EuroTimes Visits Duckworth and Kent, Ltd.Baldock, England And its Managing Director Terry Waldock

By John F. Henahan

Duckworth and Kent, Ltd. is now the world's largest manufacturer of titanium ophthalmic surgical instruments, but it didn't start out that way.

The company first put down its roots in a small workshop in Hitchin, located in the county of Hertfordshire, England. The original installation, which was set up by two mechanical engineers--Fred Duckworth and Harry Kent--in January 1959 is now an automobile sales showroom, while the company's present production, marketing and administrative staff of 50 occupy a modern 20,000 square foot two-story site in the nearby town of Baldock.

Shortly after they set up that that little workshop in Hitchin, Duckworth and Kent moved to a small plant in Baldock where they were primarily involved in highly secret contract engineering work for the UK Ministry of Defense, and the idea that their names would be attached to one of the world's foremost manufacturers of ophthalmic surgical instruments was probably quite far from their minds. Terry Waldock, who is now the company's Managing Director and sole owner was also trained as a mechanical engineer and joined that tiny engineering operation in 1963.

The Door to Titanium and Ophthalmic Surgery Opens
It wasn't until about five years later, that Duckworth and Kent would open the door to the entirely different world of ophthalmic surgery. It began with an overture from a London surgeon named Dermot Pierse, who asked them to produce four instruments for his own use in cataract operations.

"For a while after that, the surgical instrument side of our business was little more than a hobby and over the next four years the situation stayed pretty much the same. We also had the difficulty that they were made from stainless steel and were prone to oxidation and we never found a remedy to this until we were fortunate enough to meet a metallurgist who suggested that we might be better off if we made the instruments from titanium alloy. It appeared to have many advantages in that it did not oxidise, and was very light and durable," Mr. Waldock told EuroTimes.

"Up until then, titanium alloy had been used primarily in the aerospace industry, but not for surgical instruments. When we tried producing surgical forceps and needle holders in titanium, we found that they worked very well, and ever since then-in 1972-- we have used it exclusively in the more than 1,000 ophthalmic surgical instruments that we now produce for world-wide use."

An Important Transition
In 1983, the Duckworth and Kent commitment moved heavily into surgical instrument manufacture, not only for eye surgery, but for neurosurgical and ear nose and throat surgery. Initially, the instruments were manufactured for Micra, another British company. After Mr. Waldock bought Duckworth and Kent's shares in the company, the company terminated its connection with Micra and began to produce its surgical instruments independently as subcontractors for other companies, including Downs, Metico, Thackray and Storz which all had their own names on the instruments.

"That was an important transition point for us, and in 1988 we decided that we would put our own name on the instruments we produced in order to expand our activities to the design, manufacture, marketing and distribution of our own ophthalmic surgical products on a world-wide basis. During that time we were gaining more expertise in working with titanium, which required different manufacturing and engineering techniques," Mr. Waldock points out.

"Since we became involved in manufacturing instruments primarily for the use of eye surgeons, we have found that the products we make have been a close reflection of the many new developments that have marked the growth of the field of ophthalmology over the last few years. Our product line, which initially included instruments for performing traditional cataract surgery, RK and AK, using micrometer diamond knives, has expanded considerably to include the move to small incision phacoemulsification procedures, such as instruments for performing capsulorhexis and bi-manual irrigation and aspiration. We also find ourselves making instruments for facilitating, radial keratotomy, LASIK, INTACS and other forms of refractive surgery."

Keeping abreast of the IOL revolution triggered by Harold Ridley more than a half century ago Duckworth and Kent has also developed a strong line of forceps, folders and injection devices required for implanting traditional IOLs, as well as the new generation of foldable acrylic and silicone lenses. In many cases, these instruments were developed to meet the specific needs of individual surgeons as well as the more commercial needs of large companies such as Alcon, Allergan and Keravision.

"Our relationship with Alcon has been a big plus for us. They had difficulties in finding suppliers for instruments for implanting their foldable Acrysof IOL and we were able to develop instruments for folding and introducing their lenses, which they purchase and supply to surgeons who implant them the lens in their patients throughout the world.

"Recently we have developed a new all-in-one instrument for introducing foldable IOLs following phacoemulsification. It doesn't require a separate cartridge and you just load the lens straight into the injector and then implant it directly into the capsular bag. Initially it was developed for the Acrysof 3-piece lens but it has also been adapted to their one-piece lens as well as for silicone IOL implantation. This is the only lens injector in the world that doesn't require a cartridge," Mr. Waldock told EuroTimes, continuing:

"What we are doing more and more is to work with companies to develop the product they need for lens implantation or other products before they introduce them to the market. In the past, the problem was that IOL manufacturers often developed a lens without taking into account the instruments they would need to introduce it into the eye."

Over the years, Duckworth and Kent has also been working closely with individual surgeons to help them develop and perfect instruments which they require for their own surgical needs. They include Spencer Thornton, Leroy Bloomberg, Robert Osher, Richard Mackool, Azis Anis, Miles Friedlander, Lee Nordan, Gilbert O'gawa and Gregory Ogawa from the United States, Dr. Inamura and Takayuki Akahoshi from Japan, Graham Barrett from Australia, Ioannis Pallikaris from Greece and the late much-missed John Pearce from the UK to name just a few.

In many cases, such as Dr. Thornton and Pallikaris, the instruments that were developed reflect the company's growing commitment to the rapidly emerging field of refractive surgery. For example, their product line now includes instruments for LASIK developed by Dr. Lucio Buratto, and other LASIK-oriented instruments developed by Dr. Pallikaris, including his an arcutome which can be used in various surgical procedures,

"Sometimes, these surgeons may come to us only with an idea on a piece of paper. We then draw up our own design and submit it to the surgeon for his and approval. Then we make up a prototype and send the instrument back for the surgeon to evaluate clinically. However, as in the case of Dr. Pallikaris, there was a bit more to it than that. It wasn't too difficult to make an arcutome that works; the problem was to manufacture it from titanium -which is still quite an expensive material-into a product that is clinically useful and isn't cost-prohibitive in the marketplace, " Mr. Waldock notes.

Twenty-six Instruments In Five Hours
Dr. Graham Barrett is another example of what can happen when the Duckworth and Kent/surgeon relationship is really working.

"About six years ago Graham was flying to Europe from Perth for an eye congress and I asked him if we could get together in Heathrow Airport in London to discuss some of his ideas. We sat down in a hotel room at the airport for about five hours and in that time and between us we agreed on the design of 26 different instruments all of which are now in our product catalogue. They include scissors, forceps for capsulorhexis and for folding and inserting IOLs, diamond knives, as well as a keratoscope and tips and handpieces for irrigation and aspiration, to name just a few," Mr. Waldock told EuroTimes.

A Family Affair
Since Mr. Waldock took over Duckworth and Kent, it has become very much a family affair. His sons Andrew and Adrian are stockholders and members of the board. Like his father, Adrian is an engineer, while Andrew is a consultant ophthalmologist at Bristol Hospital in the UK, whose specialties include cataract, glaucoma and corneal surgery.

"Andrew has no role in running the company, but he has proved to be very helpful to us. He can give us the surgeons' view of a new product and can tell us in detail what a surgeon is trying to achieve and what problems he may encounter. He also comes to Baldock frequently to give lectures to the staff on various aspects of ophthalmology."

An International Marketplace
Currently, the major markets for the instruments that Duckworth and Kent produces are the United States, Japan and the United Kingdom The USA has proved to be a very important outlet, thanks to the activities of the company's marketing office in St. Louis, Missouri. It was established in 1993 under the guidance of Michelle Glossip, who accepted the chance to set up what seemed to be a very challenging opportunity for marketing the British company's product line on the other side of the Atlantic.

"Michelle's contributions have been very significant for us and our future. Over the last seven years, she has helped change our image from a company that was not known at all in the United States to the extent that we are now so well recognised and respected that it is out biggest market."

However, although the UK is part of the European Union, that connection has still not paid off to the economic benefit of Duckworth and Kent, Mr. Waldock told EuroTimes.

"There are two reasons for that. The UK is still the only country in Europe which has still not agreed to use the Euro as the currency of choice for carrying out commercial transactions and the second is that the Pound Sterling is very strong. This has meant that in comparison, the value of the Euro has declined by 20% since it was introduced, which in turn means that our products cost 20 % more in Europe than they would have if we had embraced the Euro."

Growing At Its Own Pace
With its present markets, Duckworth and Kent finds itself in a financially comfortable condition and expects to grow even more in the next ten years as more and more cataract and refractive surgeons require new and improved instruments to keep abreast of those new and continually expanding fields. At the same time, Mr. Waldock admits that although some observers might suggest that the company might not have grown to the extent that it could have done, he doesn't think that is a bad thing.

"I cannot dispute that viewpoint, and recognise that our company could be perhaps 10 times the size that it is now if we had done things differently. However, I am totally responsible for the control and financial dealings of Duckworth and Kent and it is up to me to approach the banks for enough financing to allow us to grow at a rate which allows us to do the things we do best, that is providing the best instruments possible to ophthalmic surgeons throughout the world. I could have gone to venture capitalists for additional financial backing, and I have been approached by several over the last few years, but that option still doesn't have much appeal for me," he says.

Obviously what has brought Duckworth and Kent to its present state of financial well being is the growing acceptance of its burgeoning catalogue of ophthalmic surgical instruments, in almost every imaginable category and all made primarily of titanium. The more than 1000-strong list of products is seemingly endless; forceps, diamond knives, specula, needle holders, corneal markers, nucleus dividers, keratometers, lid clamps, hooks, scissors, membrane punchers, I/A and bi-manuals, etc. etc. etc.

When asked whether he and the company he owns and directs has an overall guiding philosophy, he told EuroTimes:

"Our ultimate goal is to produce perfect instruments to enable the surgeon to do perfect surgery, and that is probably an impossible target. However, we are perfectionists when we set out to engineer, develop and produce instruments for the many and diverse needs of ophthalmic surgeons. If we have a motto that guides us in what we do, I think it can be put into three simple words, "quality, quality, quality".