Do I need to buy an otoscope/ophthalmoscope?

Do I need to buy an otoscope/ophthalmoscope?
And if I do, which one should I get?

These are two of the first questions I used to hear from every MS0/MS1 during welcome weekend, white coat ceremony, or orientation.

Medically, the answer for most students is “no.” Most hospitals and clinics have Welch Allyn diagnostic sets attached the walls or units hidden away in the supply room on the floors. You will play with them once during first year and probably never again. However, many schools nonetheless “require” you to buy one. My own school did that, and in hindsight, it was a soft requirement, and I probably could have avoided the purchase. That said, there are several reasons to invest in a set:

1. Your school demands you buy a “diagnostic set,” and you feel awkward not playing by the rules
2. The hospital you train at or plan to work at is ill-equipped and does not have access to these tools on a regular basis
3. You are interested in a career in neurology or ophthalmology
4. You want to do family medicine and actually see inside the eye during your fundoscopic exam instead of pretending
5. You are interested in community outreach, rural medicine, or medical mission-work

There are a lot of super cheap sets available online, but if you ever plan on actually using them, then it’s probably worth upgrading slightly. The cheap ones are extremely heavy and optically useless. Either the light is too bright or too dim and non-adjustable. Not infrequently, the optic disc remains blurry no matter how you tweak, because the manufacturing process doesn’t calibrate these devices accurately. Most otoscopes work okay (ears are easy), but you’ll almost always buy it as part of a set anyway.

Neurologists and ophthalmologists are the specialists that most routinely do fundoscopic exams. General practitioners document that they do but frequently don’t, and when they do they typically do not get diagnostic exams. Ophthalmologists actually rarely use a direct ophthalmoscope, as in the office setting they have bigger and better toys, so even for them once again it boils down to your desired clinical context.  Any physician who wants to do community outreach (e.g. glaucoma screenings at a local church) or medical missions outside of a routine clinic or hospital setting can find a use for these tools. Personally, the most use my set got was in a small village in the Dominican Republic.

So which model should I buy?

If you’re looking for a reasonable, affordable, small and light general purpose set, look no further than the Riester Ri-Mini. This is the set I purchased as an MS1, and it strikes a balance of price and quality. They’re well-made, durable, and actually work.  They use AA batteries, so they’re small and can fit in your white coat easily (unlike their full-size C-battery-sipping cousins). For a pocket set, there’s nothing better.

The best  “reasonable” full size optionsis the Welch Allyn Diagnostic Set, which is what you’ll find in just about every hospital setting. It’s big, it’s good, it’ll last forever, and it’s expensive.

If you want the Rolls-Royce of sets, then you’re forced to splurge on the holy Panoptic. To me, everything else in between just doesn’t seem worth it (if you’re really going to shell out $500+ for a Welch Allyn diagnostic set, why not upgrade all the way?). For most people, the Panoptic is a massive waste of money. Its main benefit is that you can do a much more complete fundoscopic exam without dilating the eye. As a consequence, you can accurately assess the optic disc and easily check for papilledema.  Consequently, for neurologists, the Panoptic can be extremely helpful in checking for signs of increased intracranial pressure. For ophthalmologists or family docs, the Panoptic is helpful for community outreach work and school screening, as it allows you to obtain a fast reliable exam without eye drops/dilation.

So for most people, a huge waste of money.

For people who want to do community outreach, medical mission-work, etc—it’s seriously something to consider. If you want to be a GP/PCP and actually do a real fundoscopic exam, then a Panoptic head is probably the most straightforward way to do so in a routine clinical setting. You don’t even have to know how to use one properly; it’s just that much easier.