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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.
https://www.digitaleyecenter.com/product/universal-smartphone-slit lamp-adapter (accessed on 20 October 2022) Subsequent use of these adaptors for slit-lamp smartphone fundus imaging has been successful; however, the image quality has been poor due to difficulty with optics and illumination through the 78- or 90-D lenses on the slit lamp. Camera With Hardware Attachment Akkara, J.D. Commentary: Dawn of smartphones in frugal ophthalmic innovation. Indian J. Ophthalmol. 2018, 66, 1619. [ Google Scholar] [ CrossRef]Separate your Focus and Exposure. Once the eye is close to being in focus, tap the center of the screen with two fingers. This will separate your control of the focus and exposure. Lord RK, Shah VA, San-Filippo AN, Krishna R. Novel uses of smartphones in ophthalmology. Ophthalmology. 2010;117:1274.
Figure 7: Sample pictures showing head to head comparison between Smartphone Camera (Top pictures) and conventional anterior segment camera (bottom) in a 20 year old patient with corneal foreign body. Picture A shows initial presentation. Picture B shows post-removal of corneal foreign body with retained rust ring. Picture C shows post removal of rust ring with corneal scar In addition, Maamari et al 14 described a prototype widefield lens attachment for the smartphone called Ocular CellScope, which can slide into the phone and capture widefield images using the phone’s built-in camera. Their technique could capture approximately 55º of the fundus in a single image ( Figure 8). Additional software could be used to stitch together the images to capture a larger overall image of the fundus. FUTURE APPLICATIONS Welch RJ, Nguyen QD. A novel approach to ophthalmic photography using a portable and versatile camera device. Invest Ophthalmol Vis Sci. 2015;56:4102.This is another reason to have a dedicated iPhone for the exclusive function of taking slit lamp pictures. Smartphones are an attractive option in portable ophthalmoscopy due to their widespread availability. Newer techniques have allowed the acquisition of high-quality images that compare to images obtained with the more expensive conventional fundus cameras. Available options include slit lamp attachments, adapters for direct ophthalmoscopy, and the use of smartphones with handheld or mounted lenses as an indirect ophthalmoscope. Summary I was also able to teach a nurse practitioner how to perform Goldmann applanation tonometry proficiently over 2 clinics. The practitioner had been sitting in on 1 glaucoma clinic a week over the previous 2 years to try to learn this skill, without success. Figure 3. Top left image shows EyePhotoDoc adapter, which mount an iPhone to the Haag-Streit slit lamp. Top right image shows Zarf’s iPhone adapter, which fits a variety of different slit lamps. Image to the left shows the Keeler portable Slit Lamp iPhone Image adapater, which is compatible with various models of the Keeler handheld slit lamps. The three pictures at the top are from a smartphone camera, and the ones on the bottom are from a conventional anterior segment camera.
It is possible to take slit lamp photos by placing the lens of your smartphone flush with the slit lamp ocular; however, the use of an adapter will allow you to obtain higher quality photographs. Below you will find several options. Another critical parameter to consider is the quality of the slit lamp. The lenses on the slit lamp are the most valuable component, and they will make a significant difference in the quality of the picture. So next time you think of getting a better camera, think instead about the possibility of getting a new slit lamp. When using the iPhone slit lamp adapter with different kinds of slit lamps, you will notice the big difference in output quality from an economy slit lamp to a brand-name one.
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The largest improvements in usability, efficiency, and image quality can be achieved by using a dedicated slit-lamp smartphone adapter, rather than trying to take freehand photographs. The current literature on smartphone funduscopy suggests that the limitations of the technique and its applications lie in image quality and field of view, as well as universalizing its accessibility on all types of smartphones, including iOS, Android, Windows (Microsoft, Redmond, WA), and other operating systems. Additional validation studies will be needed to integrate this technology into everyday practice. Roy, S.; Pantanowitz, L.; Amin, M.; Seethala, R.R.; Ishtiaque, A.; Yousem, S.A.; Parwani, A.V.; Cucoranu, I.; Hartman, D.J. Smartphone adapters for digital photomicrography. J. Pathol. Inform. 2014, 5, 24. [ Google Scholar] [ CrossRef] [ PubMed]
Suto et al were able to capture adequate images for diagnosing certain diseases, although they cautioned that subtle findings might be missed due to the quality of the images with the current technology. 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.The picture shows the removal process of a foreign body on a 20-year-old patient. The sequence is A) initial presentation, B) post removal of corneal foreign body, and C) post removal of rust ring. Gutner, R.K. Slit lamp photodocumentation. Am. J. Optom. Physiol. Opt. 1979, 56, 559–562. [ Google Scholar] [ CrossRef] Ludwig CA, Murthy SI, Pappuru RR, Jais A, Myung DJ, Chang RT. A novel smartphone ophthalmic imaging adapter: user feasibility studies in Hyderabad, India. Indian J Ophthalmol. 2016;64(3):191–200. https://doi.org/10.4103/0301-4738.181742. This iPhone slit lamp adapter will use a clamp that holds the phone to the ocular. If you have a slit lamp in which you can not slide out the eyepieces, this is your only option. Kalayoglu, M.V. The Evolution of Slit Lamp Biomicroscopy. 2005. Available online: https://www.ophthalmologyweb.com/Tech-Spotlights/26450-The-Evolution-of-Slit-Lamp-Biomicroscopy/ (accessed on 4 October 2022).
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