
See Better, Work Smarter With Loupes and Lights
Elevate your practice with the right loupes and lights to protect your health, enhance patient care, and ensure career longevity.
The importance of maintaining ergonomic health and visual acuity for career longevity is not a new concept to the practice of dental hygiene. Musculoskeletal disorders (MSDs) are caused by holding static positions, repetitive instrumentation, and poor postural position, negatively impacting ergonomics and visual acuity.1–3 Clinicians are at risk of pain and injuries caused by musculoskeletal disorders (MSDs), which commonly affect the spine, shoulders, and neck. These issues are often exacerbated by the number of hours spent practicing each week.2,3 To maintain clinical practice longevity, proper ergonomics is necessary. The inclusion of loupes and lights have historically been cited in medicine and dentistry to maintain correct ergonomic position and enhance visual acuity.4–8
Evidence also supports the use of loupes and lights to improve indirect vision and direct vision for instrumentation, as well as correct visual deficiencies.1,4,9 Clinicians should thoroughly research all options before investing in these important purchases.
Dental hygienists who currently own loupes should consider whether it is time to replace them. The American Optometric Association recommends that adults ages 18 to 64 at low risk for eye and vision disorders undergo a biannual visual exam.10 During the exam, loupe measurements should also be checked. Any visual changes merit an update to magnification. When selecting loupes and lights, individual ergonomic health, clinical practice setting, and user preferences should all be considered.1–3,5
Ergonomic Health and Weight
When considering loupes, the working distance, depth of field, declination angle, co-axial alignment, and weight are integral to finding the appropriate fit according to the clinician’s size and line of vision.11,12 Issues with any of these factors may cause increased head and neck flexion and back strain as well as decreased visual acuity.11–13
Approximately 90% of clinicians have a neck flexion beyond 20° which contributes to MSDs.14,15 Loupes enhance the clinician’s ability to maintain a neutral neck position of 0 to 20° and a head tilt range of 0 to 15°.14 However, the weight of loupes and headlight must be considered because for every inch the head is titled forward, it increases the weight of the clinician’s head.15
The weight of the loupe depends on the frame, type of lens, and elected accessories (light). Although these selections are elective, the type of lens may depend on the dental hygienist’s specific needs. Flip-up loupes are heavier compared to through-the-lens (TTL). Ergonomic loupes are another option. They are traditionally lighter than TTL and allow the clinician to sit up straight and reduce neck tilt during procedures. Many manufacturers also tailor loupes specifically to dental hygienists, allowing the clinician to adjust his or her own declination angle to achieve optimal posture and comfort.
Lens Type, Magnification, and Field of Vision
Important features to consider when purchasing loupes is the type of lens on the eyewear frame. TTL loups are entrenched into the spectacle lens itself and flip-up loupes are mounted to the frame. There are multiple options for loupe lenses and they all offer a range of magnifications, sharpness, and field of view. The magnification of Galilean loupes ranges from 2.0x to 3.5x and these loupes offer a larger field of vision.16 These are commonly used to magnify an arch or sextant by 2.0x to 3.5x. Galilean loupes also ease the transition of a clinician’s short working distance from the oral cavity (27 cm to 50 cm) in relation to other tasks during, such as reviewing radiographs or a computer monitor.2,3,17
The magnification of Keplarian loupes ranges from 3.5x to 8.0x and they offer a smaller field of vision. Although the magnification is greater, Keplarian have a longer barrel that increases their weight and the field of vision. Ergonomic loupes provide a magnification range of 3x to 10x and a wide field of vision.
Headlight
Headlights can improve visual acuity but they also add additional weight and cost. The LED headlight requires an attached battery pack in a corded or cordless option. The battery pack for cordless headlights is heavier and has a shorter battery life than traditional batteries. A headlight with a cord is lighter in weight and has a longer battery life. However, the cord can become tangled, therefore, it is necessary to use cord clips and secure it to the clinician’s scrubs or lab coat.
The intensity and illumination of the LED may potentially harm the retina. To reduce this risk, the LED beam should be white or colorless.18 Another advancement to consider is a fluorescence-activating headlight. This type of headlight helps to easily detect enamel demineralization, bacterial contamination, supra- and subgingival calculus, and accumulation of active periodontal bacteria around natural teeth and implants.19
Cost, Warranty, and Customer Service
When investing in ergonomic health, visual acuity, and career longevity, extra costs are incurred. A clinician may want to consider the manufacturer warranty, replacement costs, and customer service options. Some loupe manufactures offer a lifetime warranty for their products. Others may offer discounted replacement parts or service on existing loupes and headlights as maintenance options. Explore the warranty and the customer service options in order to make an informed decision.
Infection Control
Infection control of loupes and lights is a concern for dental hygienists. Personal protective equipment (PPE), N95 masks, and face shields are used more frequently post-COVID. The addition of a face shield increases the weight of equipment. Clinicians who wear a N95 mask or a face shield may want to choose a loupe and headlight that are lighter and more comfortable with the added PPE. Those who are concerned with infection control, but choose not to wear a face shield, may like aerosol-protection loupes. These loupes are fitted with silicone eyecups to reduce transmission from aerosols and spatter.
Dental hygienists need to have loupes properly fitted to avoid touching or adjusting their loupes and light during patient care to prevent cross-contamination. This may be challenging for dental hygienists who elect a flip-up loupe instead of a TTL or an ergonomic loupe. Additionally, headlamps with a cord may be prone to cross-contamination. The manufacturer’s instructions for disinfection of loupes and lights between patients should be meticulously followed.
Style and Customization
For some, style and customization are important features. Clinicians who practice with loupes and lights may wear them 30 to 40 hours per week. A customized fit that is secure and comfortable with or without nose pads tends to be highly desired.
A variety of frame styles and colors are available to suit the clinician’s esthetic preferences. These frames come in multiple options to complement the size and shape of the clinician’s face. Additionally, designer brands are available, offering both classic and sporty looks.
Conclusion
Clinicians will need to identify the most important features relevant to their clinical practice setting and ergonomic and vision needs. Dental hygienists must be properly measured for any pair of loupes, therefore, it is not recommended to purchase loupes online. Identifying a brand of interest and contacting a sales representative is one strategy to obtain more information on personalized loupe and light selection. Attending professional conferences with loupe venders is another way of exploring many loupe varieties at one time in one location. Before making a purchase or upgrading loupes, explore all options to make an informed decision to experience a positive impact on ergonomics, vision, and patient care.
References
- Hoerler SB, Branson BG, High AM, Mitchell TV. Effects of dental magnification lenses on indirect vision: a pilot studyJ J Dent Hyg. 2012;86:323-330.
- Hayes MJ, Smith DR, Taylor JA. Musculoskeletal disorders in a 3 year longitudinal cohort of dental hygiene students. J Dent Hyg. 2014;88:36-41.
- Hayes MJ, Taylor JA, Smith DR. Predictors of work-related musculoskeletal disorders among dental hygienists. Int J Dent Hyg. 2012;10:265-269.
- Perrin P, Ramseyer ST, Eichenberger M, Lussi A. Visual acuity of dentists in their respective clinical conditions. Clin Oral Investig. 2014;18:2055-2058.
- Eichenberger M, Perrin P, Sieber KR, Lussi A. Near visual acuity of dental hygienists with and without magnification. Int J Dent Hyg. 2018;16:357-361.
- Eichenberger M, Biner N, Amato M, Lussi A, Perrin P. Effect of magnification on the precision of tooth preparation in dentistry. Oper Dent. 2018;43:501-507.
- Hart RG, Hall J. The value of loupe magnification: an underused tool in emergency medicine. Am J Emerg Med. 2007;25:704–707.
- Buller AJ, Ramchndani M, Fenerty C. Better optic disc examination: wearing loupes enhances the indirect opthalmoscope image. J Pediatr Opthalmol Strabmisus. 2006;43:102–103.
- Arnett MC, Gwozdek AE, Ahmed S, Beaubien HD, Yaw KB, Eagle IT. Assessing the use of loupes and lights in dental hygiene educational programs. J Dent Hyg. 2017;91:15-20.
- American Optometric Association. Comprehensive Eye Exams. Available at: aoa.o/g/healthy-eyes/caring-for-your-eyes/eye-exams?sso=y. Accessed November 18, 2024.
- Lietz J, Ulusoy N, Nienhaus A. Prevention of musculoskeletal diseases and pain among dental professionals through ergonomic interventions: a systematic literature review. Int J Environ Res Public Health. 2020;17:3482.
- Auffret É, Gomart G, Bourcier T, Gaucher D, Speeg-Schatz C, Sauer A. Digital eye strain. Symptoms, prevalence, pathophysiology, and management. J Fr Ophtalmol. 2021;44:1605–1610.
- Wen W, Zul K, Laronde D, et al. Out of the loupe: The prevalence of coaxial misalignment of surgical loupes among dental professionals. J Am Dent Assoc. 2019;150:49–57.
- Branson BG, Bray KK, Gadbury-Amyot C, et al. Effect of magnification lenses on student operator posture. J Dent Educ. 2004;68:384-389.
- Kapandji AI. The Physiology of the Joints: the Spinal Column, Pelvic Girdle and Head. 7th ed. Pencaitland, Scotland: Handspring Publishing Ltd; 2019:1–359.
- Turcotte C. How do I know when it’s time to upgrade my loupes? Dimensions of Dental Hygiene. 2021;19(4):46.
- Kellogg Eye Center. Refractive Errors. Available at umkelloggeye.org/conditions-treatments/refractive-errors. Accessed November 18, 2024.
- Stamatacos C, Harrison JL. The possible ocular hazards of LED dental illumination applications. J Tenn Dent Assoc. 2013 Fall-Winter;93(2):25-29.
- Teier L, Figueiredo JAP, Blatz MB. Fluorescence-enhanced theragnosis: a novel approach to visualize, detect, and remove caries. Compend Contin Educ Dent. 2021;42:460-465.
From Dimensions of Dental Hygiene. January/February 2025; 23(1):18-21.