Clinical and Experimental Ophthalmology

2005;

33

: 395–401

Blackwell Science, LtdOxford, UKCEOClinical and Experimental Ophthalmology1442-64042005 The Royal Australian and New Zealand College of Ophthalmologists? 2005334395401Original Article – Laboratory Science

Portable ophthalmic microscopesTan

et al.

�

Correspondence:

Dr Anna Tan, Bendigo Base Hospital, Lucan Street, Bendigo, Vic. 3550, Australia. Email: anna__tan@hotmail.com

Original Article

Portable ophthalmic microscopes in the Philippines:an overview

Anna Tan

BMedSc

,

1,2

Clay Fraser

BSc

,

4

Brian Staples

BAPSC

,

4

Richard L Mesurier

FRCOphth

3

and Henry Newland

FRANZCO

5

1

Cataract Foundation Philippines, Bacolod City, Philippines; and

2

Christian Blind Mission Australia, and

3

Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, and

4

Scan Optics and

5

Royal Adelaide Hospital, Adelaide, South Australia, Australia

Key words:

cataract surgery

,

developing country

,

oph-thalmic microscopes

,

portable

.

I

NTRODUCTION

Blindness is a huge problem in developing countries like thePhilippines. Low cost, robust portable microscopes, whichare user-friendly, have a large role to play in addressing theproblem of cataract blindness in remote areas of great need.The preferred method of cataract surgery, extra-capsular sur-gery extraction (ECCE),

1,2

requires a microscope with goodoptics, a good visual field, depth of field and adequate illu-mination.

3,4

Accessories like foot pedals or sterile covers andlever handles enable a sterile field to be maintained andshould be considered in portable microscopes.

5,6

A protec-tive case is also necessary for safe transport over dirt andgravel roads.

Many international ophthalmic organizations do notmake much effort to address the problem of maintenance oftheir equipment. They rely on heavily professional techni-cians even for simple acts of maintenance and repair (e.g.cleaning of microscope lens or changing of light bulbs andmould pellets). This attitude is simply not suitable in areaswhere services are scarce, expensive and inaccessible. As aresult highly expensive and useful equipment (e.g. oph-thalmic microscopes) have often been left idle due to asimple technical problem like a blown light bulb or cleaningof lens. Most times these problems can be solved by someonewith minimal training. The problem lies with the lack ofconfidence in dismantling a microscope and a fear that onemay only worsen the problem. Complex microscopes withnumerous small parts add to this problem. Hence a micro-scope that is simple and easily maintained has manyadvantages.

2,7

Cataract Foundation Philippines Inc. (CFPI), a local non-government organization, in association with Christian BlindMission funded by Australian Agency for International

A

BSTRACT

Background:

Demonstrations were held all over thePhilippines to teach local microscope operators basic main-tenance skills and troubleshooting for their portable micro-scopes.

Methods:

Fifteen microscopes were examined and feed-back was obtained from 16 microscope operators. Thedifferent parameters of the microscope were evaluated asfollows: (i) user-friendliness, (ii) demand and availability oftechnical services and spare parts, (iii) portability and (iv)frequent problems encountered. Some suggestions forimprovement are proposed.

Results:

There was a general satisfaction among the oper-ators with their microscopes; however, there was a lack oftechnical support services. Most microscopes were porta-ble and the original casing was adequate for transport. Eventhough most microscopes were functioning, their qualitycould be improved with maintenance. The three most com-mon problems identified were: mouldy/dirty lenses, expiredmould pellets and poor alignment.

Conclusions:

The portable operating ophthalmic micro-scope has an important role in the prevention of interna-tional blindness. The archaic attitude of sending microscopesto professional technicians for simple maintenance andrepair should be abandoned. Instead demonstrations aimedat teaching these skills to local operators and surgeonsshould be held, in order to improve the technical supportavailable. Different microscope operators can help providemicroscope designers with feedback for future improve-ments. Similar demonstrations could be considered forother countries with a similar scarcity of technical supportservices.

396 Tan

et al.

Development (AUSAID) provides both the equipment andsupplies for cataract surgical missions in the Philippines.Most of the technical expertise for maintenance services inthe Philippines is concentrated in Manila, and much timeand money is wasted transporting microscopes from neigh-bouring islands.

Demonstrations were held all over the Philippines(Table 1

)

to teach local microscope operators basic mainte-nance skills and troubleshooting for their portable micro-scopes. The only tools used were screwdrivers and Allen keysthat were provided with the microscope. Operators weretaught to differentiate between simple problems and morecomplex ones that may need referral to a professional. Thisaimed to reduce the number of microscopes transported forfurther repairs.

The aim of this study was to determine the usability andcondition of the portable microscopes in use. The availabil-ity of spare parts and technical support is also assessed. Thefeedback from microscope users on problems encountered aswell as suggestions they have for improvements are reported.The feasibility of these suggestions is then discussed.

M

ETHODS

Microscopes

Fifteen microscopes located in different southern provincesof the Philippines were examined. (Refer to Table 1 for fur-ther details on each microscope).

They were all portable Scan Optics (Adelaide, SA,Australia) microscopes of two models: the SO-111 withzoom magnification and the SO-161 with fixed magnifica-tion. The microscopes were examined by a single technicianand assessed on their present condition. Common problemsfaced with the microscopes were identified.

The process of maintenance was made up of:

1 Examining the condition of the halogen bulb andchanging the bulb if necessary.

2 Examining the quality illuminated field and adjustingthe bulb and focal length to obtain the optimum illu-mination.

3 Cleaning the lenses and eye-pieces.4 The prism was examined for damage, replaced if nec-

essary and cleaned.

†

5 If the mould pellet had expired that was replaced bydismantling the head.

6 The microscope was then re-aligned.7 Other troubleshooting was done where necessary.

†

Cleaning was done with alcohol swabs and antistatictissue for drying the lens.

Tools used were Allen keys and screwdrivers. Refer to therespective Scan Optics user manuals for a labelled figure ofthe parts.

The above process was demonstrated to about 50 micro-scope operators. Service manuals

8

and contact details of thecompany were given for further assistance in the future.

Feedback forms

Ophthalmologists and microscope operators who attendedthe demonstrations completed surveys on 16 microscopes.Those who had no problems with their microscope did notbring them to be examined. Instead they learnt the skills thatthey could then apply later to their own microscopes. Themicroscopes not examined were not included in the surveysmentioned above. Also some organizations owned two micro-scopes but only filled out one form for both microscopes.Due to the above reasons, the number of surveys reporteddoes not correspond with the number of microscopes seen.

R

ESULTS

Microscopes

The condition of 13 of 15 microscopes is shown in Fig. 1.Two microscopes were excluded, as they did not have cor-responding surveys from the operator.

Figure 1 shows that three microscopes were unable to beused. The condition of the corresponding microscopes, asreported by the surgeons, indicated one of the three micro-scopes was unable to be used. The other two had not beenused for some time and the surgeons were not aware of theproblems.

Figure 2 is a summary of the problems identified thatrequired maintenance. ‘Other’ problems include meltedknobs due to overheating and damaged head.

Table 2 is a record of the maintenance done on each ofthe microscope.

• A spare bulb was given out to those who did not haveone. Proper instructions were given on how to changethe bulb to preserve its life.

• Mould pellets were changed if expired. The new oneswere provided free, a new expiry date was recorded onall changed mould pellets and the operators were toldwhen to change it again and where to obtain thesepellets.

Figure 1.

Condition of 13 microscopes: (black square) as foundon examination and (white square) as reported by the operators.

0

1

2

3

4

5

6

7

8

Good Needs maintenance Unable to be used

Microscope condition

No.

mic

rosc

opes

Portable ophthalmic microscopes 397

Tabl

e 1.

A f

ull p

rofil

e of

the

mic

rosc

opes

, the

ir lo

cati

on, s

eria

l num

bers

, nam

es o

f op

erat

ors

date

of

purc

hase

and

org

aniz

atio

n w

ho p

urch

ased

the

mic

rosc

ope

Loca

tion

of

mic

rosc

ope

Seri

al n

oSe

rial

no.

of P

SM

icro

scop

e op

erat

ors

Dat

e of

purc

hase

Org

aniz

atio

n/pe

rson

of p

urch

ase

1. M

olul

e, M

anill

a7A

0187

(SO

-161

)PS

7040

7M

r La

rry

Das

wan

i (d

emon

stra

tion

uni

t)19

94H

olly

woo

d O

ptic

alSu

pply

2. R

amir

o C

omm

unit

y H

ospi

tal,

Boho

l57

0478

(SO

-111

)PS

608

18D

r O

liver

Yu

1996

Dr

Fran

cis

Nat

han,

Aus

tral

ia3.

CFA

RD

Clin

ic, B

ay

Lagu

ne7A

0183

(SO

-111

)PS

7040

4C

FAR

D-L

agun

a M

s Jo

selin

ne

D. R

equi

so19

98C

atar

act

Foun

dati

onPh

ilipp

ines

– C

BM4.

Ilo

ilo D

octo

rs H

ospi

tal,

Iloilo

Cit

yN

A (

rubb

ed o

ff)

(SO

-111

)N

AD

r U

ri B

est/

Dr

Ron

nel F

Qui

non

1999

Cat

arac

t Fo

unda

tion

,Ph

ilipp

ines

– C

BM5.

Kab

acan

Pol

ymed

ic

Hos

pita

l, K

abac

anN

A (SO

-111

)N

AD

r K

adil

Sino

lindi

ng J

unio

r19

99C

atar

act

Foun

dati

onPh

ilipp

ines

– C

BM6.

Riv

ersi

de M

edic

al

Cen

tre

Baco

lod/

Neg

ros

Occ

iden

tal

BG03

500

(SO

-111

)PS

9041

4D

r Fo

rtun

ato

Euse

bio,

D

r Ja

y Eu

sebi

o, D

r Ti

na E

useb

ioJu

ly 1

999

Rot

ary

Clu

b of

Can

terb

ury,

Baco

lod

Nor

th

7. B

roke

nshi

re H

ospi

tal,

Dav

ao C

ity

8G02

627

(SO

-111

)N

ASo

cial

Con

cern

s U

CC

P Fo

unda

tion

- D

r Pi

neda

, Dr

Prad

o, D

r V

erga

ra, D

r Se

lga,

Dr

Libr

e, D

r Em

bals

ado,

Dr

Mel

ocot

on

June

200

0So

cial

Con

cern

s U

CC

PFo

unda

tion

8. D

avao

Del

Sur

Pro

vici

al

Hos

pita

l, D

avao

Del

Sur

/Dig

os8G

0350

1(S

O-1

11)

NA

Dr

Mel

vin

Am

asol

Febr

uary

200

0D

avao

Jub

iliee

Fou

ndat

ion

9. Z

ambo

anga

8G02

658

(SO

-111

)PS

905

05D

r A

nton

Lim

/Dr

Vin

cent

Yu

III

2001

AU

SAID

10. G

erm

an D

octo

rs H

ospi

tal,

Cag

ayan

D’o

ro/B

ukid

non

Com

mun

ity

Hos

pita

l, V

alen

cia

Buki

dnon

OD

2181

4(S

O-1

11)

PS00

0714

Com

mit

tee

of G

erm

an D

octo

rs-

Dr

Agu

sto

Dej

os, D

r N

oel

Pena

rand

a, D

r T.

Gui

nito

R.N

.

2001

Cat

arac

t Fo

unda

tion

Phili

ppin

es –

CBM

11. E

ast

Ave

nue

Med

ical

Cen

tre,

Q

uezo

n C

ity-

Man

illa/

Kav

iti

8L00

25(S

O-1

61)

PS00

5?D

r Ja

mes

L C

oshu

min

gU

nkno

wn

Cat

arac

t Fo

unda

tion

Phili

ppin

es –

CBM

12. R

ichs

tone

Hos

pita

l, Q

uezo

n C

ity-

Man

illa/

Kav

iti

NA (S

O-1

11)

PS61

007

Dr

Jam

es L

Cos

hum

ing

2001

AU

SAID

13. M

J So

mta

r H

ospi

tal,

Butu

an C

ity

OV

2050

5(S

O-1

11)

PS01

0413

Dr

Jose

ph T

Cus

todi

oM

arch

200

1A

USA

ID

14. B

roke

nshi

re H

ospi

tal,

Dav

ao C

ity

1F11

125

(SO

-111

)PS

0204

06So

cial

Con

cern

s U

CC

P Fo

unda

tion

- (a

s ab

ove)

2002

Soci

al C

once

rns

UC

CP

Foun

dati

on15

. Mag

says

ay M

emor

ial D

istr

ict

Hos

pita

l, Lo

pez

Que

zon

Prov

ince

IJ19

125

(SO

-111

)PS

0202

08D

r Jo

hn J

oan

T E

scot

eM

ay 2

002

Flyi

ng M

edic

al S

amar

itan

s

16. D

atu

Hal

un S

akila

n M

emor

ial

Hos

pita

l, Bo

ngao

/Taw

i-ta

wi/S

ulu

2L02

503

(SO

-111

)PS

0303

02D

r R

eden

tor

T R

abin

oJu

ne 2

003

Cat

arac

t Fo

unda

tion

Phili

ppin

es –

CBM

17. E

vrui

c, T

aclo

ban

Cit

y3A

2059

5(S

O-1

11)

PS03

0404

Dr

Lem

uel G

atch

alia

nJu

ly 2

003

Cat

arac

t Fo

unda

tion

Phili

ppin

es –

CBM

NA

, rub

bed

off

or u

nabl

e to

be

read

.

398 Tan

et al.

Tabl

e 2.

Diff

eren

t as

pect

s of

mai

nten

ance

car

ried

out

on

each

mic

rosc

ope

exam

ined

(

n

=

15)

Cle

aned

lens

Seri

al n

o of

mic

rosc

ope

(Mod

el n

o)C

hang

e of

bul

bA

djus

ted

field

of

illu

min

atio

nTo

p I

nsid

eC

lean

edEy

e-pi

eces

Cle

aned

Pris

mA

djus

ted

Alig

nmen

tM

ould

pel

let

chan

ged

(exp

iry

date

)C

omm

ents

5704

78(S

O-1

11)

XX

XX

XX

X (

1997

)Ill

umin

ated

fiel

d w

as d

im, b

ulb

blac

kene

d, s

crew

s on

lam

phou

seda

mag

ed w

ith

a ba

d th

read

8G02

658

(SO

-111

)X

XX

XX

XX

(20

02)

Eye-

piec

es v

ery

dirt

y, m

ould

on

pris

m

8G03

500

(SO

-111

)X

XX

XX

X (

2001

)D

ark

edge

s on

illu

min

ated

fiel

d w

as a

prob

lem

for

ope

rato

r3A

2059

7(S

O-1

11)

XX

XX

XFi

lam

ent

shad

ow o

n ill

umin

ated

fiel

d

7A01

87(S

O-1

61)

XX

XX

XX

X (

1997

)Ill

umin

ated

fiel

d sm

all d

espi

te a

djus

ting

1B00

30(S

O-1

61)

XX

XX

XD

ust

on le

ns

NA

(Q

uino

n)(S

O-1

11)

XX

XX

XX

XX

(19

96)

Cha

nged

bro

ken

pris

m, m

ould

on

lens

,zo

om in

hea

d ja

mm

ed w

hich

cou

ld n

otbe

fixe

dO

V20

505

(SO

-111

)X

XX

XX

X (

2003

)G

ood

cond

itio

n

8G03

501

(SO

-111

)X

XX

XX

XX

(20

02)

Eyep

iece

s an

d le

ns d

irty

, foc

us k

nob

loos

e, b

ad a

lignm

ent

OD

2181

4(S

O-1

11)

XX

XX

XX

(19

98)

Gru

b sc

rew

s on

hea

d m

issi

ng, p

rism

was

chip

ped

but,

no e

ffec

t to

fun

ctio

n1F

1112

5(S

O-1

11)

XX

XX

XX

Bulb

blo

wn

due

to b

eing

cha

nged

wit

hfin

gers

8G02

627

(SO

-111

)Bu

lb c

lean

edX

XX

XX

X (

2002

)R

ight

edg

e of

the

illu

min

ated

fiel

d ha

s a

dark

fila

men

t sh

adow

7A01

83(S

O-1

11)

XX

XX

XX

(20

00)

Illum

inat

ed fi

eld

need

s m

inor

adj

ustm

ent

8L00

25(S

O-1

61)

XX

XX

XX

(20

03)

Bulb

not

per

pend

icul

ar t

o pr

ism

hen

cesh

adow

on

illum

inat

ed fi

eld,

pri

smsh

adow

obv

ious

NA

(C

oshu

min

g)(S

O-1

11)

XX

XX

X (

?)M

ould

on

pris

m

TO

TAL

515

152

1514

1512

NA

, rub

bed

off.

Portable ophthalmic microscopes 399

Feedback forms

The results of the feedback forms are reported below.

1

Use of the microscope.• Three out of the 16 microscopes were used for

ocular exams. All the microscopes were used forcataract surgery (16/16).

• For the frequency of use of the microscopes insurgery refer to statistics of surgeries done by thedifferent doctors in different areas.

9

2

Availability and quality of microscope user manual (onecopy is supplied with the microscope).• Eleven out of 16 reported having the manual, 4/16

did not have the manual and 1/16 was not sure asthe case was kept separate to the microscope.

• All 11 manuals were the English version and werereported as easy to read and understand.

3

Condition of microscope.• As reported in Fig. 1.

4

Availability of technical support services.• Two of the 16 microscopes had been sent, to be

serviced at least once.• Spare parts were not available locally and had to

be imported. So far no microscopes have requiredany spare parts.

5

Portability of the microscope.• All the 16 microscopes were reported to be porta-

ble but 13/16 were actually moved on a frequentbasis.

• Three out of 16 did not have an aluminium carrycase.

• Fifteen of 16 had kept the original packaging. Onemicroscope was transported in a vinyl bag insteadof the original cardboard box.

• Two of the 16 operators reported the originalpackaging as not being adequate. The problemsdescribed were the durability of the foam insert,which could flake.

• Refer to Fig. 3 which shows how frequently eachmicroscope was moved from each base area forwhich the microscope was purchased.

6

Microscope issues.• Refer to Fig. 2 for the microscope issues identified

by the operators that required maintenance.

7

Reliability of power supply.• All the microscopes use the mains as a power sup-

ply, 2/16 reported problems with frequent powerdisruptions in their area.

8

Suggestions for improvements.• A foot pedal accessory to be made available.• Improvement in the cooling mechanism to stop

overheating.• Coaxial binocular viewing scope and video attach-

ments be made available for teaching.• A more durable casing for the power supply.• Sponge packaging to be replaced by glazed

Styrofoam to increase durability.• ‘FRAGILE’ engraved on cases to reduce incidence

of mishandling; stickers were inadequate.

D

ISCUSSION

Maintenance and quality control issues of a portable micro-scope is an important part of a larger issue of supplyingcapital items, instruments and consumables, all essential forquality cataract surgery.

10

In is an important component ofinfrastructure support required for the blindness preventionprogramme. Although there was overall satisfaction with themicroscopes, on closer examination there were a few areasthat by using simple maintenance skills the satisfaction couldbe improved.

Mould, dirt and alignment were the most common prob-lems identified both on examination and reported by theoperators. A possible reason for high incidences of mouldcould be attributed to the lack of knowledge about the mouldpellets. Another contributing factor is a lack of protection ofthe optical heads. In extremely humid regions sealed plasticbags with regenerative drying agents have been used to pre-vent mould growing on the outside in turn preventing sporeentering and mould growing on the internal optics. Improv-ing the awareness that mould is a problem that can easily beprevented with simple methods is the first step in reducingthe incidence of mould. Many were unaware of the exist-

Figure 2.

Problems that required maintenance for 15 micro-scopes: (black square) as found on examination and (white square)as reported by the operators. ‘Mould/dirt’ was further classified onexamination as in the lens top for 15 microscopes and in theeyepiece for two microscopes.

0

2

4

6

8

10

12

14

16

None Bulb Alignment Mould/dirt Expired mouldpellet

Other

Problem with microscope

No.

mic

rosc

opes

Figure 3.

Frequency that each microscope was moved from thebase area for which the microscope was purchased.

0

1

2

3

4

5

0 1 2 3 4 5 6 7 8

Frequency of move (times/month)

No.

mic

rosc

opes

400 Tan

et al.

ence, function, and need for renewal of their mould pellets.Details on how to order new pellets and change existingmould pellets were covered in the demonstrations.

The bulb life and quality had mostly good reports, andproblems were only identified in cases where the bulb wasold and blackened giving a poor source of light. Inappropri-ate handling of the bulb (touching with fingers) shortens thebulb life. The bulb then needs to be removed, cleaned withalcohol and replaced. Also it was worth noting that a localalternative supply of bulbs was found, which made it easierto obtain extra bulbs in the future.

Shadows on light patches were easily removed by adjust-ing the bulb and the focal length. Many had not known thatit was possible to adjust this with a simple Allen key orscrewdriver.

Overheating during long hours of use (15–20 h/day) wasraised as an issue. The design uses cooling fins on the top ofthe lamphouse to dissipate the heat but this may be insuffi-cient for long hours of surgery. The feasibility of installingan additional fan with the motor yet keeping the microscopelightweight and portable may be a challenge. Rheostat knobsmade of more heatproof material should also be consideredas problems with melted knobs were reported. Also thepower supply casing was quite susceptible to rust and shouldbe made more durable with a better paint finish. It is neces-sary to enable microscopes to withstand long hours of use inhot, tropical conditions as missions to rural areas do close to50–100 operations in a 2-day tour.

A poor system of maintenance is a large barrier to theprevention of blindness

11,12

The availability of infrastructuresupport is an important contributing factor. Until this visit,technical services around the country were very limited. Astrategy to establish a system of maintenance would be totrain key local staff members to carry out demonstrations allover the country and in areas not reached by visiting dem-onstrators. The skills of these local staff members should becontinually updated by visiting professionals and overseastraining according to the needs of the area they are serving.Even though 75% of the operators had an easy to read andunderstand user manual, the practical application of thoseskills described in the manual had not been carried out.Hence demonstrations are important to provide techniciansand surgeons with the practical skills to tackle simple repairsand maintenance and the ability identify complex problems,which may need referral to the manufacturer. Visual demon-strations simplify the concepts, which may be hard to graspfrom a written manual. Copies of the service manual werestill given to each operator for future reference and consol-idation of their knowledge.

8

It would be worth consideringadding simple repair and maintenance skills to general sur-gical training of younger surgeons to help instil the cultureof maintenance.

The adequacy of packaging is another issue worthaddressing. Two microscopes moved quite frequently had noaluminium case while four microscopes with cases were notmoved at all. It was suggested to the CFPI that some redis-tribution of the aluminium cases would benefit the two

unprotected microscopes used for outreach missions. Thedurability of the foam packaging, which disintegrates withage, was also identified as a problem. Glazed Styrafoam wassuggested as an alternative material.

An unreliable power supply is a potential barrier to sur-geries. Battery cables are provided with all microscopes andcan be used to connect the microscope to a wide range of12 V batteries including car batteries. CFPI could considerproviding back-up batteries as an alternative power supplyand additional accessory cables if the original has been lost.

The most common suggestion from the operators wasprovision of a foot pedal. While having a foot pedal may beconvenient, its advantage may not warrant its cost. Also itadds unnecessary complexity, which may make the micro-scope less user-friendly. Other accessories like coaxial bin-ocular viewing scope and video attachments are alreadyavailable from Scan Optics.

In summary, portable ophthalmic microscope mainte-nance is an important issue that should be addressed moreclosely by international ophthalmic organizations dealingwith the prevention of blindness. Below are some importantpoints worth reviewing:

• A good system of maintenance can be established byproviding key local staff members with simple repairand maintenance skills that they can demonstrate tomicroscope operators in their area.

• Practical, visual demonstrations are much more effec-tive in skill building than written manual alone.

• Mould, dirt and alignment (most common problems)are easily solved with simple actions like changing ofmould pellets and minor adjustments.

• If a local supply of spare parts (e.g. halogen bulbs) isavailable operators should be encouraged to utilizethem to save cost and time of import.

• Aluminium carry cases to prevent damage during trans-port should be redistributed to microscopes that aretransported frequently or additional cases could insteadincluded in the budget.

• Back up battery supplies could be considered as analternative power source.

• Consider including simple aspects or maintenance andrepair microscopes in surgical training.

A

CKNOWLEDGEMENTS

Anna Tan would like to thank: (i) Christian Blind Missionled by David Lewis for providing the funding needed to carryout these demonstrations; (ii) staff at the Cataract Founda-tion Philippines lead by Ms Mavis Campos for showing meamazing hospitality and organizing my travel and accommo-dation around the Philippines; (iii) the microscope operatorsand other organizations like Davao Jubilee, UCCP that pro-vided me with accommodation during these demonstrations;(iv) Professor Hugh Taylor and Dr Richard Le Mesurier forlinking me up with the necessary people and organizations;(v) Scan Optics in Adelaide-Brian Staples and Clay Fraser for

Portable ophthalmic microscopes 401

teaching me the technical skills, providing the spare parts;and (vi) Dr Henry Newland for organizing the scholarshipand funding as well as giving me the outline to write thisarticle.

R

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