When I was in school at the Pennsylvania
College of Optometry (PCO), I needed some cash to pay the rent and utilities.
As fortune had it, my class was making a
group purchase of Keeler indirect ophthalmoscopes. I found that I could make a
nice profit by making the power supplies for the binocular indirect
ophthalmoscopes (BIOs), while still providing my classmates with a 40% savings.
(I'm sure that nowadays, I'd run afoul of the FDA, OSHA and God only knows what
other government regulatory agencies.)
So instead of eating lentil loaf, my wife
and I paid the rent and bought some chicken for dinner!
Since then, I've had the privilege to come
to know David Keeler, who runs Keeler Instruments Inc.'s American division, and
is probably one of the finest people in this industry.
BIO history and the Vantage
Keeler introduced their first BIO (the
Fison) in 1958. I still own one myself. In 1986, they introduced the Keeler All
Pupil binocular indirect.
In 1994, Keeler decided to change the way we
think about indirects, viewing them as a platform to which other devices can be
added depending on changes in technology and diagnostic procedure. They called
this next generation BIO the Vantage.
A new option for the Vantage
The Vantage demonstration unit that I used
was configured with a rechargeable battery pack and the company's latest 2000
addition to the Vantage options � the HiMag Lens.
The HiMag provides up to 1.6x higher
magnification when used with a double aspheric condensing lens. It's designed
to eliminate the need for repositioning the patient in front of a slit lamp to
use a 78D or 90D lens so you have a more magnified stereoscopic view of the
optical disk or retinal lesion.
The product is a scratch-resistant,
anti-reflective coated optical surface and can be flipped out of the field of
view when not in use. Because it introduces another optical system, your normal
working distance will decrease by approximately 6 inches, depending on the type
of indirect lens you use.
The basic Vantage has some really nice
� Both the vertical and horizontal straps on the
headrest are easily adjustable, as is the pupillary distance (PD) between the
oculars, which has plenty of adjustment room for people who have small PDs.
� The Vantage also has Variable Mirror Height Control
and Independent Converging Optics, which minimize reflections and optimize
stereopsis through all pupil sizes, ensuring shadow-free images. This feature
allows you to adjust the light source for optimal illumination of the angle of
view and pupil size.
For example, when viewing far into the periphery and obliquely through what's
now an oval-shaped pupil, lowering the mirror allows a much brighter view. When
looking through a small pupil, you can converge the light source and the
observer's optics to create a better view by using the optics converging lever
under the oculars.
It takes a few minutes to get the hang of it, but once you do, it makes my old
Fison look like the museum piece that it is.
� The Vantage also includes Keeler's Unique Wide Angle
Diffuser, which extends the illuminated field to simplify retinal examinations.
� The instrument includes a safety filter that removes
ultraviolet and infrared light. The cobalt blue and red-free filters are
located internally and are easily selected using a small bar on the left side
of the optical head. The battery pack clipped easily to my belt and wasn't
� Any eyecare professional who owns a Vantage indirect
ophthalmoscope can simply convert it into a video system. The Keeler Video
Vantage PPV is a lightweight Penta Prism video system that captures retinal
images either digitally to a computer imaging system or via a VCR.
The instrument in action
Once you've located the area that you wish
to see under higher magnification, flip the HiMag down and lower the Vantage
mirror. You instantly have an image that subjectively seems to be more than the
1.6x magnification promised.
I really found the system a timesaver and
frankly, somewhat easier to use than the 78D lens I normally like to work with.
I think I obtain more magnification using the slit lamp, but in most cases, the
Vantage was more than adequate.
I'd like to put a couple of things on my
wish list for the Vantage.
� I'd like to have some sign on the battery pack, maybe
an LED, that the unit was charging and an indicator for when the battery is
� When using a battery pack, the cord from the head to
the pack was too long. No big deal -- a rubber band took care of it, but a more
eloquent method would be nice.
� A slit of illumination in combination with the HiMag
would really enhance the 3-D view of the optic cup.
Understand that these would all be minor
improvements to what's really an excellent unit.
Take a look for yourself
For more information, contact Keeler at
(800) 523-5620. If you have the opportunity to visit their booth at a trade
show, spend a little time with the Vantage and HiMag. Once you get the hang of
it, it really enhances your diagnostic abilities with a BIO and certainly has
the potential to decrease chair time.
And for you culinary aficionados: don't
e-mail me. I've thankfully � and without regret � forgotten the
recipe for lentil loaf.
Dr. Buscemi has no interests in Keeler
Instruments. You can reach him at firstname.lastname@example.org. Please type
"OM" in the subject field and indicate the topic.