Keeler Works with its Partners and will Launch a New Product at Optrafair

Working with its new distribution partners, Keeler products will now be available on several distributor stands at this year’s Optrafair. Keeler partners include Birmingham Optical, Topcon, Mainline, Carleton Optical, Hanson Instruments, Grafton Optical, BiB Ophthalmic Instruments, Bondeye, Stat One Services and Ulster Anaesthetics.

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As usual, Keeler will also have its own Eye Shop at the stand and customers can purchase its extensive line of existing products such as Specialist Ophthalmoscopes, Professional Retinoscopes, KAT Tonometers and various practice essentials; the popular Pulsair family of tonometers will also be available.

Keeler will be launching its brand new Symphony Slit Lamp at this year’s show. Symphony has been crafted by the Keeler team to combine modern technology, high-quality optics into a classic, elegant design and will be available for demonstration. The latest portable Classic Slit Lamp will also be on display.
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Free engraving on Keeler handles and Volk lenses is available for any products bought at the stand and Keeler will give away a Specialist Ophthalmoscope by prize draw every day of the show. To make any purchases, or have a browse and demonstration of any Keeler products, please visit Stand G40.

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Keeler Introduces New Spectra Iris Indirect Ophthalmoscope

Spectra Iris is a new addition to Keeler’s indirect ophthalmoscope range. It has been specifically designed as a compact, lightweight and portable indirect with an adjustable aperture for all pupil sizes.

Spectra Iris features an adjustable aperture slider that easily changes the aperture between 20mm to 60mm to match pupil size and improve examination. The unit has variable PD (pupil distance) settings between 48 and 76mm, there are no restrictions on the user – simply adjust the PD as necessary.
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The indirect system is supplied with Keeler’s lightweight wraparound Sport Frames designed to ensure maximum comfort and balance; the indirect can also fit over the top of spectacles.

An in-built bright, homogenous LED light source eliminates the need for bulb replacements and allows up to four hours of continuous use. The entire optical unit and light pod can be flipped up to allow direct eye contact when talking to a patient or writing up notes. Spectra Iris can be packed away in its neat carrying case or hung around the user’s neck when not in use. The compact lithium ion battery can be clipped on to a belt or stored in its charger when not in use.

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Richard Scawn Awarded Keeler Scholarship

In conjunction with The Royal College of Ophthalmology, Keeler has awarded Richard Scawn its scholarship worth £30 000.

The money will fund Richard’s fellowship in orbital and oculofacial plastic reconstructive surgery at the University of California, San Diego. Over two years, Richard will gain special experience in endoscopic surgery, thyroid eye disease treatment and facial reconstruction as well as participating in on-going university research. His current post is Specialist Registrar at Moorfields Eye Hospital NHS Trust, set to complete in August at which time he will leave for the USA.

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Richard comments, “This is a fantastic fellowship opportunity. I am extremely grateful to Keeler for providing such a generous scholarship to make this experience possible. I look forward to utilising my knowledge and contributing to ophthalmology on my return to the United Kingdom.”

The Keeler Scholarship was established in 1990 and is awarded every two years. Its purpose is to give young ophthalmologists the opportunity to study, research or gain special skills, knowledge or experience in ophthalmology at specialist centres of excellence for at least six months. Richard will join the impressive list of 12 Keeler alumni who were awarded the Keeler Scholarship and completed specialist training that subsequently benefitted ophthalmology in the UK and abroad.

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Keeler Launches New Portable Slit Lamp

In addition to its Classic Portable Slit Lamp (PSL), Keeler has launched a new version, PSL One. PSL One offers one standard magnification 10x, a more cost effective option that gives the customer a choice of Keeler slit lamp depending on their practice needs.

Keeler’s PSL One has been designed to be lightweight and durable, ideal for use on paediatric, elderly and disabled patients, in on- or off-site clinics, with a precision-machined aluminium chassis that creates a sturdy structure able to withstand daily travel and use in a busy practice.
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PSL One features slit and wheels from 0.15 to 1.6 mm, a 12mm circle and a 1mm square to produce anterior chamber flare, aiding the diagnosis of uveitis. Red free, blue and ND (Neutral Density) filters all come as standard. Its advanced optics offer x10 magnification, with illumination control down to zero.

Keeler’s Classic PSL and PSL One are high-performance, British-designed and -manufactured instruments. For more information on the PSL One, please visit the company website at www.keeler.co.uk.

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Keeler Appoints New Sales & Marketing Director

Keeler Ltd has appointed Keith Watson as its new Sales & Marketing Director.

Keith joins Keeler with a proven track record of success. He was previously Sales & Marketing Director at Halma sister company Hanovia, where he implemented major changes to the sales organisation and helped increase sales revenues by 35%.
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Keith commented: “I am delighted to join a manufacturing company with such a strong global brand and background in healthcare and optics. Keeler has performed exceptionally in recent years and I look forward to continuing and improving the growth strategies that have contributed to this success.”

After gaining a Chemistry degree from Exeter University Keith spent several years in industrial chemistry before pursuing a career in instrumentation sales. He was Sales Director of Arun Technology, a pioneer in miniature optical spectrometers, in the UK before spending 10 years in Hong Kong and China where he was Managing Director of Spectro Analytical (Asia Pacific) Limited and General Manager of Martek Marine Limited.

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Keeler Donates to Vision Care for Homeless People

Leading ophthalmic instrument manufacturer Keeler has donated ophthalmoscopes and retinoscopes to non-profit charity Vision Care for Homeless People at its clinic in London.

Vision Care for Homeless People is a registered charity that provides free eye care services and glasses to homeless and vulnerable people who have little access to mainstream eye care services. The clinics are run by volunteer, trained opticians.
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Keeler’s Laura Haverley presents Vision Care CEO Harinder Paul with donated Keeler instruments

Harinder Paul, CEO and founder of Vision Care, commented: “Demand for our services is incredibly high. The ophthalmoscopes and retinoscopes donated by Keeler, along with their earlier donation of the Pulsair intellipuff, will help us deliver the highest level of comprehensive care to large numbers of patients.”

Laura Haverley, Keeler’s Senior Product Manager, visited Vision Care to deliver the diagnostic instruments. She commented: “Vision Care is a remarkable charity and we are very happy to donate our diagnostic equipment to ensure vulnerable people in the community have access to high quality eye care.”

For more information about Vision Care for Homeless People, please visit www.visioncarecharity.org.

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Keeler Scholarship Winner Receives Unusual Referral

Keeler Scholarship winner Rob Henderson received an unusual referral while undertaking a clinical fellowship at the Royal Victorian Ear & Eye Hospital in Melbourne, Australia. As the specialist on call, he was contacted by vets at the local zoo in Melbourne and asked to perform an eye examination on one of their gorillas which had recently been transferred from another zoo and was undergoing a full health check to make sure he was in tiptop condition.

Rob performed an eye examination on a 500lb silverback gorilla, after he was anaesthetised by a human anaesthetist.

“It was a magical experience. In many ways it was just like a regular patient though finding a vein was apparently extremely hard since they are buried deeply under thick skin. The keepers made sure everyone knew where the exits were in case he woke up! Once he was laid out it was remarkable just how big he really was, his head was massive, though his face interestingly was much smaller. His eyes were virtually identical to a human eye, the retina only differing by the relatively youthful appearance of the nerve fibre layer.”

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Fortunately there appeared to be little wrong with the silverback’s eyes. He is now doing well in his new enclosure.

Rob will complete his fellowship in Australia in August and is set to return to the UK where he will begin his final fellowship at Moorfields Eye Hospital NHS Foundation Trust.

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Rob Henderson examines the silverback gorilla with a Keeler Spectra Indirect

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Article: A year at Sick Kids

Rob Henderson was awarded the Keeler Scholarship by the Royal College of Ophthalmologists for his fellowship plans to specialize in paediatric vitreo-retinal surgery. He spent a year at the world-renowned Hospital for Sick Children (‘Sick Kids’), Toronto, and is going on to a fellowship in VR at the Royal Victorian Eye & Ear Hospital in Melbourne before coming back to London to compete his training

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As I walked in to clinic for the last time I saw, sitting in the waiting room, the slightly gaunt and angular frame of the first patient I had met at Sick Kids. Rachel looked up at me with a smile of recognition and, as I caught up with her progress – she had been accepted into university and started coaching tennis again – I reflected on how far both she and I had come during this last year.

Rachel was a 17 year old girl with a pre-existing history of JIA and aphakia who, in the spring, had acquired a small Fusarium contact lens related keratitis which cleared up with topical amphotericin. Her rheumatologist then started her on Humira (adalumimab), which reactivated her keratitis with endothelial plaques and a hypopyon. With a unicameral eye, fungal endophthalmitis was a distinct possibility. She was treated with topical, IV, oral, and intracameral antifungals – all to no avail. She eventually required a therapeutic PK, followed by a second, vision restoring, graft. Now, some 10 months later, her vision was 20/40, she was not taking any anti-fungal medication, and she was back to considering starting Humira again.

Her case initiated me in to a hospital where ophthalmology is deeply integrated into the care of many of the complex needs patients. We were four paediatric ophthalmology fellows and, in addition to the clinic and Operating Room (OR) duties, were responsible for covering the ‘consult service’. The admitting services in this 370 bed quaternary referral center often requested input from other specialties. There were multiple consults daily to rule out both common and vanishingly rare associations – whether it be KF rings for Wilsons; posterior embryotoxon for alagille; or vitreous findings for sticklers. There were dysmorphology exams; endless papilloedema checks for the neurosurgeons; conjunctival biopsies; non-accidental injury exams; sedated exams in MRI or IGT for the young JIA patients. There was a relentless onslaught of rare conditions that frequently had one running to Google for help but as the year passed these esoterica, which often accounted for less than a line in a textbook, became less foreign.

The four fellows rotated departments every three months through four main firms – anterior segment, ROP, strabismus, and retinoblastoma. There were further clinics in retina, neuro-ophthalmology, oculoplastics, and oculogenetics. Additionally, we had additional required sessions that were to be spent in electrophysiology, orthoptics, and in the children’s rehab centre. The clinical diversity and amount of pathology was extraordinary. In one week I saw new presentations of Peters anomaly, congenital cataract, a Sturge Weber associated and uveitic glaucoma, a new retinoblastoma presentation, and a child with posterior Coats disease. This quantity of pathology was surprising to me at first until I realized that while in the UK we have a population twice as big as that of Canada, the cases are divided amongst ten times as many hospitals; Sick Kids drains the case load from almost two thirds of Canada with no competition due to its concentration of expertise and the exalted place it occupies in the firmament of Canada’s health care system.

From the outset, the attitude to training was different to the apprenticeship style that I was used to. A number of fellowship requirements were stated including: research projects that to be completed and written up; additional supernumerary clinic sessions to be attended; journal clubs and teaching sessions to participate in. The implied threat was that, were one not to fulfill these requirements, we would not ‘graduate’. It swiftly became apparent that this was not a fellowship that relied upon ad hoc teaching and ‘on-the-job’ learning opportunities: we were very much there to be taught and to learn. It was said to us when we first started in clinic: “It is not your responsibility to make sure the clinic is finished – that is the job of the Staff [Consultants]; your responsibility here is to learn as much as possible.” There was a service provision element of course, but every case had to be presented to the Staff, whether the diagnosis was simple or complex. This occasionally slowed clinic progress to a level of inefficiency that reached screaming point for both patients and fellows alike. For the most part, though, it meant that every case we saw had a learning point. The strabismus clinics were good examples because, in general, we did all our own orthoptics and refractions. Each duction and version, each over and underaction was checked by the strabismology consultant; it was an amazing way to calibrate one’s technique. As a way to see large numbers of patients, however, it was painfully slow and waiting lists to see the great man were well over a year as a consequence.

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All the major Toronto hospitals are affiliated with the University and staff, therefore, have teaching titles – with most starting as Associate Professor. At the end of our year the fellows at Sick Kids had each attended approximately 240 separate teaching sessions! These happened at the beginning and end of the clinical day meaning that days were often long (7am-8pm), sometimes testing our endurance levels. Dinner was often provided with journal clubs though, and occasionally took place in restaurants around the city. In addition, there were pastoral sessions where the fellows were taken out, at the department’s expense, and a guest speaker would talk on subjects such as ‘how to have an academic career’; ‘working in the developing world’; or ‘surgical innovation’ whilst dinner was served. There were also quarterly ‘fellows-breakfasts’ when we met the fellowship director over waffles, bacon and maple syrup to identify if there were any problems. From a didactic teaching perspective this year was an extraordinary experience, and one that I cannot imagine being able to emulate in the service provision culture of the NHS.

A criticism that I have often heard of North American trainees is that they are all very book smart (and with all that teaching one could hardly fail to be!), but less clinically ‘savvy’ and less experienced surgically. The Canadian trainee, like his American counterpart, goes to medical school for a 4-year post graduate degree. They choose their specialty during medical school and apply nationally for a residency program. In Canada, once accepted on to this, residents in ophthalmology have a 5-year specialty training program that includes one year of general medical and surgical internship. In Ontario, at the start of Post Graduate Year (PGY) 2, all ophthalmology trainees are enrolled on a 6-week intensive course taking place in Toronto. During this they are exposed to a complete overview of ophthalmology – the basic and clinical science – taught by the clinicians. Years 2 and 3 are spent in clinic with very limited surgical exposure. The PGY 4 and 5 trainees are then given unobstructed access to the Operating Room time. At Sick Kids, certain cases were designated as resident only cases (all horizontal strabismus for example). This meant that, in Ontario, trainees had surgical numbers that were not significantly less than their UK counterparts, and in provinces where there are no fellows and very few departments eg Saskatchewan or Alberta, the surgical numbers are far greater. All trainees had an exam three times a year; all took the same exam regardless of experience, and were expected to perform better the more senior they became. In addition, most took the North American wide MCQ exam (OCAP) yearly to give themselves the option of working across the border. All of this resulted in residents who were highly drilled for their final exit exam and failure rates were low. One might argue that some lacked a little of the clinical acumen that comes of the years spent at the coal-face in the UK. However, the aphorism ‘you only really start learning when you become a consultant’ bore out when I paused to consider that my fellowship director, a man of hugely impressive clinical and surgical prowess, had been staff for 5 years already and, at 39, was only 2 years older than me!

Many residents, on completing their training, elect to go into general practice without further need of fellowship. Those wanting to sub-specialise further are often in the unenviable position of looking for ‘dead man’s shoes’ Staff positions – there being no compulsory retirement age in Ontario. This was frequently the case in Toronto: two of my senior staff colleagues were in their seventies with no obvious signs of wanting to slow down or make way for younger trainees.

Physicians in Ontario have, by and large, retained their autonomy from the state/federal government to a far greater degree than in the UK. This has enabled doctors to shape their practice to a much larger extent. There are many fewer government edicts about waiting times, audit practice, or clinical governance in general since there is little way to enforce them. Salaries are, on average three times that of their NHS equivalents (though a parallel private practice sector does not really exist). The feeling, therefore, one is left with is that the practice of medicine is more comfortable for physicians and surgeons, though, it is possible the patients have a less good deal.

The Ontario Health Insurance Plan (OHIP) covers all hospital stays, inpatient medications, and clinic visits but outpatients are forced to rely on their own work based ‘benefits’ programmes to subsidise drug costs. Frequently, parents would choose to hold off getting their children new glasses until the new ‘benefits’ year. Those without one of these programmes often faced crippling drug bills that were unaffordable and, while the hospital and social services made some provision for the least well off, there were many that had less than ideal treatment as a consequence. On the flip side there were no qualms about ‘topping up’ with all hospitals advertising the pros and cons of different IOLs that were available to upgrade to.

Despite the sense that Doctors have a better quality of life in Ontario all those that I met at Sick Kids were immensely dedicated. The hospital, like many such institutions has a huge international presence and strives to better the lives of children not only in Canada, but worldwide. The retinoblastoma program run by Dr Brenda Gallie is one such example, with links forged with institutions in Kenya, Egypt, China and India amongst others. The remit is to teach, advise and improve the quality of care, and form collaborations that enable international multicenter treatment trials. The only exception was that the hospital, by and large, refused to treat patients from the US owing to the risks of litigation

The Sick Kids brand is a phenomenon: it was rebuilt during the 1980s based mainly on fundraising and good will from local Torontonians. The ‘Main street’ down the centre of the hospital is lined with plaques dedicated to ‘benefactors’, ‘grand benefactors’, and even more rarified VIPs who are accorded special status if their children became unwell. The money-making and marketing machine is a behemoth: for their new research and learning tower they obtained donations of $750,000 from each member of the executive board alone. Every day there were new fund raising initiatives: lotteries, sales of clothing, jewellery, or leather goods in booths down the ‘Main street’. Volunteers abounded in clinics, on the wards, in the children’s library, or in the surgical waiting room looking after anxious parents. The hospital was awash with gifts and endowments: at Christmas, the number of presents donated to the inpatients was so large that often toys were diverted to less well known institutions to provide for their children.

Overall, the impression one gets is of an enormously well funded hospital replete with all the latest technology, electronic patient records, and computer systems that offers the very best care to patients from all over Canada and further afield; and takes huge pride in its status as one of the premier teaching institutions in North America.

I left Sick Kids having learnt a huge amount, having seen an amazing amount of pathology both in general medicine and paediatric ophthalmology, but most of all I felt tremendously impressed at the dedication to and quality of teaching that we received and so very grateful for having had the opportunity to go to this amazing institution.

Article first published in Eye News 2011;18(3):26-9. © Pinpoint Scotland Ltd. All rights reserved.

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Truly Portable Imager Produces Still and Video Images of the Eye

Keeler’s lightweight Pictor digital imager delivers internal retinal and external corneal views

For convenient ocular imaging in any setting, keeler’s new portable Pictor digital device enables ophthalmic imaging not possible with traditional fixed systems. The Pictor delivers high resolution images of the retinal and external eye structures in office, on non-ambulatory patient visits, at off-site clinics and for paediatric patient exams difficult to conduct on a fixed system.

The extremely compact Pictor weighs about 450 grams, and fits easily with its accessories into a small briefcase. Its high quality jpeg images, easily uploaded to computer, are compatible with most major imaging software programs and adaptable to any patient database system. The files can be used for patient records, or shared for remote diagnosis and consultation.

Keeler’s Pictor imager is highly portable for use in examining convalescing, geriatric and pediatric patients

Keeler’s Pictor imager is highly portable for use in examining convalescing, geriatric and pediatric patients

Keeler’s Pictor imager is highly portable for use in examining convalescing, geriatric and pediatric patients

Ideal for retinal and external imaging and associated interpretation, Pictor’s low system price results in a short payback period. Two modules are included with the Pictor. The Retinal module provides a 45 degree field of view of the fundus. It is a non-mydriatic imaging method for use with pupils as small as 3mm. The Anterior module is used for imaging surface parts of the eye and has a series of cobalt blue LEDs for fluorescent imaging. Pictor also comes with otoscopic and dermascopic attachments for further general medical applications.

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Moorfields Purchases its 100th Keeler Indirect Ophthalmoscope

In response to Moorfields Eye Hospital NHS Foundation Trust purchasing its 100th Keeler Vantage Indirect ophthalmoscope, Keeler has donated a digital version, the Vantage Plus LED Digital indirect ophthalmoscope, to the hospital.

Moorfields is one of the world’s leading eye hospitals, providing expertise in clinical care, research, teaching and education. Keeler’s relationship with Moorfields has spanned several decades and is reciprocal in nature; Keeler has worked very closely with Moorfields to develop its range of innovative products and ensure the ophthalmic equipment is at the forefront of hospital diagnostic care and tailored to the needs of the surgeon.

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Mr. Ezra examines patient with Thamby Rajah and assistant

Mr Eric Ezra, MA, MD, FRCS, FRCSOphth, Director of Vitreo Retinal Surgery at Moorfields, has had significant influence in the design of the latest Vantage Plus indirect ophthalmoscope and Keeler’s latest development, the Keeler Vantage Plus Digital. Mr Ezra commented: “Teaching is one of the key areas we are developing and the Keeler Vantage Plus Digital is a valuable tool that really helps us to show our Fellows what they need to be treating and the on-going progress of treatment. I have worked very closely with Laura Haverley at Keeler to ensure we get the right product that will enhance and develop this very important work.”

Thamby Rajah, Clinical Sister and Out Patient Coordinator at Moorfields added: “One of my key responsibilities is to make sure that diagnostic equipment is available and ready to go and Keeler streamlines this process by ensuring products are up to date and working correctly. This helps to keep all of my clinics running smoothly so we can focus on patient care and making sure patients are diagnosed and treated without delay.”

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From L-R: Thamby Rajah, Laura Haverley from Keeler presents a Vantage Digital to Eric Ezra with Keeler’s Phil Nyquist

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