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.

Vantage features

The basic Vantage has some really nice features:

�         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 excessively heavy.

�         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.

Suggested improvements

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 fully charged.

�         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 pbuscemi@email.msn.com. Please type "OM" in the subject field and indicate the topic.