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As smartphone and digital technology continues to evolve, newer phones will have better image-capturing capabilities, improved image processing software, and more accessible networks for image sharing and telemedicine. Recent publications have shown that more complex fundus imaging can be accomplished with smartphones.
The quality and quantity of illumination is just as important as the quality of your smartphone camera. The biggest variables affecting light quality are diffusion and color temperature. Diffuse light offers uniform illumination of a large area and is helpful when examining structures that don’t require high magnification such as the ocular adnexa, eyelids, and conjunctiva. Diffusion can be achieved by using diffusers that were built into your slit lamp or by placing a semi-transparent filter (such as a cough syrup measuring cup) over the slit lamp’s light source. In addition, neutral or daylight-balanced color temperature (ie, 5,500 K) is ideal because it helps to ensure that findings such as conjunctival hyperemia are represented accurately in photographs. A good way to achieve brightness or color temperature balance is to use an LED module or an external light LED light source, which can be obtained from companies such as EyePhotoDoc and Augmented Vision Labs. CAMERA SETTINGS Maamari RN, Keenan JD, Fletcher DA, Margolis TP. A mobile phone-based retinal camera for portable wide field imaging. Br J Ophthalmol. 2014;98:438-441. Given such benefits and the ubiquity of smartphones, why hasn’t slit-lamp photography become a mainstream imaging modality? The truth is, capturing a freehand slit-lamp image with a smartphone is not nearly as easy as capturing a typical smartphone photograph. Although it is possible, taking freehand photos often disrupts the examination workflow and increases chair time. For smartphone use to gain mass adoption as an imaging modality, we must improve the usability, efficiency, and image quality of smartphone slit-lamp photography. USABILITY AND EFFICIENCYThere is a dedicated LabCam adapter for nearly every model iPhone that will fit portable or stationary slit lamps. LabCam is designed to mount perfectly so there are no adjustments, and the iPhone remains securely in place without vibration during an exam. Right out of the box, your iPhone's auto focus and white balance work flawlessly through your slit lamp's optics. Most people report it takes less than a minute from unboxing to capturing their first image. Images Captured with LabCam for iPhone 13 Pro installed on a Haag-Streit BQ-900 The images obtained with smartphone fundoscopy are typically not as sharp as those obtained with traditional cameras; however, they are of sufficient quality to be interpreted, and recent studies have validated their potential for screening and telemedicine. For example, the recent reports by Giardini et al 8 and Russo et al 9 showed that smartphone funduscopy images could be successfully used to screen for glaucoma and diabetic retinopathy. The results were comparable to standard images or examinations, and they could largely expand its utility in the community setting and in isolated rural areas with poor resources.
Gurram MM. Ophthalmic cell-phone imaging system: a costless imaging system. Can J Ophthalmol. 2013;48(5):135–9. https://doi.org/10.1016/j.jcjo.2013.06.007.
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They can now send me pictures remotely and I can conduct a televideo visit with them and ask them to show me their eye,” he says. “And that improves telemedicine. I can then bring in the people who really need to be seen in person, and those who are not an urgent case can still get care conveniently at home.”It works with all sizes of eyepieces. These adapters come with plastic covers you must put on the other until the clamp fits tightly. The smaller the diameter, the more covers you need; after taking the picture, you have to remove the adapter and the 2 or 3 covers; this is not as easy as just replacing the ocular, but it works. Steps and Tips to Take the best pictures EyeWiki. Smart phoneography — How to take slit lamp photographs with an iPhone. Available at: http://eyewiki.aao.org/Smart_Phoneography_How_to_take_slit_lamp_photographs_with_an_iPhone. Accessed March 25, 2015. SteadyPix Telescope Photo Adapter for iPhone. The adapter fits Leica M840 operating microscopes and Haag-Streit 900 BM models. The adapter's adjustable eyepiece clamp has a diameter of 35 mm (1.38 in) and should fit a wide range of slit lamp oculars. Aligning the slit lamp ocular and the camera lens can take a little longer than the Keeler Adapter because the eyepiece clamp's arm is also adjustable. To achieve more rapid centration of the slit lamp ocular and the camera's lens, prealign the iPhone in the adapter so that only a small portion of the adapter’s clamp is symmetrically seen in the corners of the phone’s screen.
Lobel, D. Instant photography with the Polaroid SX-70 Alpha I camera mounted on a slit lamp. Arch. Ophthalmol. 1980, 98, 748. [ Google Scholar] [ CrossRef] [ PubMed] Some examples of direct diffuse illumination include the following: A man came to our office complaining that his left eye was dilated for no apparent reason (Fig. 3). A woman with iris heterochromia (Fig. 4). A café-au-lait spot shows up nicely under the patient’s right eye (Fig. 5). A very advanced pterygium (Fig. 6). What looked like a small salmon patch of the conjunctiva, but was later found to be a conjunctival nevus after excision (Fig. 7). Deciding on the best method of illumination remains the same as with slit-lamp photography the traditional way. All of the slit-lamp images in this article were taken by the handheld method with my smartphone camera using multiple methods of illumination.You can avoid this unfortunate situation by using a dedicated camera adapter in your slit-lamp eye examination.
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