Purpose Widefield imaging can detect signs of retinal pathology extending beyond the posterior pole and is currently moving to the forefront of posterior segment imaging. We report a novel, smartphone-based, telemedicine-enabled, mydriatic, widefield retinal imaging device with autofocus and autocapture capabilities to be used by non-specialist operators. Methods The Remidio Vistaro uses an annular illumination design without cross-polarizers to eliminate Purkinje reflexes. The measured resolution using the US Air Force target test was 64 line pairs (lp)/mm in the center, 57 lp/mm in the middle, and 45 lp/mm in the periphery of a single-shot retinal image. An autocapture algorithm was developed to capture images automatically upon reaching the correct working distance. The field of view (FOV) was validated using both model and real eyes. A pilot study was conducted to objectively assess image quality. The FOVs of montaged images from the Vistaro were compared with regulatory-approved widefield and ultra-widefield devices. Results The FOV of the Vistaro was found to be approximately 65° in one shot. Automatic image capture was achieved in 80% of patient examinations within an average of 10 to 15 seconds. Consensus grading of image quality among three graders showed that 91.6% of the images were clinically useful. A two-field montage on the Vistaro was shown to exceed the cumulative FOV of a seven-field Early Treatment Diabetic Retinopathy Study image. Conclusions A novel, smartphone-based, portable, mydriatic, widefield imaging device can view the retina beyond the posterior pole with a FOV of 65° in one shot. Translational Relevance Smartphone-based widefield imaging can be widely used to screen for retinal pathologies beyond the posterior pole.

Background Refraction is one of the key components of a comprehensive eye examination. Auto refractometers that are reliable and affordable can be beneficial, especially in a low-resource community setting. The study aimed to validate the accuracy of a novel wave-front aberrometry-based auto refractometer, Instaref R20 against the open-field system and subjective refraction in an adult population. Methods All the participants underwent a comprehensive eye examination including objective refraction, subjective acceptance, anterior and posterior segment evaluation. Refraction was performed without cycloplegia using WAM5500 open-field auto refractometer (OFAR) and Instaref R20, the study device. Agreement between both methods was evaluated using Bland-Altman analysis. The repeatability of the device based on three measurements in a subgroup of 40 adults was assessed. Results The refractive error was measured in 132 participants (mean age,30.53 ± 9.36 years, 58.3% female). The paired mean difference of the refraction values of the study device against OFAR was − 0.13D for M, − 0.0002D (J0) and − 0.13D (J45) and against subjective refraction (SR) was − 0.09D (M), 0.06 (J0) and 0.03D (J45). The device agreed within +/− 0.50D of OFAR in 78% of eyes for M, 79% for J0 and 78% for J45. The device agreed within +/− 0.5D of SR values for M (84%), J0 (86%) and J45 (89%). Conclusion This study found a good agreement between the measurements obtained with the portable autorefractor against open-field refractometer and SR values. It has a potential application in population-based community vision screening programs for refractive error correction without the need for highly trained personnel.

Telemedicine-enabled, portable digital slit lamps can help to decentralize screening to close-to-patient contexts. We report a novel design for a portable, digital slit lamp using a smartphone. It works on an advanced optical design and has the capability of instantaneous, objective photodocumentation to capture anterior segment images and is telemedicine-enabled. Methods:The device is constructed keeping its usability and the importance of design ergonomics for nonspecialized field personnel in mind. The optical design is described, and the resolution and magnification are compared with traditional desktop-based slit lamps. A Health Insurance Portability and Accountability Act (HIPAA)-compliant, patient management software is integrated to synchronize the captured images with a secure cloud server along with a sharpness algorithm to extract the best focused frames of the cornea, iris, and lens, from videos. We demonstrate its photodocumentation ability and teleophthalmology feasibility by capturing images in a pilot study from nine subjects.Results: Images were obtained in various illumination, magnification, and filter settings. Synchronous and asynchronous teleophthalmology consults were conducted. The performance of the device was shown to be limited by the smartphone sensor resolution and not the optical design, because the Air Force target resolution was found to be the same on smartphone-mounted traditional slit lamps despite a lower magnification. Conclusions:The novel, portable, digital slit lamp with advanced optical design using smartphones has the ability to screen for anterior segment pathologies using telemedicine.Translational Relevance: A portable, telemedicine-friendly, ergonomically designed, slit lamp used by nonspecialist personnel allows for both synchronous and asynchronous modes of consultation at remote locations, facilitating mass screening programs.

Purpose: To report a novel, telemedicine-friendly, smartphone-based, wireless anterior segment device with instant photo-documentation ability in the COVID-19 era. Methods: Anterior Imaging Module (AIM) was constructed based on a 50/50 beam splitter design, to match the magnification drum optics of slit-lamps with a three-step or higher level of magnification. The design fills the smartphone sensor fully at the lowest magnification and matches the fixed focus of the slit-lamp. It comes with a smartphone for instant photo-documentation, an in-built software application for data-management and secure HIPAA compliant cloud storage, and a Bluetooth trigger for a one-tap image capture. The construction of the device is explained, and the optical resolution measured using U.S. air-force resolution test. AIM’s performance was characterized with traceability to internationally relevant performance standards for digital slit-lamps after image quality assessment through a pilot study. Results: Clinically useful anterior segment images were obtained with both diffuse and slit illumination at different magnification settings with the highest magnification (40X) resolution of 359 lines per cm and the lowest magnification (16X) resolution of 113 lines per cm. Conclusion: AIM is a novel, wireless, telemedicine-enabled design that digitizes existing, analog slit lamps with at least three-step magnification. The settings ensure the focus is determined purely by the position of the slit-lamp. Hence, the image viewed and captured on the smartphone is exactly what the clinician sees through the eyepiece. This helps in maintaining distance from the patient in the ongoing COVID-19 pandemic, as well.