|Year : 2022 | Volume
| Issue : 1 | Page : 273-274
Montage image of fundus nearly upto the ora serrata with the help of an android mobile
Vitreo-Retinal Diseases, Shri Dadaji Retina Care, Near Gadda Chowk, Supela, Bhilai, Chhattisgarh, India
|Date of Submission||30-Jul-2021|
|Date of Acceptance||01-Sep-2021|
|Date of Web Publication||07-Jan-2022|
Dr. Chhaya Bharti
Vitreo-Retinal Diseases, House No. 6, Gandhi Nagar, Post Nehru Nagar, Distt Durg, Bhilai - 490 020, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Keywords: Additional devices, android mobiles, fundus photography, montage view
|How to cite this article:|
Bharti C. Montage image of fundus nearly upto the ora serrata with the help of an android mobile. Indian J Ophthalmol Case Rep 2022;2:273-4
Retinal imaging was first described in the late 19th century. In the early 1860s, Henry Noyes and Abner Mulholland Rosebrugh both assembled fundus cameras and tried fundus photography on animals. There is a controversy regarding the first-ever successful human fundus photo; William Thomas Jackman and J. D. Webster are credited as they published their technique along with a reproduction of a fundus image in two periodicals in 1886. According to some historical accounts, Elmer Starr and Lucien Howe may have been the first to photograph the human retina in their fundus photography project in 1886–88. The revolution of fundus photography changed in 1926 when Stockholm's Johan Noderson and Zeiss marketed the first modern commercial Fundus camera with a field of view of 20°. The Equator-plus camera is a specialized contact lens-based camera that was developed in 1975 by Pomerantzeff that captured a 148° field of view. The revolution of mobile fundus photography started when Lord et al. took fundus photographs in 2010 using an Apple mobile phone with an external light source. With advances in technology, mobile phones now come equipped with an inbuilt flash that can be used as a light source when switched on in the continuous mode. Reports of fundus imaging with the help of additional devices are available.
Fundus photography was done from July 2018 to April 2021 by using a smartphone (Nokia 8.1) with the help of condensing lens 20D and pan-retinal lenses in a dilated pupil without any attachment or indentation. Approximately 2000 pictures were taken. Compilation of these photographs of a particular disease entity was done in their respective quadrants on PowerPoint to obtain a complete fundus picture.
Step 1: Capturing images on android mobile
The nondominant hand holds the 20D lens/pan-retinal lens, and the dominant hand holds the mobile with camera; flash “ON” is coupled with condensing lens. The working distance is approximately 20 and 25 cm for 20D lens and pan-retinal lens, respectively. The patient is asked to look straight. As soon as the flash and camera become coaxial over the lens, the fundus becomes visible and images are captured; thus, a central image up to equators is captured. For peripheral images from equators to ora, the patient is asked to look in different directions, and pictures are captured from diagonal positions. Images can be magnified before capturing by zooming, depending on the magnification provided by the mobile, thus making the images more clear, magnified, and sharp. Fundus image is cropped to remove images outside lens margin.
Step 2: Image editing is done on personal computer (PC)
- Open PowerPoint on PC
- Bring the central image of the posterior pole and crop the image to remove all the lens margins
- Insert the peripheral image, align the vessels, and merge them accordingly
- Coincide all the peripheral images one by one with the central image along the direction of vessels in their respective quadrant, thus completing the image
- Save this image in picture format, and printouts can be taken accordingly if needed.
Photoshop can be used to create a montage picture to remove edges of the lens and make the picture circular like commercially available fundus equipment, but it needs a learning curve and is a bit more tedious.
Images are magnified, of high resolution, are of true colors, and no lash artifacts or peripheral distortion are seen. The only artifact in this technique is two flash-related white dots, which can be removed by picture-editing applications. Sometimes, all four quadrants may not be achieved if the patient is uncooperative [Figure 1] and [Figure 2].
|Figure 1: (a) Foveal involving RC Coloboma with prominent episcleral vessels and intercalary membrane; (b) Silicon oil in situ with superior lasered break; (c) Sub-hyloid hemorrhage; (d) Foveal sparring lasered RC Coloboma|
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|Figure 2: (a) Viral retinitis with macular star; (b) Vasculitis; (c) Silicon oil in situ with inferior retinectomy; (d) Photoshop image of silicon oil in situ with inferior retinectomy|
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| Discussion|| |
Commercially available fundus cameras offer good-quality images but are bulky, office-based, technician-dependent, and costly, thus restricting their use only to higher-end clinical settings. In contrast, the technique presented in this study is inexpensive, portable, and easy to operate.
- The images captured are of true colors, without lash artifacts, and no peripheral distortion seen as compared to pictures captured by “Optos.”
- Special focus on disease entity at ora and beyond equators can be done.
- Magnified and resolution is high as compared to indirect ophthalmoscopy and wide-field cameras.
- Sharp in quality as the details can be clearly seen.
Images of this technique are of high resolution and magnification. The described technique of creating montage pictures is easy, handy, light-weight, and inexpensive, and can done on portable devices. The picture is of wide-field, true colors with no lash artifacts and no peripheral distortion seen. Useful for counseling, disease monitoring, sharing on social media, teaching, telescreening, storage, and documentation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Timothy J. Benett CRA OCT-C FOPS, Thursday, September26, 2013 Milestones, Rivalieries and controversy: The origin of Photography and Ophthalmic Photography Part III, The First Human Fundus Photograph.
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Museum of Vision Exhibition. www.Museumofvision.org.
Pomerantzeff O. Equator plus camera. Invest Ophthal 1975:14:401-6.
Lord RK, Shah VA, San Filippo AN, Krishna R. Novel uses of smartphones in ophthalmology. Ophthalmology 2010;117:1274-4.e3.
Sharma A, Subramaniam SD, Ramachandran KI, Lakshmikanthan C, Krishna S, Sundaramoorthy SK. Smartphone-based fundus camera device (MII Ret Cam) and technique with ability to image peripheral retina. Eur J Ophthalmol 2016;26:142-4.
[Figure 1], [Figure 2]