Keeler VANTAGE 1204-P-2440 User manual

Instructions
VANTAGE
EP59-09548
Keeler Limited
Clewer Hill Road
Windsor
Berks SL4 4AA
Tel: [phone]
Fax: [phone]
Keeler Instruments Inc.
456 Parkway
Broomall
PA 19008
USA
Toll Free: 1 800 523 5620
Tel: [phone]
Fax: [phone]

Deutch Francais
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Gebrauchsanleitung
Bitte lesen und befolgen Sie diese Anleitung sorgfältig
Mode d’emploi
PRIERE DE LIRE ATTENTIVEMENT CE MODE D’EMPLOI A
RESPECTER MINUTIEUSEMENT
Istruzioni
LEGGERE E SEGUIRE ATTENTAMENTE QUESTE ISTRUZIONI
Instrucciones
LEA ESTAS INSTRUCCIONES Y SIGALAS CUIDADOSAMENTE
English
User Manual
Please read and follow these instructions carefully

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English
Thank you for purchasing the KeelerVantage Indirect
Ophthalmoscope.Wehavetakenthegreatestcarein
the design, development and manufacture of this
product to ensure that you get many years of trouble-
free service. However, it is important that you read
thedescriptions,installation and operatinginstructions
carefully prior to installing or using your new indirect
Ophthalmoscope.
Introduction

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Contents
Descriptionofthe Product
Headband ................................................................................ 98
Optics ..................................................................................... 100
UsingtheVantage ...................................................... 102
Accessories
Teaching Mirror ..................................................................... 107
SterilisableLevers.................................................................. 108
Rubber Eyepiece Caps.......................................................... 108
Plano Lenses ......................................................................... 108
CleaningInstructions................................................. 109
SterilisationProcedures ............................................ 109
BulbReplacement ......................................................
109
Servicing .................................................................... 109
HowtouseaBinocular
IndirectOphthalmoscope .......................................... 110
KittingLists................................................................ 116
As part of our policy for continued product
development we reserve the right to amend
specifications at any time without prior notice.

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Description of the Product
A
FG
DC
E
B

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AHeadbandSizeAdjustmentKnob
(Occipitally)
BHeadbandHeightAdjustmentKnob
(Cranially)
CMetal Outer Brow Band
DBrow BandTension Knob
EOphthalmoscopeAngleKnob
FLeather Comfort Pads
GHingeSystem
Description of the Product

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Description of the Product
HI
J
M
N
L
Q
S
TU
V
P
O
R
K

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Description of the Product
HApertureSelection Knob
IFilterSelectionKnob
JMirrorAngleControl
KMirrorHeight Control
LOpticsConvergenceLever
MIndividualEyepiece
NFrontWindow
OPortfor SterilisableLever
PTeachingMirror
QScrewtoattachTeachingMirror
RBinocularBlock
SBulb
TRubberCaps
UOpticsof Eyepiece
VInterpupillaryDistance Control

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ComfortableFit
Adjustthesize(A) fig.1 andtheheight(B) fig.2 ,sothatthe
instrumentissupportedcomfortablyaround andontopofthe
head.
OphthalmoscopeAngle Alignment
Forverticalalignmentoftheeyepiecesand binocular block(R),
adjusttheheightoftheMetalOuter Brow Bar(C)ifnecessary
byusingthebrowbandtensionknobs(D)locatedonthe sides of
theheadset(Fig3).
Positionthe BinocularBlock(R)asclose totheeyesor
spectaclesaspossibleformaximumfieldofview. Slightly
loosenthehingemechanismcontrol(E)knobto allow for
adjustmentandtightenwheninpositionasin(Fig4).
Forfurtherinstructionsseepage110
HowtouseanIndirectOphthalmoscope.
Using the Vantage
fig 4
fig 3
fig 1
Headband Adjustment
fig 2

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Interpupillary Distance Setting Control (V)
Because the eyes are dissociated, particular care must
be taken to ensure the optics (eyepieces) are set properly
in front of each eye.
Always set the Aperture Selection (H) to the large light
patch for this exercise.
Place an object, perhaps the thumb, approximately 40cm
from the face and centre it horizontally in the light patch.
Then, close one eye. Using the thumb and forefinger of
the opposite hand, slide the P.D.Control (V) of the open
eye (located directly under each eyepiece) so that your
objectmoves into the centre ofthe field, keeping the object
in the centre of the light patch. Repeat for the other eye.
Obtaining a Fused Image
Ensure that a singular, fused image is obtained as follows:
Mirror Angle Control (J)
The light is positioned vertically into the upper two thirds
of the field of view by rotating the spindle (J) located on
either side of the binocular block.
Using the Vantage
OverlappingimagesSeparateimages Fusedimage

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Aperture Selection Control (H)
Byrotatingtheknob(H)differentapertures
maybeselected
TheKeelerVantagehas4lightapertures which offermaximum
versatilitywhenencounteringavarietyof pupil sizes,opacities
andconditions:
Large
Thelarge,round,homogeneouspatchissuitableforroutineexaminationsthrough
fullydilatedpupils.
Medium
Theintermediatepatchisdesignedtoreducereflectionswhenenteringapartially
orpoorlydilatedpupil(3mm).Itisalsoidealforcloserinspectionofparticularfundal
areas.
Small
Thislightpatchisidealforsmall,undilatedpupilsandmaybeusedinconjunction
withtheOpticsConvergenceLeversettothesmallpupilsetting
(seepage106).
Diffuser
Thisuniqueextrawidebeamof diffused lightpermitsamorerelaxedtechnique
duringmorechallengingfundusexaminations;theperipheralretina,poorlydilated
eyesanduncooperativepatients.Beginnersmayalsofindthisapertureparticularly
helpfulsincethealignmentbetweentheheadset,thecondensinglensandthe
pupil,inordertoachieveafulllensimage,isnotascriticalaswiththeconventional
beam.
Using the Vantage
Setting the Aperture and Filter
123
1
2
3
123

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Using the Vantage
Filter Selection Control (I)
By rotating the knob (I), different filters may be selected.
Note: For use in surgery, steriliseable levers may be screwed
into the ports located on both the Filter and Aperture Selec-
tion Control Knobs.
1 ) Silver Circle
Clear light - Select the clear light with no filter when inspecting a specific
pathology and a brighter, whiter light is desired.
2) Safety Filter
Use this filter for all routine examinations, as it reduces infrared, ultra-violet
and blue hazard wavelengths without compromising tissue colour.This
setting is also more comfortable for the patient, as the light is slightly
yellow rather than white.
3) Green Circle
Red Free Filter - This filter reduces red light, so blood will appear black,
silhouetted against a dark background.
4) Blue Circle
Cobalt Blue Filter - For fluorescein angioscopy.
34
12
s

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Fig 3
Using the Vantage
Mirror Height Control (K)
The Keeler Vantage offers the unique facility to raise and
lower the height (not just the angle) of the illumination
mirror, independently of the viewing optics, for optimum
binocular viewing through small pupils and when viewing
the peripheral retina (Fig 1).
Formaximum stereopsiswith largerpupils, keep the mirror
in the upper position, creating a steeper angle between
theviewing axisand theillumination axis,whilst minimising
reflections.
To view through undilated pupils, lower the height of the
mirror, then adjust the mirror angle, which will align the
axis of illumination more closely with the viewing axis. If
full lens illumination still proves difficult, selecting the
Diffuser may offer the best opportunity to illuminate the
widest fundal area possible.
For optimal stereopsis when examining the peripheral
retina (which means viewing through a elliptical pupil),
withthe KeelerVantage,the mirror height maybe lowered,
and the mirror angle adjusted, bringing the illumination
more coaxial to the viewing axis whilst providing the best
opportunity for stereopsis.
Optics Convergence Lever (L)
The lever in the right hand position (Fig 2) allows the
mirrors to be separated achieving improved stereopsis in
a dilated eye. By moving the lever either partially or
completely to the left (Fig 3) the optics are converged to
view through a small pupil.
Fig 2Fig 1

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1. Teaching Mirror (P)
To enabletheKeelerVantage to beused with ateaching
mirror, the teaching bi-mirror attachment must be fitted
as follows:
a. Remove the posidrive screws
fromthe panel beneaththe front
window with the screwdriver
supplied. (Fig 4)
b. Fit the MountingBar with the pin
pointing to the right and secure
with screws removed in step 1
(Fig 5)
c. Slide the Teaching Mirror onto
thepin onthe Mounting Bar.The
bi-mirror can now be swivelled
up and down.
d. To remove, slide the teaching
mirror to the right of the pin and
return to its case leaving
mounting bar in position (Fig 6).
To make the Teaching Mirror
Non-Removable for security
purposes proceed as follows:
Removetheposidrive screwsas
in
(a) above.
Fit the Mounting Bar as in
(b)
above but replace screw on left
side only.
Fit the Teaching Mirror as in
(c)
above.
Accessories
Fig 4
Fig 5
Fig 7
Fig 6

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Accessories
Fold theTeaching Mirror down and slide it slightly to the right
to reveal fixing hole. Then secure the mounting bar with the
special washer and pan head screw provided (Fig 7).
Return the Teaching Mirror to its central position.
TheTeachingMirror cannow bedemounted only byremoving
the screw.
Retain the screwdriver for future use.
Sterilisable Levers (O)
Stainless steel levers are provided in the Accessory Case
and can be screwed into the ports located in the Aperture
and Filter Selection Control Knobs for surgical applications.
Rubber Eyepiece Caps (T)
Rubber eyepiece caps are provided to protect spectacles
and have been manufactured in rubber to avoid any abra-
sions. To use, simply fit over the eye caps.
Plano Lenses
The Keeler Vantage is supplied with +2 diopter lenses as
standard. Plano lenses, if preferred, are available and can
be fitted as shown in (Fig 8).
Scleral Depressors
Scleral Depressors are available
to view the ora serrata.
Gown clips
Gown clips can be used to tidy
the Vantage wire by clipping the
wire to an article of clothing
Fig 8
unscrew

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Bulb Replacement
Caution: The Bulb may get
very hot after prolonged use.
Disconnect the instrument
from the electricity supply.
Remove the bulb from the
back of the instrument and
insert the new bulb,
ensuring the bulb's key is
aligned with the aperture
and securely pushed in.
Cleaning Instructions
Disconnect the unit by unplugging the DIN-style connector
from the system power source.
You can clean your indirect optics and front window with
theKeelercleaning cloth provided.Theheadband cushions
can be cleaned by using soapy water but do not immerse
the Instrument in water. The instrument can be cleaned
with a damp cloth if prefferred.
Sterilisation Procedures
NON-STERILE
Recommended Sterility Method
The optional sterilisable levers for the aperture and filter
selection control knobs may be sterilised by autoclaving.
Autoclave to AAMI Guidelines
Sterility assurance level 10o
Maximum Temperature 260oF (1260F)
These parts are designed to withstand conditions
employed for dry heat and ethylene oxide sterilization.
Servicing
There are no user serviceable parts on the Instrument.
Please contact your authorised Keeler distributor or return
your Instrument to Keeler.
(S)

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How to use a Binocular Indirect
Ophthalmoscope
1. Preparationofthe Patient
Explaintheproceduretothepatientandinform them that
thelight,althoughbright,isnotdamagingtotheeyesand
subsequentafter-imagesmaybeseen.
Takeanynecessary precautionswhen dilatingthe pupil
such as assessing the depth of the anterior chamber.
Instilling a topical anaesthetic first will allow better
absorptionofthemydriaticaswellasreducingtheblinking
urge. Followwiththedilationroutinepreferred.
2. HeadbandAdjustment
TheVantageheadbandisdesignedtoensurecomforteven
withprolonged use;however,care mustbe takento see
thattheheadband is balancedso that themainweight is
supported by the top headstrap rather than by the
circumferenceband.
a) Loosentheheadbandwiththeadjustmentknobattheback
(A)andplacetheheadbandonthehead. Tightenuntiljust
snug(theheadbandshouldbeabletobepulledoffthehead
withoutlooseningthisratchetmorethanoneortwonotches).
Donotovertighten.
b) Lengthenorshortentheheadbandheightwiththeratchetat
thetop(B)untiltheinnerleatherpaddedbrowbandonthe
frontoftheheadbandrestscomfortablyabovetheeyebrow.
c) Raiseorlowerthe ophthalmoscope (E)tovertically align
theeyepiecesinfrontoftheeyesbyslightlylooseningthe
knobsoneithersideoftheheadset,thenmanuallyloweror
raisetheoutermetalbrow banduntilalignmentiscorrect
andre-tighten.
d) Swingtheeyepiecesintowardtheeyesascloseaspossible

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How to use a Binocular Indirect
Ophthalmoscope
byslightlylooseningtheophthalmoscopeknob(E)and re-
tighteningwheninposition.
ProvidedtheVantageisonlyusedbyonepractitioner,itwill
remaininadjustmentfromonepatienttothenext.
3. Adjusttheheightofthelightbeamintotheuppertwothirds
ofthefieldwith the mirroranglecontrol spindles (J).
4. Select the appropriate light patch size with the aperture
selectionknob(seeapertureselection,page104).
5. Set the interpupillary distance (PD). Slide the eyepiece
controllocatedunderneatheachocularuntilitispositioned
directlyinfrontofeacheye. Thisisbestdonebylookingat
anobject, likeyour thumb, which has beenplaced inthe
centreofthelightpatch,atapproximately40cmawaywhile
closingeacheyealternately. Eachocularincorporatesa+2
diopterlens to makeaccommodationunnecessary. (For
furtherinstructiononsettingthePD,seepage103).
6. Selectanyrequiredfiltersat this point(seefilterselection,
page105).
7. MethodofObservation
a) It is best to have the patient reclining in order to obtain
optimumviewsof theperiphery,although examinationof
theposteriorpolecanbedonewiththepatientsittingupright.
b) Turntheroomlightsdowntoenhancecontrastandminimise
ambientlightreflections.
c) Adjusttherheostaton thetransformerso there isenough
lightto seesubtle colourvariation onthe patient’sretina.
This is usually just below half way for lightly pigmented
retinas,andslightlymoreformorehighlypigmentedretinas.

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How to use a Binocular Indirect
Ophthalmoscope
d) Directthepatient’s gazeto whereyouintendtobeginthe
examination,and ask them to fixate at somepoint. It is
bestto examine thecomplete peripheryfirst toallowthe
patient to acclimatise to the light before examining the
posteriorpole.
e) Holdthecondensinglensbetweenthethumbandforefinger
withthesilverside(leastconvexside)towardsthepatient
at a little less than arm’s length away. The lens can be
steadiedbyrestingtheotherfingersonthepatient’scheek
orforehead.
f) Withthecondensinglensheldtoone side, directthelight
beamatthepatient’spupil and obtain a red retinalreflex.
g) Begin by placing the condensing lens in the light path
approximately1inchfromthe patient’s pupil. Centre the
pupilinthelens.
Keeping the pupil centred andthe lens parallel to the
headset,slowlymovethecondensinglensawayfromthe
eye,directlyupwardtowardtheheadset, untilanimageof
the fundus spreads to completely fill the lens (this will
occur at the fixed focal length of the condensing lens
selected,seepage114).
h) It is imperative at the moment the retinal image fills the
lensthatanymovementsorminoradjustmentsaremade
verydelicately. If the lens is moved even slightly too far
fromthe eye, aninverted, minified imagewill come into
view.
Conversely, ifthelens isnotbrought out farenoughfrom
theeye,strong,whitereflectionswillbevisible. Toremove
thesereflections,gentlypullthelensdirectlybacktoward
theheadset,untilachievingtheproperfocallengthfromthe
patient’seyeforthatlens.

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How to use a Binocular Indirect
Ophthalmoscope
i) To view different areas of the retina, it is easiest to use a
combinationofaskingthe patient tochangetheir direction of
gazeand the practitioner to move his body inthe opposite
direction,alwaysmaintainingparallelalignmentbetweenthe
headset,condensinglensandpupil.
Note: the retinal image captured at any given time in the
condensing lens is optically both inverted and reversed;
however, the quadrant from which this image is taken is
accurate. Inotherwords,ifthe superior-nasal retinaisbeing
examined, what is seen in the condensing lens is, indeed,
supra-nasalfundus,butthatareaistheninvertedandreversed.
j) Ifadistinctpatchoflightisseen on theretina,thisisusuallya
result of too short a distance between the headset and the
condensinglensorimprecisealignmentbetweentheheadset,
condensinglensandpupil. Ifthiscannotbecorrectedeasilyby
extendingthearmormanipulatingalignments, thediffuseron
theapertureselectioncontrolshouldbe selected.
5. ChoiceofCondensingLenses
Asshownbelowthehigherthepowerofthelens,thesmaller
themagnificationandtheshortertheworkingdistancebut
thelargerthefieldof view willbe.