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J L Calkins, B F Hochheimer; Retinal light exposure from ophthalmoscopes, slit lamps, and overhead surgical lamps. An analysis of potential hazards.. Invest. Ophthalmol. Vis. Sci. 1980;19(9):1009-1015.
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The projected beam radiance of several common ophthalmologic instruments was measured, and potential hazard to the patient from light exposure was analyzed with reference to safety standards for coherent light. The indirect ophthalmoscopes tested appear to be "safe" under moderate voltage settings, provided exposure is reasonably brief. Slit-lamp biomicroscopy of the fundus, however, merits caution. It produces a three-times-higher retinal irradiance than the indirect ophthalmoscope. Overhead surgical lamps produce a retinal irradiance about one-third that of the indirect ophthalmoscope (for clear media and dilated pupil). This could be dangerous, since an operation may take long enough to exceed the maximal permissible exposure by several orders of magnitude. Major design changes are indicated for surgical illuminators to extend the "safe time" to the 40 to 60 min range.
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