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Loupes:
Magnification and Illumination

ore and more dental professionals are adding magnification and illumination as adjuncts to their armamentarium of dental equipment. In dental and dental hygiene schools, students are encouraged, if not required, to purchase magnification in the form of dental loupes. However, the seasoned professional may have multiple questions before deciding to make this investment. There are multiple benefits to magnification and illumination. Improved ergonomics is the most important; a compromised posture can lead to disability and a shortened professional career. Other benefits include reduced eyestrain, work, time savings, and quality patient care.1 Before purchasing magnification, the clinician must consider various factors: resolution, field width, field depth, weight, magnification power, and angle of declination. Resolution is the capability to visualize small structures, and is set by the quality of the optical design and ones use of precision lenses. Field width is the range of focus delivered by the loupe. Other considerations are diameter of the telescope, optical design, distance from the lens to the eye and magnification power.2 Field depth is the range of focus delivered by the loupe. Weight is the comfort of the complete frame and loupe system. Magnification power is the size of the image. Angle of declination is the correct working angle (angle of declination) allowing the user to work in a
Susan P. Burzynski, RDH, MSEd Vice President Buffalo Dental Hygienists Association Private Practice Tonawanda, NY E-mail: KleenTeeth@verizon.net

comfortable, ergonomically correct position, thus helping prevent neck and back pain.2,3 In addition to the above factors, the clinician must decide what types of loupes best fit their needs. Clinicians have the choice of Single Lens Loupes (Class 1), Galilean Loupe System (Class II), Prismatic Loupes System (Class III), and Keplerian Prismatic Loupe System (Class IV) (Figure 1). In Class I loupes the refractive power is measured in diopters (a measurement of refractive power and applies only to single corrective lenses). Class II power is between 2.0 and 2.9 in magnification power; Class III is between 3.0 and 3.9; and Class IV is between 4.0 and 4.9.3 Class I loupes are the simplest form of magnification, with the lens attached to a frame or headband. They have limited magnification, a single working vision, and poor peripheral vision. Class II loupes incorporate 2 or more lenses that result in higher magnification, are usually tailor made for individuals, and can accommodate illumination. Class III and IV loupes are similar to binoculars, can be tailor made, are more expensive, and, because of the higher power, can result in a smaller field of view.2 Loupes are also available as flip-up or through-thelens (TTL). Each has benefits and disadvantages. The flipup can be moved out of the way for an unmagnified assessment of the field of view, though they can be bulkier and heavier compared with TTLs. A change in an eyeglass prescription can alter the working distance and result in eyestrain. In addition, as lenses are moved up and down, the telescopes tend to go out of alignment and the possibility of cross-contamination is increased. TTL loupes are lightweight, can allow the clinician to sit in an ergonomically correct position, and the eyeglass prescription can be added to the lenses. This can also be a disadvantage because clinicians may need to be without their loupes while their script is being changed.2
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Figure 1Magnification loupes terminology.

Some dental clinicians decide to add illumination to their magnification in the form of a headlamp. Illumination will eliminate shoulder pain from reaching to adjust the light, intensity can be controlled, and because the light source is focused in one location, shadows are eliminated from the operating field.4 Clinicians need to evaluate the illumination for their personal needs. Considerations for illumination are intensity of the light source, throughput of the fiber-optic cable, performance of the optics, portability, color temperature, and CRI (color rendering index), battery life (light-emitting diode only), and operator comfort.5 Without the use of magnification, loupes, and lights, the clinician cannot see or diagnose what conditions are present. Various resolutions in loupes aid in detection of carious lesions, leakages around margins of restorations, leakages around crown margins, as well as reading of the periodontal probe in diagnosing periodontal conditions. For dental hygienists, detection of supragingival and subgingival calculus is easily detected. Additionally, magnification, loupes, and lights aid in the dental professional sitting in a more ergonomically correct posture eliminat-

ing work-related disabilities. Loupes and lights can be purchased, from various dental supply companies, now offering lighter weight units; some without cable and battery packs, or others with laser eye protection that aids against harmful radiation. When the dental environment is safer and productive for both the professional and the patient, it is a win/win situation for both parties.

References
1. Sheets CG, Paquette JM. Is magnification for you? http://www.dentistryiq.com. Accessed: August 13, 2010. 2. Juggins KJ. Current products and practice, the bigger the better: can magnification aid orthodontic clinical practice? J Ortho. 2006;33:62-66. 3. A Dental Loupes Buyers Guide From Orascoptic. Accessed: August 13, 2010. 4. Cohen MD. Fiber-optic lighting: superior and cost-effective. http://www.dentistryiq.com. Accessed: August 14, 2010. 5. Dental Economics. Vision enhancement in the operatory. http://www.dentistryiq.com. Accessed: August 21, 2010.

Dental Learning / February 2011

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