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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 21-23

Utility of smartphone-based fundus camera device in a social outreach setting


Bose Eye Microsurgery and Laser Centre, Hooghly, West Bengal, India

Date of Web Publication20-Aug-2018

Correspondence Address:
Dr. Siddhartha Bose
Bose Eye Microsurgery and Laser Centre, Chinsurah, Hooghly - 712 101, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/erj.erj_5_18

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  Abstract 


Context: Fundus photography. Aim: To demonstrate the use of smartphone-based fundus camera device for detecting retinal pathology in social outreach camps. Settings and Design: Prospective comparative study. Subjects and Methods: Two investigators were recruited, one trained in conventional indirect ophthalmoscopy and the other in smartphone-based fundus photography. A smartphone and a 20D lens were used to record the fundus in video mode. Thirty-six patients having nonproliferative diabetic retinopathy were included in the study and examined by both the investigators. Clinical staging done by them on the basis of their individual photographs were compared. Statistical Analysis Used: Chi-square test. Results: Smartphone-based fundus photography was able to capture quality images of the retina. The investigators were able to deduce the same clinical staging for 33 out of 36 patients (P = 0.02). Conclusions: The images can be forwarded to the retina specialist via E-mail or digital messenger and opinion on management or referral can thus be sought. This will help bring specialized medical expertise to masses at remote places.

Keywords: Fundus photography, smartphone, social outreach setting


How to cite this article:
Bose S, Bose AK. Utility of smartphone-based fundus camera device in a social outreach setting. Egypt Retina J 2018;5:21-3

How to cite this URL:
Bose S, Bose AK. Utility of smartphone-based fundus camera device in a social outreach setting. Egypt Retina J [serial online] 2018 [cited 2018 Nov 17];5:21-3. Available from: http://www.egyptretinaj.com/text.asp?2018/5/1/21/239457




  Introduction Top


Modern smartphones have excellent image-capturing systems, and several researchers have successfully utilized the technology in ophthalmic imaging.[1],[2] In India, many ophthalmologists find it difficult to purchase expensive portable fundus cameras at the beginning of their practice. This is one of the main reasons that the detection of retinal pathologies is neglected at social outreach camps. Our team has been regularly using smartphone-based fundus photography to diagnose retinal diseases at outreach programs and utilizing the images to seek specialized medical advice.


  Subjects and Methods Top


Images are captured with a smartphone, iPhone 7 (Apple Inc., Cupertino, CA, USA), and a 20D lens (Volk Optical Inc., Mentor, OH, USA). The smartphone camera is used as an indirect ophthalmoscope by switching to video mode and using the continuous flash to have coaxial light constantly illuminated. For fundus imaging, pupillary dilatation is achieved at first, then the user holds the 20D lens close to the eye, and once fundus glow is visualized through the dilated pupil, slowly brings it back until a clear image can be visualized in the smartphone camera. Peripheral fundus imaging can also be done by asking the patient to look at the area of interest. For still images, the user can browse the video, freeze the video at the desired image, and take a snapshot. The images are easy to transfer electronically and to print.[3]

Two investigators (trained optometrists) were recruited for the study. One was trained for a month in conventional indirect ophthalmoscopy and the other was trained for the same period of time in smartphone-based fundus photography. They were also trained in staging of nonproliferative diabetic retinopathy (NPDR) as per the International Clinical Disease Severity Scale for diabetic retinopathy (DR).[4]

DR is known to be a prevalent retinal disease in camp settings.[5] Thus, 36 patients of NPDR were included with no or minimal media opacity and pupillary dilatation of at least 6 mm. All of them were examined by both the investigators separately, and fundus diagrams were made by both using conventional color coding.[6] Clinical staging was done by them based on their diagrams, which were compared at the end of the study.

Results were analyzed using the Chi-square test.


  Results Top


Some of the high-quality images captured using the device are illustrated in [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Figure 1: High-quality fundus photograph of patient number three

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Figure 2: High-quality fundus photograph of patient number nine

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Figure 3: High-quality fundus photograph of patient number seventeen

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Figure 4: High-quality fundus photograph of patient number twenty-two

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The investigators were able to deduce the same clinical staging for 33 out of 36 patients (P = 0.02). Upon discussion with the investigators, we found that detection using the smartphone camera was easier when clinical features of NPDR such as microaneurysms, dot/blot hemorrhages, splinter hemorrhages, and venous beading were more in number. The remaining 3 out of the 36 cases where the stagings did not match actually had mild NPDR with just few microaneurysms in each case.


  Discussion Top


Simplicity, portability, and effectiveness of smartphone-based fundus photography make it a useful tool for screening and detection of blinding retinal pathologies at every community-based ophthalmic setup. This diagnostic tool can also be combined with social media-based telemedicine for obtaining specialized medical advice without having the patient to travel great distances from remote places.[7] This will, in the near future, revolutionize the sophistication of ophthalmic care at a camp setup.


  Conclusion Top


Smartphone based fundus camera along with social media based telemedicine is a useful tool for improving medical care at a camp setup

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Haddock LJ, Kim DY, Mukai S. Simple, inexpensive technique for high-quality smartphone fundus photography in human and animal eyes. J Ophthalmol 2013;2013:518479.  Back to cited text no. 1
    
2.
Myung D, Alexandre J, He L, Mark SB, Robert TC. 3D printed smartphone indirect lens adapter for rapid, high quality retinal imaging. J MTM 2014;3:9-15.  Back to cited text no. 2
    
3.
Sharma A, Subramaniam SD, Ramachandran KI, Lakshmikanthan C, Krishna S, Sundaramoorthy SK, et al. Smartphone-based fundus camera device (MII ret cam) and technique with ability to image peripheral retina. Eur J Ophthalmol 2016;26:142-4.  Back to cited text no. 3
    
4.
Wu L, Fernandez-Loaiza P, Sauma J, Hernandez-Bogantes E, Masis M. Classification of diabetic retinopathy and diabetic macular edema. World J Diabetes 2013;4:290-4.  Back to cited text no. 4
    
5.
Gadkari SS, Maskati QB, Nayak BK. Prevalence of diabetic retinopathy in India: The all India ophthalmological society diabetic retinopathy eye screening study 2014. Indian J Ophthalmol 2016;64:38-44.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Zinn KM. Fundus color code. In: Clinical Atlas of Peripheral Retinal Disorders. New York: Springer; 1988. p. 115-30.  Back to cited text no. 6
    
7.
Park CH, Rahimy E, Shahlaee A, Federman JL. Telemedicine in ophthalmology. Retina Today 2017;12:55-8.  Back to cited text no. 7
    


    Figures

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



 

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Abstract
Introduction
Subjects and Methods
Results
Discussion
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