Obtaining a secure, photographic record of clinical findings during patient encounters can serve as a powerful adjunct to the otherwise text-heavy documentation that dominates modern electronic health record systems. This is particularly true in ophthalmology, which is one of several medical specialties that relies heavily on images for diagnosis and treatment. Conventionally, ophthalmic imaging has required expensive, tabletop units operated by a trained technician in an outpatient clinic setting. The ubiquity and evolution of smartphones into both high-resolution cameras and conduits for encrypted data transfer has the potential to change this; however, their use is inherently limited by the optics and lighting required to image the eye, and in particular, the retina. Here, we report the development of a lightweight, compact, user-friendly, 3D printed attachment enabling high quality fundus photos by coupling smartphones to indirect ophthalmoscopy condensing lenses. The attachment is designed to hold a specific lens at a prescribed but adjustable distance from the camera lens, can utilize either the phone's native flash for lighting or another coaxial light source, and has the potential to be operated with one hand. Using both mechanical prototypes and subsequent 3D printed versions of the device, we were able to photodocument a variety of both normal and abnormal retinal findings.

Background: Smartphones with high quality photographic and video capabilities are now ubiquitous. However their utility for documenting ocular pathology has been limited by the optics, magnification, and lighting control required to capture key anatomic details of the eye. While various adapters have been designed to attach a smartphone to a slitlamp to obtain clinically useful photos, we sought a way for practitioners to achieve similar photos using only their existing smartphones with minimal additional hardware. Methods:We report the design of a simple, point-of-care optical adapter for imaging the anterior segment that combines a low-cost macrolens, LED external light source, and a universal attachment system for use with all smartphones. The adapter is easily attached and detached from a phone in seconds and is small enough to fit in a pocket when not in use.Results: A series of anterior segment photographs were obtained with the adapter that satisfactorily portrays a wide range of pathology of the eyelids, conjunctiva, cornea, iris, and lens without the need for a slitlamp. The external LED adjacent to the macrolens was key in creating a single light reflex that eliminated reflections on the cornea caused by ambient light.Conclusions: A simple, low-cost smartphone adapter can provide useful clinical information regarding the appearance of the lids and lashes, the clarity of the cornea, the state of the conjunctiva, the shape of the pupil and health of the iris, and the presence or absence of a hyphema or hypopyon. This may be useful for urgent triage and teleophthalmology in various settings.

Aim of Study:To evaluate the ability of ancillary health staff to use a novel smartphone imaging adapter system (EyeGo, now known as Paxos Scope) to capture images of sufficient quality to exclude emergent eye findings. Secondary aims were to assess user and patient experiences during image acquisition, interuser reproducibility, and subjective image quality.Materials and Methods:The system captures images using a macro lens and an indirect ophthalmoscopy lens coupled with an iPhone 5S. We conducted a prospective cohort study of 229 consecutive patients presenting to L. V. Prasad Eye Institute, Hyderabad, India. Primary outcome measure was mean photographic quality (FOTO-ED study 1–5 scale, 5 best). 210 patients and eight users completed surveys assessing comfort and ease of use. For 46 patients, two users imaged the same patient's eyes sequentially. For 182 patients, photos taken with the EyeGo system were compared to images taken by existing clinic cameras: a BX 900 slit-lamp with a Canon EOS 40D Digital Camera and an FF 450 plus Fundus Camera with VISUPAC™ Digital Imaging System. Images were graded post hoc by a reviewer blinded to diagnosis.Results:Nine users acquired 719 useable images and 253 videos of 229 patients. Mean image quality was ≥ 4.0/5.0 (able to exclude subtle findings) for all users. 8/8 users and 189/210 patients surveyed were comfortable with the EyeGo device on a 5-point Likert scale. For 21 patients imaged with the anterior adapter by two users, a weighted κ of 0.597 (95% confidence interval: 0.389–0.806) indicated moderate reproducibility. High level of agreement between EyeGo and existing clinic cameras (92.6% anterior, 84.4% posterior) was found.Conclusion:The novel, ophthalmic imaging system is easily learned by ancillary eye care providers, well tolerated by patients, and captures high-quality images of eye findings.

ObjectiveWe aimed at evaluating the ability of individuals without ophthalmologic training to quickly capture high-quality images of the cornea by using a smartphone and low-cost anterior segment imaging adapter (the “EyeGo” prototype).MethodsSeven volunteers photographed 1,502 anterior segments from 751 high school students in Varni, India, by using an iPhone 5S with an attached EyeGo adapter. Primary outcome measures were median photograph quality of the cornea and anterior segment of the eye (validated Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department [FOTO-ED] study; 1–5 scale; 5, best) and the time required to take each photograph. Volunteers were surveyed on their familiarity with using a smartphone (1–5 scale; 5, very comfortable) and comfort in assessing problems with the eye (1–5 scale; 5, very comfortable). Binomial logistic regression was performed using image quality (low quality: <4; high quality: ≥4) as the dependent variable and age, comfort using a smartphone, and comfort in assessing problems with the eye as independent variables.ResultsSix of the seven volunteers captured high-quality (median ≥4/5) images with a median time of ≤25 seconds per eye for all the eyes screened. Four of the seven volunteers demonstrated significant reductions in time to acquire photographs (P1=0.01, P5=0.01, P6=0.01, and P7=0.01), and three of the seven volunteers demonstrated significant improvements in the quality of photographs between the first 100 and last 100 eyes screened (P1<0.001, P2<0.001, and P6<0.01). Self-reported comfort using a smartphone (odds ratio [OR] =1.25; 95% CI =1.13 to 1.39) and self-reported comfort diagnosing eye conditions (OR =1.17; 95% CI =1.07 to 1.29) were significantly associated with an ability to take a high-quality image (≥4/5). There was a nonsignificant association between younger age and ability to take a high-quality image.ConclusionIndividuals without ophthalmic training were able to quickly capture a high-quality magnified view of the anterior segment of the eye by using a smartphone with an attached imaging adapter.

Background: Smartphones provide a diverse range of functions, including the ability to communicate rapidly, store information and consult online medical applications (apps). Whilst their use by doctors is popular, there is little data on their clinical use and application by surgical trainees. Aims: Here we assess smartphone ownership, usage in clinical environments, medical app download patterns, and knowledge of current app regulation by surgical trainees. Methods: An online questionnaire was distributed to all core and specialty NHS general surgical trainees working in Scotland. Results: Thirty three percent (76/233) of trainees responded. Ninety two percent owned a smartphone. Trainees used smartphones at work for email (96%), calls (85%), SMS/MMS (81%), Internet browsing (76%) and medical app access (55%). Eighty two percent of respondents had downloaded at least one app, including clinical guidelines (70%), medical calculators (59%), anatomy guides (50%) and study aids (32%). There was no statistical difference between demographics and smartphone use or app downloads. Thirty five percent had used apps to help make clinical decisions. Thirteen percent felt they had encountered erroneous outputs, according to their own judgement and/or calculation. Fifty eight percent felt apps should be compulsorily regulated however only one trainee could name a regulatory body. Conclusion: Smartphone possession amongst NHS surgical trainees is high. Knowledge of app regulation is poor, with potential safety concerns regarding inaccurate outputs. Integration of apps, developed and approved by an appropriate authority, may improve confidence when integrating them into training and healthcare delivery.