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Background: Smartphones with high quality photographic and video capabilities are now ubiquitous. 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. 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. 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. The widespread adoption of the modern smartphone now allows everyone, including physicians, to easily capture photographs and videos during a patient encounter. Our group designed a “minimalist” optical system for imaging the anterior segment from the ground up that combines the following three elements (1) a low-cost macrolens, (2) a properly positioned LED light, and (3) a mounting system universal to all smartphones. After multiple attempts, we learned that reflections caused by ambient lighting can be best minimized by the creation of a single corneal light reflex. An LED light source was then fixed to the lens clip with or without plastic (ABS) spacers using commercially available adhesives. For protection of privacy, photographs taken with these adapters are being transmitted either through (1) the EPIC Haiku mobile application, that enables direct upload of photos to a patient’s medical record, (2) secure, encrypted institutional email, or (3) a HIPAA-compliant messaging application called Medigram (Los Altos, CA), which has been approved and is being deployed by the Stanford Hospital IT department for the capture and transmission of textpages and photos. Macro lenses for smartphones have been on the market for sometime, such as the Olloclip, Easy-Macro Lens, and other examples. Figure 2: (a) Photograph of ocular surface with macro lens alone, without LED illumination.
Figure 3a-b juxtaposes photos of a patient’s eye using only the stock camera app and lens (Figure 3a) and the same stock camera app used in conjunction with the macrolens and LED (Figure 3b) shown in Figure 1a.
We found that to image fluorescein staining, no separate blue light was needed, and that white LED illumination was sufficient. Our photodiary demonstrates the proof of concept that high quality anterior segment images can be easily and reproducibly captured by the lens adapter described, coupled with an iPhone 4 or higher and the stock camera application. Important limitations of the current adapter is the inability to create a slit of light that would be useful in estimating depth of corneal pathology, and for capturing cell and flare. Another potential drawback is the close working distance of the macrolenses (about 2.5 cm). The combination of secure message transmission, smartphones with cloud access and high quality camera technology, and a user-friendly, low cost adapter to easily couple lenses to a smartphone are now making teleophthalmology increasingly accessible. Ocular herpes (HSV) is one of the leading causes of blindness from corneal disease worldwide. Disclaimer: The information contained on this web site is presented for the purpose of warning people about LASIK complications prior to surgery. Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. 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. 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. 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.


This trend is poised to explode as seamless mobile data encryption and uploading to cloud storage becomes widespread. Here, we report the development of our first generation, compact, user-friendly, attachment and clinical photos obtained with it. Many of them, such as the Olloclip (which was one of the first such macrolens attachments available), are custom designed for a particular iPhone model. On a slitlamp system, this is provided in two ways: first, by the slitbeam itself, and second, through a reflected light source that creates a flash emanating inferiorly at the time of photocapture. Both designs utilize a macrolens with universal clip (CamKix, Inc.) capable of positioning the macrolens on nearly any smartphone on market today, including both Apple and Samsung devices.
In version 1, the light was redirected with a mirror placed just below the macro lens (Figure 1). In the event contact is made, the adapter and phone can be wiped clean with an alcohol swab; the adapter itself can be submerged in soap and water or another cleaning solution. All phones that are used to capture images are encrypted using the university or hospital Mobile Device Management (MDM) application. Proper illumination was the main challenge in trying to obtain maximum level of detail of the ocular surface without unwanted background reflections that obscure detail of the actual eye. Both photographs were taken without the use of the digital zoom function available on the iPhone. We are developing a version of this adapter that incorporates the option of blue LED illumination, which may provide additional finer details of more punctate or subtle fluorescein staining patterns.
Our design is believed to be an improvement for ease-of use and cost-effectiveness as the adapter bypasses the need for a slitlamp for capturing high magnification and well-illuminated images of the ocular surface, with a total cost of goods of less than $15 for the mechanical prototypes described herein.
However, we feel that images captured with the current adapter provides sufficient information with regard to the (1) clarity of the cornea, (2) quality of the epithelium, (3) fluorescein uptake, (4) the state of the conjunctiva (whether it is injected, chemotic, or hemorrhagic), (5) the shape of the pupil, (6) the health of the iris, (7) the presence or absence of a hyphema or hypopyon in the anterior chamber, and (8) the appearance of the lids and lashes. Currently we recommend using an alcohol swab to wipe down the adapter and case of the phone after use (or use soap and water on the adapter alone).
We have concurrently been developing a low-cost posterior segment imaging adapter for smartphones as well. My concern is the logistic needed for the detailed photo to reach and be analyzed by a competent ophthalmologist that will make recommendation for treatment if needed.
LASIK may lead to herpes simplex virus activation, resulting in sight-threatening herpes simplex keratitis lesions.Problems from Lasik?
The photo below shows the cornea of a patient who developed ectasia and herpes simplex infection after LASIK.
In the reported cases of herpetic reactivation after LASIK procedures done via a microkeratome and surface laser ablations, the trauma exerted by lamellar dissection and the ultrviolet light of the excimer laser have been blamed as the potential causes.
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. The key feature is that it is a lightweight low-cost adapter that reversibly couples with the iPhone 4 and higher. Our initial work was done with an Olloclip, but the model we purchased soon became unusable once the iPhone 5 was released, which not only had a better camera but also was substantially thinner and thus was no longer compatible with the lens. Ambient lighting led to background reflections on the surface of the cornea, obscuring important details.
In our experience, the iPhone stock camera is able to take excellent and arguably better resolution photos without a flash than it does with a flash.


In version 2, the light was redirected with a plastic endcap, thus providing direct light rather than reflected light (Figure 1c). All image acquisition and transmittal was handled with strict attention to the confidentiality of personal data in accordance with the Data Protection Act of 1998 and Access to Health Records of 1990.
We found that digital zoom could be used in the absence of the macrolens and light source, but that this caused a reduction in image quality compared to the optical zoom provided by the macrolens, and the lack of proper illumination using digital zoom alone led to unwanted corneal reflections.
Our primary criteria for image quality was iris detail; when iris detail was in focus, the majority of the ocular surface would come into the appropriate focus. However, we are also exploring the possibility of using a lens with a slightly longer focal distance. Our ultimate goal is for this system to be usable by healthcare staff with minimal specialized training to remotely capture and share high quality anterior segment images in order to enhance healthcare provider communication.
Application of mobile technology in ophthalmology to meet the demands of low-resource settings. Simple, Inexpensive Technique for High-Quality Smartphone Fundus Photography in Human and Animal Eyes. If he will just advise to see a local Ophthalmologist, then it is not necessary because the patient can see one without sending the photo. History of herpes keratitis is a contraindication for LASIK surgery, as surgical trauma may trigger reactivation. Our group sought a way to simplify ocular image capture with a smartphone that did not require a slit lamp or specialized training. With it, we were able to quickly photodocument a variety of anterior segment pathologies without the need for a slitlamp. We subsequently found a number of “universal” macrolens fittings for smartphones that not only were agnostic to phone make and model, but also were significantly cheaper ($10-$20 versus the $70 for the Olloclip).
When the iPhone native flash was used in “torch” mode (with the macrolens covering the camera lens but not the adjacent flash), patients found the light to be too intense, and, at the same time, photos were over-exposed.
Thus, we decided that an external LED would simultaneously provide (a) a level of illumination that would be comfortable for the patient, (b) the right amount of exposure, and (3) a single light reflex that eliminates reflections on the cornea. We have an ongoing IRB-approved study at our institution directed toward evaluating the quality of the photos taken with this adapter. An example would be enabling a triage nurse to text a secure, reliable image to an ophthalmologist on-call. Alternatively, you may call FDA at 1-800-FDA-1088 to report by telephone, download the paper form and either fax it to 1-800-FDA-0178 or mail it to the address shown at the bottom of page 3, or download the MedWatcher Mobile App for reporting LASIK problems to the FDA using a smart phone or tablet. This was the case even when the intensity was reduced with filters or by using the FilmicPro application (available on the iTunes app store), which is currently the only one on the market that we are aware of provides control over flash intensity. In future work, we plan to deploy subsequent generations of the adapter to non-ophthalmologists to evaluate their potential use in developing nations, inpatient consults, and areas where access to an ophthalmologist is limited.
This condition may lead to permanent scarring with associated vision loss and need for corneal transplant.



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