A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging.

Purpose:High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods:The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results:The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions:Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance:Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening

Digital Image Sensor Integration in the Scope of EyeFundusScope: a Retinal Imaging System for Mobile Diabetic Retinopathy Assessment

Diabetic Retinopathy is a pathology, asymptomatic in early stages, that is a consequence of diabetes mellitus, a disease that affects millions of people worldwide. Specifically on people with Diabetic Retinopathy, long periods of hyperglycemia lead to the creation of very fragile blood vessels in the retina, or to the suppression of old ones, leading to problems like hemorrhages or exudates, that may cause blindness. Diabetic Retinopathy can be diagnosed with several devices, but these are mainly too expensive and non-portable, not allowing the screening of a great part of the population. This way, EyeFundusScope was created, being a smartphone based, non-mydriatic, handheld and low-cost Embedded Retinal Imaging System. Image quality depends on the system’s optical alignment and it should provide fundus images with a wide field-of-view. A communication protocol for streaming video and capturing still fundus images, from an UVC-Compliant Camera was developed, after a careful examination of the types of cameras that could be integrated in the system. Such cameras can be placed meticulously in the compact optical system, and suppress issues related to the different specifications of smartphone cameras, that often vary according to the manufacturers. An approach for low level control of high resolution and low cost camera modules was also evaluated. With the system developed, the user can select Internal Fixation Point Actuators, that are extremely important for this diagnosis, since they allow a fixed target for the patient to fixate on, reducing image aberrations due to its eye movement and providing wider field-of-view images. In the future, the UVC-Compliant Camera and Internal Fixation Points Actuators should be integrated on the current prototype, providing an accurate Diabetic Retinopathy screening tool which can enhance the early treatment of the pathology to a greater percentage of the population

A portable widefield fundus camera with high dynamic range imaging capability

Fundus photography is indispensable for clinical detection and management of eye diseases. Limited image contrast and field of view (FOV) are common limitations of conventional fundus cameras, making it difficult to detect subtle abnormalities at the early stages of eye diseases. Further improvements of image contrast and FOV coverage are important to improve early disease detection and reliable treatment assessment. We report here a portable fundus camera, with a wide FOV and high dynamic range (HDR) imaging capabilities. Miniaturized indirect ophthalmoscopy illumination was employed to achieve the portable design for nonmydriatic, widefield fundus photography. Orthogonal polarization control was used to eliminate illumination reflectance artifact. With independent power controls, three fundus images were sequentially acquired and fused to achieve HDR function for local image contrast enhancement. A 101{\deg} eye-angle (67{\deg} visual-angle) snapshot FOV was achieved for nonmydriatic fundus photography. The effective FOV can be readily expanded up to 190{\deg} eye-angle (134{\deg} visual-angle) with the aid of a fixation target, without the need of pharmacologic pupillary dilation. The effectiveness of HDR imaging was validated with both normal healthy and pathologic eyes, compared to a conventional fundus camera.Comment: 12 pages, 8 figure

Psychiatric Case Record

Bipolar Disorder-Mania: Patient was apparently normal one-month back, Then all of a sudden he developed sleep disturbances –mainly difficult in initiation of sleep. He also started abusing his family members for unwanted things. Subsequently, he started talking excessively and irritable. Sometimes he sings film songs and dances. He used to say that God Supreme exists in himself and so he has all the powers of Almighty. With that superior power he says that he can solve all the problems in this world. He also says that he has invented herbs to keep people young. For the past one week, he talks excessively without having an hour of sleep & wanders here and there & found excessively smoking. He becomes excessively spiritual and goes to near by villages for offering prayers to God. He takes only a little food everyday and he is very much keen in personal cleanliness. Paranoid Schizophrenia: She was apparently normal 8 months back, then she developed sleep disturbances in the form of difficult in falling asleep. She was found talking & smiling to herself at night & day with mirror gazing. She started saying that her neighbour & relatives are planning to kill herself by poisoning. In this context she had frequent quarrels with them and she refused to take food prepared by her mother in law. She left the home at night without informing any one and started wandering in the road side near her home. She was complaining that she hears voices as if her neighbour & relatives were talking about her among themselves She was not doing house hold activities for past 6 months and she was not taking care of her child. Her personal hygiene was very much deteriorated slowly as she used to take bath & brush, only if she was asked to do so. She started abusing & assaulting the strangers and family members. Generalised Anxiety Disorder: Six months back he was apparently normal. He is working as a system analyst in a private bank . He had once, made a mistake in his bank work for which he was given charges by his employer, followed this event he becomes very tense and afraid whenever his boss called him. He is very cautious that he should not commit any mistakes. Even though he is not doing so, he fears that he may commit some mistake in his work. At that moment he develops palpitation, giddiness, breathlessness, excessive sweating over palms and soles. Slowly these symptoms present through out the day even when he was not in his office, and he could not control his fearfulness. For the past 6 months he didn’t sleep well. His sleep is disturbed by bad dreams. Recurrent Depressive Disorder: Patient was apparently alright 2 months back. Then she developed sleep disturbances particularly early morning awakening, she use to wake up by 3.00 am and use to brood about herself and started crying. She was not doing her domestic work as before, as she felt excess tiredness and use to take frequent rests. She developed poor communication. She had lost her interest in pleasurable activities and was not interested in watching TV, and attending family gatherings. She stayed aloof most of the time & calm, quiet and withdrawn. She was expressing her helplessness and hopelessness about the future. She started to have decline in maintaining self care. 15 days back, she frequently expressed suicidal ideas and she had attempted suicide by hanging herself and was rescued by neighbours. 5 days back, she started talking in an irrelevant manner. She was smiling to self. She was assaulting her family members. She was suspicious that her neighbour had done black magic on her and also saying that people are talking about her. She reported hearing the voice of her neighbour scolding and threatening her. Organic Brain Syndrome – Dementia: Ten months back he was apparently alright. Then his relatives noticed himself frequently misplaces things inside his home. Then he started behaving aggressively. He was beating his wife without reason. He was roaming here and there, running out of home and wandering aimlessly. He was not able to come back home when he goes out. He was brought back to home by his relatives. Slowly he developed fearfulness and tremulousness while he was staying alone. He also started saying that his family members & neighbours were talking about himself, in this context he would make frequent quarrels with them. He also started hearing voices of known male voices abusing himself in third person. He sleeps for few hour only. He is passing urine and motion inside the house. He is asking about his brother and mother-in-law who were expired long back. He behaves abnormally such as pouring water in the plate while eating. And his relatives found the symptoms were worsened by evening. All these symptoms started insidiously, increased in severity through time and attained the present state. No history of loss of appetite / crying spells / suicidal tendencies / convulsions / fever / head injury

Nonmydriatic Fundus Photography In A High-Risk Population Of Samoans With Diabetes: The Soifua Manuia Eye Screening Program

IMPORTANCE Novel methods of detecting eye disease are needed due to the challenges associated with service delivery in resource-limited settings. BACKGROUND The objective of this study is to determine whether clinically gradable fundus images can be obtained using a low-cost, handheld non-mydriatic fundus camera by a non-ophthalmic provider in a remote setting. DESIGN Cross-sectional study PARTICIPANTS Two-hundred and six individuals (412 eyes) in the Pacific Island nation of Samoa with pre-diabetes and diabetes (HbA1c ≥5.7% or FBG ≥110 mg/dl). METHODS Participants underwent non-mydriatic fundus photography with the PanOptic iExaminer System, along with an assessment of near vision, medical, and ophthalmic histories. Images were remotely graded by an ophthalmologist and optometrist, who were blinded to participants’ demographic and biometric data. MAIN OUTCOME MEASURES The percentage of clinically gradable images, positive findings, and degree of inter-rater reliability and agreeability among graders were measured. RESULTS Clinically gradable images were obtained from 337 eyes (81.8%). Positive findings were identified in 29.1% of participants: 7 participants (3.4%) had non-proliferative diabetic retinopathy, 19 participants (9.2%) had evidence of background retinopathy, 33 participants (16.0%) had features of glaucoma, and 10 participants (4.9%) had other lesions, tumors, or structural abnormalities. Those with positive findings were referred for expedited review by a local ophthalmologist. CONCLUSION AND RELEVANCE Positive ophthalmic findings, including features of diabetic retinopathy and glaucoma, were readily identified in individuals at risk for undiagnosed eye disease screened with the PanOptic iExaminer. Use of smartphone-based remote screening holds promise as a cost-effective public health intervention in resource-constrained settings

The Effectiveness of Teleglaucoma versus In-Patient Examination for Glaucoma Screening: A Systematic Review and Meta-Analysis

BACKGROUND: Glaucoma is the leading cause of irreversible visual impairment in the world affecting 60.5 million people worldwide in 2010, which is expected to increase to approximately 79.6 million by 2020. Therefore, glaucoma screening is important to detect, diagnose, and treat patients at the earlier stages to prevent disease progression and vision loss. Teleglaucoma uses stereoscopic digital imaging to take ocular images, which are transmitted electronically to an ocular specialist. The purpose is to synthesize literature to evaluate teleglaucoma, its diagnostic accuracy, healthcare system benefits, and cost-effectiveness. METHODS: A systematic search was conducted to help locate published and unpublished studies. Studies which evaluate teleglaucoma as a screening device for glaucoma were included. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. The improvements to healthcare service quality and cost data were assessed. RESULTS: Of 11237 studies reviewed, 45 were included. Our results indicated that, teleglaucoma is more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The relative odds of a positive screen test in glaucoma cases are 18.7 times more likely than a negative screen test in a non-glaucoma cases. Additionally, the mean cost for every case of glaucoma detected was $1098.67 US and of teleglaucoma per patient screened was$922.77 US. CONCLUSION: Teleglaucoma can accurately discriminate between screen test results with greater odds for positive cases. It detects more cases of glaucoma than in-person examination. Both patients and the healthcare systems benefit from early detection, reduction in wait and travel times, increased specialist referral rates, and cost savings. Teleglaucoma is an effective screening tool for glaucoma specifically for remote and under-services communities

Evaluation of a portable retinal imaging device: towards a comparative quantitative analysis for morphological measurements of retinal blood vessels

This study investigated the possibility of using low-cost, handheld, retinal imaging devices for the automatic extraction of quantifiable measures of retinal blood vessels. Initially, the available handheld devices were compared using a Zeiss model eye incorporating a USAF resolution test chart to assess their optical properties. The only suitable camera of the five evaluated was the Horus DEC 200. This device was then subjected to a detailed evaluation in which images in human eyes taken from the handheld camera were compared in a quantitative analysis with those of the same eye from a Canon CR-DGi retinal desktop camera. We found that the Horus DEC 200 exhibited shortcomings in capturing images of human eyes by comparison with the Canon. More images were rejected as being unevaluable or suffering failures in automatic segmentation than with the Canon, and even after exclusion of affected images, the Horus yielded lower measurements of vessel density than the Canon. A number of issues affecting handheld cameras in general and some features of the Horus in particular have been identified that might contribute to the observed differences in performance. Some potential mitigations are discussed which might yield improvements in performance, thus potentially facilitating use of handheld retinal imaging devices for quantitative retinal microvascular measurements