For retina specialists, ophthalmologists, and other eye care professionals, control of the orbit and adequate scleral depression is critical in many procedures, and the importance of patient comfort during these procedures cannot be underestimated. Scleral depression can be uncomfortable (sometimes painful) and intimidating for both physician and patient.
With this in mind, my colleague, Eduardo Besser, MD, and I developed a new scleral depressor that is meant to alleviate and reduce these factors by having an ergonomically curved tip and contour to the curvature of the eyes. The scleral depressor may be used on the lid itself (usually the case) or directly on the sclera for more difficult areas and difficult-to-reach areas.
The recently patented and trademarked Josephberg- Besser scleral depressor (Stephens Instruments) has a curved blade, which conforms to the globe and can be placed and/ or attached to a thimble or a handle, which is very comfortable to the examiner. The examination is well facilitated due to the width and length of this instrument. One can actually sweep the entire globe in approximately 6 to 8 depressions. The pressure needed is minimal.
The Josephberg-Besser scleral depressor facilitates holding the lid and bringing it back, which is particularly advantageous for patients with tight lids and/or who secrete moisture to the area around their eye. The instrument has been in development for many years and been manufactured for over 3 years, with several thousand sold. I have found that first-year residents report it to be less intimidating than a standard Schocket and/or Schepens scleral depressor and that the learning curve is minimal. In my experience, the field is substantially clearer and wider with this depressor.
Several different models have been developed (Figure 1). The double-tip Josephberg-Besser scleral depressor is similar to an Schocket except for the patented curved tip on 1 end. The single-tip Josephberg-Besser scleral depressor is similar to the thimble-type of Schepens depressor. The single- tip scleral depressor has also been developed on a short handle to facilitate depression within the OR during vitrectomies. The blade can easily go on the lid or under the eye speculums to facilitate depression during vitrectomies. This negates the use of cotton swabs, muscle hooks or other devices that makes scleral depression fast, easy, and safe.
The Josephberg-Besser scleral depressor overcomes several difficulties encountered during the fundus examination of adults and infants, where the bulk and configuration of oversized instruments, both conventional and unconventional, hinder and may frequently preclude their use.
Robert G. Josephberg, MD, is Chief of the Retina and Vitreous Department of the Westchester Medical Center, New York Medical College in Valhalla, NY. Eduardo Besser, MD, is Founder and CEO of Angeles Eye Institute and Volunteer Clinical Faculty at Jules Stein Eye Institute in Los Angeles. Dr. Josephberg and Dr. Besser both have a financial interest in this instrument and collect royalties from Stephens Instruments. Dr. Josephberg can be reached at +1 914 965 2526; fax: +1 914 965 2527; or via email at firstname.lastname@example.org.