-
Journal of Visualized Experiments : JoVE Jul 2017Smartphone fundus photography is a simple technique to obtain ocular fundus pictures using a smartphone camera and a conventional handheld indirect ophthalmoscopy lens....
Smartphone fundus photography is a simple technique to obtain ocular fundus pictures using a smartphone camera and a conventional handheld indirect ophthalmoscopy lens. This technique is indispensable when picture documentation of optic nerve, retina, and retinal vessels is necessary but a fundus camera is not available. The main advantage of this technique is the widespread availability of smartphones that allows documentation of macula and optic nerve changes in many settings that was not previously possible. Following the well-defined steps detailed here, such as proper alignment of the phone camera, handheld lens, and the patient's pupil, is the key for obtaining a clear retina picture with no interfering light reflections and aberrations. In this paper, the optical principles of indirect ophthalmoscopy and fundus photography will be reviewed first. Then, the step-by-step method to record a good quality retinal image using a smartphone will be explained.
Topics: Fundus Oculi; Humans; Ophthalmoscopy; Photography; Smartphone
PubMed: 28715396
DOI: 10.3791/55958 -
Asia-Pacific Journal of Ophthalmology... 2018With the increasing survival of preterm babies in the Asia-Pacific region, there has been an increase in the incidence of retinopathy of prematurity (ROP). There is also... (Review)
Review
With the increasing survival of preterm babies in the Asia-Pacific region, there has been an increase in the incidence of retinopathy of prematurity (ROP). There is also a lack of trained ophthalmologists to screen for this disease. New strategies for screening of ROP are required, wherein the load on the ophthalmologist can be reduced. Telemedicine is an excellent tool to address this need. This paper reviews the initial studies comparing digital imaging with indirect ophthalmoscopy, the current active ROP telescreening programs in the world, and ends with studies dealing with automated diagnosis of ROP.
Topics: Humans; Infant, Newborn; Mass Screening; Ophthalmoscopy; Retinopathy of Prematurity; Telemedicine
PubMed: 29405045
DOI: 10.22608/APO.2017478 -
Indian Journal of Ophthalmology Oct 2019
Topics: Humans; Male; Middle Aged; Ophthalmoscopy; Retina; Retinoschisis; Visual Acuity
PubMed: 31546543
DOI: 10.4103/ijo.IJO_193_19 -
Asia-Pacific Journal of Ophthalmology... 2018Throughout ophthalmic history it has been shown that progress has gone hand in hand with technological breakthroughs. In the past, fluorescein angiography and fundus... (Review)
Review
Throughout ophthalmic history it has been shown that progress has gone hand in hand with technological breakthroughs. In the past, fluorescein angiography and fundus photographs were the most commonly used imaging modalities in the management of diabetic macular edema (DME). Today, despite the moderate correlation between macular thickness and functional outcomes, spectral domain optical coherence tomography (SD-OCT) has become the DME workhorse in clinical practice. Several SD-OCT biomarkers have been looked at including presence of epiretinal membrane, vitreomacular adhesion, disorganization of the inner retinal layers, central macular thickness, integrity of the ellipsoid layer, and subretinal fluid, among others. Emerging imaging modalities include fundus autofluorescence, macular pigment optical density, fluorescence lifetime imaging ophthalmoscopy, OCT angiography, and adaptive optics. Technological advances in imaging of the posterior segment of the eye have enabled ophthalmologists to develop hypotheses about pathological mechanisms of disease, monitor disease progression, and assess response to treatment. Spectral domain OCT is the most commonly performed imaging modality in the management of DME. However, reliable biomarkers have yet to be identified. Machine learning may provide treatment algorithms based on multimodal imaging.
Topics: Diabetic Retinopathy; Diagnostic Techniques, Ophthalmological; Fluorescein Angiography; Humans; Macular Edema; Multimodal Imaging; Ophthalmoscopy; Optical Imaging; Optics and Photonics; Tomography, Optical Coherence
PubMed: 29376234
DOI: 10.22608/APO.2017504 -
Asia-Pacific Journal of Ophthalmology... 2020The diagnosis and treatment of medical retinal disease is now inseparable from retinal imaging in all its multimodal incarnations. The purpose of this article is to... (Review)
Review
The diagnosis and treatment of medical retinal disease is now inseparable from retinal imaging in all its multimodal incarnations. The purpose of this article is to present a selection of very different retinal imaging techniques that are truly translational, in the sense that they are not only new, but can guide us to new understandings of disease processes or interventions that are not accessible by present methods. Quantitative autofluorescence imaging, now available for clinical investigation, has already fundamentally changed our understanding of the role of lipofuscin in age-related macular degeneration. Hyperspectral autofluorescence imaging is bench science poised not only to unravel the molecular basis of retinal pigment epithelium fluorescence, but also to be translated into a clinical camera for earliest detection of age-related macular degeneration. The ophthalmic endoscope for vitreous surgery is a radically new retinal imaging system that enables surgical approaches heretofore impossible while it captures subretinal images of living tissue. Remote retinal imaging coupled with deep learning artificial intelligence will transform the very fabric of future medical care.
Topics: Artificial Intelligence; Fluorescein Angiography; Fundus Oculi; Humans; Macular Degeneration; Ophthalmoscopy; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 32487917
DOI: 10.1097/APO.0000000000000292 -
Progress in Retinal and Eye Research Jan 2020Quantitative fundus autofluorescence (qAF) is an approach that is built on a confocal scanning laser platform and used to measure the intensity of the inherent... (Review)
Review
Quantitative fundus autofluorescence (qAF) is an approach that is built on a confocal scanning laser platform and used to measure the intensity of the inherent autofluorescence of retina elicited by short-wavelength (488 nm) excitation. Being non-invasive, qAF does not interrupt tissue architecture, thus allowing for structural correlations. The spectral features, cellular origin and topographic distribution of the natural autofluorescence of the fundus indicate that it is emitted from retinaldehyde-adducts that form in photoreceptor cells and accumulate, under most conditions, in retinal pigment epithelial cells. The distributions and intensities of fundus autofluorescence deviate from normal in many retinal disorders and it is widely recognized that these changing patterns can aid in the diagnosis and monitoring of retinal disease. The standardized protocol employed by qAF involves the normalization of fundus grey levels to a fluorescent reference installed in the imaging instrument. Together with corrections for magnification and anterior media absorption, this approach facilitates comparisons with serial images and images acquired within groups of patients. Here we provide a comprehensive summary of the principles and practice of qAF and we highlight recent efforts to elucidate retinal disease processes by combining qAF with multi-modal imaging.
Topics: Fluorescein Angiography; Fundus Oculi; Humans; Macular Degeneration; Ophthalmoscopy; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 31472235
DOI: 10.1016/j.preteyeres.2019.100774 -
Asia-Pacific Journal of Ophthalmology... 2020With the advent of smartphone-based fundus imaging (SBFI), a low-cost alternative to conventional digital fundus photography has become available. SBFI allows for a... (Review)
Review
With the advent of smartphone-based fundus imaging (SBFI), a low-cost alternative to conventional digital fundus photography has become available. SBFI allows for a mobile fundus examination, is applicable both with and without pupil dilation, comes with built-in connectivity and post-processing capabilities, and is relatively easy to master. Furthermore, it is delegable to paramedical staff/technicians and, hence, suitable for telemedicine. Against this background a variety of SBFI applications have become available including screening for diabetic retinopathy, glaucoma, and retinopathy of prematurity and its applications in emergency medicine and pediatrics. In addition, SBFI is convenient for teaching purposes and might serve as a surrogate for direct ophthalmoscopy. First wide-field montage techniques are available and the combination of SBFI with machine learning algorithms for image analyses is promising. In conclusion, SBFI has the potential to make fundus examinations and screenings for patients particularly in low- and middle-income settings more accessible and, therefore, aid tackling the burden of diabetic retinopathy, glaucoma, and retinopathy of prematurity screening. However, image quality for SBFI varies substantially and a reference standard for grading appears prudent. In addition, there is a strong need for comparison of different SBFI approaches in terms of applicability to disease screening and cost-effectiveness.
Topics: Diagnostic Imaging; Diagnostic Techniques, Ophthalmological; Eye Diseases; Fundus Oculi; Humans; Ophthalmoscopy; Photography; Smartphone; Telemedicine
PubMed: 32694345
DOI: 10.1097/APO.0000000000000303 -
Progress in Retinal and Eye Research Sep 2017Imaging techniques based on retinal autofluorescence have found broad applications in ophthalmology because they are extremely sensitive and noninvasive. Conventional... (Review)
Review
Imaging techniques based on retinal autofluorescence have found broad applications in ophthalmology because they are extremely sensitive and noninvasive. Conventional fundus autofluorescence imaging measures fluorescence intensity of endogenous retinal fluorophores. It mainly derives its signal from lipofuscin at the level of the retinal pigment epithelium. Fundus autofluorescence, however, can not only be characterized by the spatial distribution of the fluorescence intensity or emission spectrum, but also by a characteristic fluorescence lifetime function. The fluorescence lifetime is the average amount of time a fluorophore remains in the excited state following excitation. Fluorescence lifetime imaging ophthalmoscopy (FLIO) is an emerging imaging modality for in vivo measurement of lifetimes of endogenous retinal fluorophores. Recent reports in this field have contributed to our understanding of the pathophysiology of various macular and retinal diseases. Within this review, the basic concept of fluorescence lifetime imaging is provided. It includes technical background information and correlation with in vitro measurements of individual retinal metabolites. In a second part, clinical applications of fluorescence lifetime imaging and fluorescence lifetime features of selected retinal diseases such as Stargardt disease, age-related macular degeneration, choroideremia, central serous chorioretinopathy, macular holes, diabetic retinopathy, and retinal artery occlusion are discussed. Potential areas of use for fluorescence lifetime imaging ophthalmoscopy will be outlined at the end of this review.
Topics: Fluorescein Angiography; Humans; Ophthalmoscopy; Retina; Retinal Diseases
PubMed: 28673870
DOI: 10.1016/j.preteyeres.2017.06.005 -
Current Opinion in Neurology Feb 2019The funduscopic examination can be a technically difficult, and often omitted, portion of the neurologic examination, despite its great potential to influence patient... (Review)
Review
PURPOSE OF REVIEW
The funduscopic examination can be a technically difficult, and often omitted, portion of the neurologic examination, despite its great potential to influence patient care.
RECENT FINDINGS
Medical practitioners are often first taught to examine the ocular fundus using a direct ophthalmoscope, however, this skill requires frequent practice. Nonmydriatic tabletop and portable fundus photography and even smartphone-based photography offer alternative and practical means for approaching examination of the ocular fundus. These alternative tools have been shown to be practical in a variety of settings including ambulatory clinics and emergency departments. Decreased retinal microvascular density detected with fundus photography has been linked to accelerated rates of cognitive decline. Research has also found optic disc pallor and retinopathy detected via fundus photography to be more prevalent in patients with recent stroke or transient ischemic attack.
SUMMARY
Alternative methods of funduscopic examination based on fundus photography have the potential to improve the ease of use, portability, and availability of funduscopy. Recognition of changes in retinal microvasculature has the potential to noninvasively identify patients at the highest risk for cognitive impairment and cerebrovascular disease. However, further research is needed to determine the specific utility of measurements of retinal microvascular changes in clinical care. Innovative funduscopy techniques offer neurologists new approaches to this essential facet of the neurological examination.
Topics: Eye Diseases; Fundus Oculi; Humans; Neurologic Examination; Ophthalmoscopy; Photography
PubMed: 30516640
DOI: 10.1097/WCO.0000000000000637 -
Indian Journal of Ophthalmology Jul 2015The methods of fundus examination include direct and indirect ophthalmoscopy and imaging with a fundus camera are an essential part of ophthalmic practice. The usage of... (Review)
Review
The methods of fundus examination include direct and indirect ophthalmoscopy and imaging with a fundus camera are an essential part of ophthalmic practice. The usage of unconventional equipment such as a hand-held video camera, smartphone, and a nasal endoscope allows one to image the fundus with advantages and some disadvantages. The advantages of these instruments are the cost-effectiveness, ultra portability and ability to obtain images in a remote setting and share the same electronically. These instruments, however, are unlikely to replace the fundus camera but then would always be an additional arsenal in an ophthalmologist's armamentarium.
Topics: Fluorescein Angiography; Fundus Oculi; Humans; Ophthalmoscopy; Retinal Diseases; Smartphone
PubMed: 26458475
DOI: 10.4103/0301-4738.167123