How to furnish an ophthalmology exam lane

When I opened up five years ago, I equipped my exam lane with top of the line equipment, although almost all of it was used.  The equipment has held up very well over the years, so I decided to go the same route.  I thought about going new to save time and energy (had plenty of time to snipe on ebay when I was unemployed), but the cost savings was well worth my time trade off as I’ll describe below. 


It is worth mentioning that some folks on our thread use the company S4optik.  You can get a new chair and stand, slit lamp, phoropter and visual acuity system for $17,800 plus tax and shipping.  If you started out with S4optik and like it (which many folks on our thread evidently do) I would stick with it.  No need to mix and match.  There have been folks that thought it was too cheap and unsturdy and switched to Reliance and Haag products.  Just for comparison’s sake, my chair/ stand, slit lamp, phoropter, and visual acuity system cost me $19,000, and that’s including tax and shipping.  I will discuss the details below.


Let’s start off with the chair and stand.  Reliance is the model that lasts forever and according to my dealer one of the few companies that actually has resell value.  There are three main chairs:  the 6200, 7000, and FX920.  The 6200 is manual to tilt back a patient (but electrical up and down) , and the 7000 and FX920 are electric motor tilt back as well as up and down.  It’s a matter of personal preference if you want to manually tilt back a patient; this is what I and many others prefer as it’s quicker.  Evidently the way the patient is tilted back is slightly different between the 7000 and FX920.  For a 6200, chairs new are about $4800, but I was able to get one used for $3200.  The difference in price is a few hundred between the three models. 


If this is your very first exam lane, you will want to get a 6200L which is wheelchair accessible with the reliance 942 chair mover.  I got a package with the 8700 stand (I think this has been discontinued) as well as a stool for $10,260 with tax, but for your first handicapped accessible exam lane you get a $5000 ADA tax credit (form 8826) so the equipment really only cost me $5260.


For a Reliance stand, you will probably want to get the 7800 or 7900 as these are the most recent models.  What holds true for ALL used equipment is to get models that are currently in production, so service won’t sunset anytime soon. The stands come in two flavors, IC and NC.  You will want to get the IC as it has charging wells, and is usually a few hundred more than NC.  For a new 7900 IC I was quoted $4700, but I was able to get a used 7800 IC for $3200.


As this post said, you can’t negotiate the price of new equipment such as reliance chair and stand, or Haag slit lamps, but you could try to get them to throw in extra stuff, used equipment for less, or reduce the shipping and handling (which can significantly vary among dealers). 


I used (hidden behind paywall) (one thing I like about them is that they list their prices for all equipment on their web site, while many dealers say to contact us for price)  for a Reliance 5346 stool for $500.  My dealer told me they usually retail for about $700 out the door.  The 5346 has a ring to move the chair up and down, which is easier than just a single knob you have to “search” for with the 4246 which is $280 new.  IMO worth spending the extra $220, as cheap as I am.  Usually if you buy a Reliance chair and stand package new they throw in the 5346 stool.  Ho Sun recommends the (hidden behind paywall- please send us a receipt for $1000 donation to the SSF or ophthpac to advance our profession and protect our patients)


For the slit lamp, there are folks who use S4Optic, Keeler, Topcon, or Marco slit lamps and are happy with them (search the archives).  Again, if you’re happy with what you have, I advise you not to mix and match.  


I will focus on Haag Streit.  The three main slit lamps are BM900, BI900, and BQ900.  BM has been around the longest, and by far is the most popular, meaning even old ones can still be serviced.  It comes with a halogen light (older models), or LED (newer models).  The LED doesn’t have the transformer box and you won’t have to change the light bulbs, but frankly I didn’t notice any difference whatsoever in the intensity of the light or examining the anterior segment, undiluted fundus with a 90d, or the test rod.  I went to their warehouse and spent a good 20 minutes going back and forth between the halogen and LED, and noticed no difference.  I also noticed the on/ off switch was in a different location on the BI, and I wanted to keep things consistent.


You can upgrade a non- LED to a LED slit lamp for about $3000-4000, but since I noticed no difference I have no plans to do so (I have a ample supply of extra bulbs and my Haag has not given me any problems).  If my transformer blows, I might consider paying up, as there would be a cost to replace it.  For used slit lamps, make sure that a tonometer is included, or you might wind up paying a extra $2000 for one.


When I opened, I found a BM900 halogen for the bargain price of $3800, with tonometer, from a local retiring doc who my real estate agent introduced me to.  This time, I bought a exact copy of the same slit lamp for $7500 (with tonometer again).  They are giving me a warranty.  Eyedealequipment in florida wanted $8200 and it would’ve been more difficult for them to service since they aren’t local.


The difference between a BM and BI (other than LED) is the ability to capture anterior segment photography.  There’s a sale until December 31, 2018 for a BI900 plus tonometer for $11,600 pretax (they state it usually runs $15,655).  If you get the imaging set (most people on our thread haven’t) it’s an extra $4000.  I hear there’s also a BP900 that has posterior segment imaging.

A BQ LED slit lamp will run about $18,700.  It will be capable of imaging, have higher magnification, and supposedly better optics.  I was told the optics on the BI and BM are identical and was not able to notice a difference.  


Phoropters:  I took a chance on ebay five years ago and got a Reichert negative cylinder (be sure to get positive cylinder if that’s what you’re used to) for $2050.  This time I got one on ebay for $2450.  In contrast, Walman wanted to charge me $2900 with tax for a used Reichert phoropter.  I’ve heard of new Reichert phoropters going for $3500 up.


Lensometer:  the Marco 101 is a very popular manual lensometer.  I got one off ebay for $560 when I opened. This time it was $700 off ebay, and while it works great, the base isn’t in as good cosmetic condition (pretty banged up), not that I care too much.  Walman wanted to charge me $1400 for a lensometer. 



Visual acuity monitor:  

To learn about Indirects and visual acuity monitor, please send us a receipt to the SSF or ophthpac for $1000 and we will send you a login password.  Thank you for supporting our profession!

Finally, all of this was paid for by credit cards, to ophthalmic instruments and ebay.  $10,000 on my Amex business platinum for a offer of bonus 25,000 points (40,000 points total, worth $600) to offset my annual fee.  $2000 spend offer to Hilton AMEX to get 40,000 bonus points (worth $220).  $600 reliance chair on apple pay which gets me 4.5% back ($27).  And the remaining $7000 on my AMEX business blue which gets me two membership rewards points per dollar (14,000 points or $280).  So I got the equivalent of $1127 in credit card rewards, which is 5.8% back, and $739 (post tax) more than the $387 I would’ve got back with a 2% capital one card.


Total costs:

Reliance chair and stand used $6400 (vs new at $9500)

Reliance chair $500 (free if buy new chair and stand)

Haag Streit BM900 halogen used $7500 (vs BI new at $11,600)

Reichert phoropter ebay $2445 (new $3000; used from Walman $2700)

Marco lensometer $700 (Walman $1400)

Visual acuity system $800 (vs $1600 new with EZER)

Keeler all pupil wireless $1250 ($2000 upwards elsewhere)

Extra Volk lens from first indirect; free Katena 90 D lens thanks to this thread

Computer moved in from procedure room

Taxes $1400 (no tax on ebay purchases)

Shipping $75 (this is where they get you, some companies wanted to charge me $500-700 for new chair and stand and slit lamp shipping)

Total cost with tax:  $21,000 or so; buying at more expensive prices would’ve been over $30,000.  This is about a week’s revenue for me, so it was worth my time to research and get deals. 


Finally, if you live in California, Arizona, or Colorado, it’s worth repeating that Ophthalmic instruments is great. They have offices in Hayward and Irvine CA. They mostly sell new equipment, but after some negotiating gave me great deals (not much more than eBay prices) for used equipment, but included a six month warranty and promised me servicing at reasonable prices afterwards. They’re a family run business, and support our local and state societies. I would also use ophthalmic instruments if i had to get repairs or servicing (have toured their warehouse, they have a repair room) or moving my equipment to a different building. Although i didn’t buy from them, In Florida seems to be a reputable outfit, one of my friends looked at them.