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 Table of Contents  
INNOVATIONS
Year : 2021  |  Volume : 33  |  Issue : 3  |  Page : 362-364

Eye to Eye Fundus Imaging with Ophthalmic Wand - Anytime! Anywhere!!


1 Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
2 Department of Glaucoma Services, Aravind Eye Hospital, Madurai, India
3 Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India

Date of Submission03-Jun-2021
Date of Acceptance07-Jun-2021
Date of Web Publication08-Dec-2021

Correspondence Address:
Dr. Vishnu Teja Gonugunta
Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_133_21

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  Abstract 


Conventionally, fundus camera is the only source for taking retinal images. With the advent of smartphones, fundus photography has become more portable, simpler, cheaper, and easier. Various techniques of fundus imaging with smartphones were put forth in the last decade. Senior ophthalmologists always prefer using a direct ophthalmoscope (DO) for viewing the fundus. DO has the advantage of viewing magnified images giving no scope in missing findings. We illustrate the use of a smartphone and a DO in recording patient's facial details, distant direct ophthalmoscopy apart from taking images of normal/pathological lesions of the optic disc, vessels, and retina in the form of a videograph or photograph. This technique is extremely useful for training purposes, bedside-imaging as in intensive care unit/wards, in remote areas such as camps, creating patient awareness, counseling, monitoring the progression, documentation, sharing, and cross consultation. These advantages are being utilized in our institute since 2014.

Keywords: Direct ophthalmoscope, fundus imaging in COVID times, smartphone, smartphone-based fundus imaging, smartphone fundoscopy, smartphone ophthalmoscopy


How to cite this article:
Gonugunta VT, Pabolu C, Srikanth K, Jha KN. Eye to Eye Fundus Imaging with Ophthalmic Wand - Anytime! Anywhere!!. Kerala J Ophthalmol 2021;33:362-4

How to cite this URL:
Gonugunta VT, Pabolu C, Srikanth K, Jha KN. Eye to Eye Fundus Imaging with Ophthalmic Wand - Anytime! Anywhere!!. Kerala J Ophthalmol [serial online] 2021 [cited 2022 Jan 19];33:362-4. Available from: http://www.kjophthal.com/text.asp?2021/33/3/362/331918



Clinical photographs are important in the understanding of any condition. Conventionally, fundus camera is used in imaging the posterior segment. It is always expensive, needs space to accommodate, and not easily portable. It cannot be afforded by many of the private ophthalmologists. The advent of smartphones had come to this rescue. Various techniques of imaging with smartphones were put forth in the last decade.[1],[2] We illustrate the use of a smartphone (iPhone 5, Apple Inc.,) and a direct ophthalmoscope (DO; Neitz BX α, Neitz instruments, Tokyo) for imaging the eye in undilated or dilated pupils [Figure 1]a. The technique avoids proximity of the examiner to the patient, unlike using a routine DO, which is especially useful in this COVID era [Figure 2]a, [Figure 2]b, [Figure 2]c.
Figure 1: Technique of imaging. (a) A smartphone and a direct ophthalmoscope are required. (b) Smartphone- direct ophthalmoscope unit utilization in capturing images. (c) Side view of the technique of holding the smartphone camera eye in contact to the viewing aperture of the direct ophthalmoscope

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Figure 2: Uses of the Smartphone- direct ophthalmoscope imaging technique. (a) Avoids examiner's proximity to the patient. (b) Useful in examining intensive care unit patients. (c) Imaging in camps. (d) Patient education

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  Technique Top


The light source from the DO is turned on and it illuminates the retina. The smartphone camera is opened in video/camera mode and the camera eye is placed in contact to the viewing aperture of the DO. Any brand model Smartphone or DO can be employed for using this technique. The examiner uses both of his/her hands to stabilize the smartphone and DO unit [Figure 1]c. The fingers of the nondominant hand can be used to retract the eyelids for better exposure [Figure 1]b. The DO-Smartphone unit [Figure 1]c can be used for viewing distant direct ophthalmoscopy when held 30–40 cm from the eye [Figure 3]. The patient's face details also can be captured [Figure 3]a. As the illumination is brought near to the patient's eye, the retina is visualized on the smartphone screen. The examination is then done as with a routine DO in the order of visualizing the optic disc first and macula last. During the examination, necessary photographs can be captured simultaneously from the recording video or extracted later as screenshots from the recorded video. The audio of the examiner explaining the lesions can also be utilized for training purpose. The imaging helps in viewing, recording, and documenting the fundus details like cup: disc ratio, appearance with red-free filter, venous pulsations, A-V crossing changes, background retina, and related pathologies [Figure 4]. The imaging can also be done in lying position, thus useful in bedside imaging as in medical ward/intensive care unit/comatose patients [Figure 2]a and [Figure 2]b, in remote areas like camps [Figure 2]c, for patient education [Figure 2]d, cross-consultation and training purpose.
Figure 3: Distant direct ophthalmoscopy. (a) Can capture the patient's facial details along with the red-reflex in both eyes. (b) Red reflex of the right eye. (c) Red reflex of the left eye

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Figure 4: Clinical pictures of the optic disc and retina captured with our technique. (a) Normal optic disc with healthy NRR. (b) Utility of a red-free image. (c) Glaucomatous optic atrophy with loss of NRR. (d) Torsional disc. (e) Optic disc hemorrhage. (f) Optic disc pallor secondary to CRAO. (g) A-V crossing. (h) Microaneurysm (i) Bony spicules in RP (j) Retinal detachment (k) Horse-shoe tear noted in the RD (l) Chorioretinal scar

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We conclude that smartphone imaging with DO without the need of any adapter or lens is a simple, quick, and cost-effective technique of acquiring magnified fundus images anytime and anywhere.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lord RK, Shah VA, San Filippo AN, Krishna R. Novel uses of smartphones in ophthalmology. Ophthalmology 2010;117:1274-1274.e3.  Back to cited text no. 1
    
2.
Wintergerst MW, Jansen LG, Holz FG, Finger RP. Smartphone-based fundus imaging–Where are we now? Asia Pac J Ophthalmol 2020;9:308-14.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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