is unlikely that you would match that precision setting. An improperly set ocular will result in eye strain.

Many dental hygienists work in multiple practices or provide temporary clinical services in different locations. As soon as you arrive on location, place your car keys in your loupes storage box. This ensures that your loupes will make it home with you or to your next location. Speaking of location, get in the habit of taking your loupes with you. Cars can be stolen or broken into. Don’t let your precious loupes be a target for a thief. If you work in a large office and have a locker, stow your loupes and headlight in your personal storage space. This will eliminate the chances of your loupes getting broken by a cleaning crew or by a colleague who decided to test-drive your loupes on your day off.

Even though loupes are still not considered the standard of care by all dental professionals, it is becoming rarer for clinicians to practice without magnification. Those who hesitate often worry about becoming dependent on using loupes, and clinicians who already use magnification get concerned when their loupes have to go in for a repair or a prescription change. There is a very simple solution: have a second pair. No one would willingly drive a car without a spare tire, so why should you risk your health and the quality of your work by trying to complete clinical tasks without magnification?

Trial periods, warranties, and customer care

While it may seem logical to contact your sales representative if you have a question about a product, need small parts, or want to schedule a repair, customer care is the best place to start. Customer service representatives are trained to handle most problems immediately and effectively. As with any purchase, it is important to understand the fine print.

Complimentary trial periods have defined time frames and allow customers to try products in a clinical setting. If everything does not seem right during your trial period, contact customer service immediately. If it is an adjustment issue, follow the advice in this article. If it is a comfort issue, don’t expect it to get better magically. Give the company a chance to investigate the issue and resolve the problems. Small tweaks with nose pads and frames can go a long way toward creating the perfect fit.

A product warranty is a legal contract that outlines what part of the product will be covered, how the product will be repaired or replaced, and how long the product will be under the warranty period. Some sales representatives might bend the truth to get a sale. If you are told a product has a 100% lifetime warranty on every aspect of a product, be a wise consumer and check the actual written warranty. A remark like this is often a sales ploy. Similarly, companies with inexpensive products sometimes claim their products are just as good as premium products. Also, take any mentions of online reviews with a grain of salt—anyone can write a review.

It is important to notify customer care when returning a product. Find out how shipping costs are covered. Ask for a return materials authorization, or RMA, number. Wrap the product in bubble wrap, place it in a sturdy box, and make sure it is stabilized and can’t move around. Consider insuring the product before sending it back. Save all shipping receipts.

Products made in the United States

Companies throughout the world manufacture magnification systems, but most premium products are manufactured in the United States. There are advantages to purchasing a system from a company that has American roots. Shipping is easier, there are no language barriers, and you won’t have to deal with another country’s customs rules, import fees, and taxes. Whatever dollars you could save from purchasing products made on the other side of the world will immediately be lost when you need a repair. Overseas shipping alone can be a nightmare. Plus, supporting a US-based company helps US workers and their families.

Cost and payment plans

There is a lot of chatter online regarding cost, but those conversations are not always useful. For instance, what someone paid as a student seven years ago can’t be compared to the cost of today’s products. Every year, major innovations are made in optics, systems, and lighting. Much like a new car, premium products will have a higher price point than middle-of-the road or bargain products. Essentially, you get what you pay for. Bargain products are often made with lower quality components that are not as durable. Also, if the loupes are not properly fitted, this can cause significant optical issues and ramp up the risk of a musculoskeletal disorder due to poor posture.

Price does not always reflect the value of an item. If your new loupes cost $1,500 and you use them for eight and a half years, the magnification actually costs $176 per year, which is a small price to pay for improved posture and visual acuity. With loupes, clinicians report feeling better and that visits to the chiropractor and massage therapist are for preventive maintenance, rather than for crisis care. After graduation, you can often find special discounts at conventions or via CE courses, or by purchasing multiple products, such as a loupe and headlight combo. Periodically there are specials on the internet for items such as headlights that do not need custom fitting.

Companies often offer interest-free payment plans, allowing us to spread the cost of our purchase over time. Every company has different terms. Some offer extended time frames when multiple products are purchased at a time.

Final thoughts

Many first-time users focus on price. This can be very dangerous. Purchasing a used pair of loupes or using an employer’s hand-me-downs can increase your risk of developing a workplace-related musculoskeletal disorder, unless your personal measurements match those of the previous user. It’s also dangerous to order a pair directly off the internet without consideration of your personal measurements or facial geometry.

While there are many ways to obtain magnification loupes, the goal should be to find a product that meets your personal needs, enables low-stress postures, and enhances visual acuity for many, many years to come.

ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].