Design and Performance Characterization of a Novel, Smartphone-Based, Portable Digital Slit Lamp for Anterior Segment Screening Using Telemedicine

Abstract

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.

Telemedicine for Cornea and External Disease: A Scoping Review of Imaging Devices

“…The CellScope device has also been used to photograph the everted superior tarsal conjunctiva for community trachoma surveillance [ 32 ]. More advanced optical systems have been developed for smartphone attachments designed to be used as handheld slit lamp cameras [ 9 ]. One such attachment allows patients to take slit lamp videos of their own eyes; this device was reported to correctly identify the presence or absence of corneal pathology in 74% of eyes relative to a slit lamp examination [ 17 , 34 ].…”

“…The included studies and reports were published between 1998 and 2023 and consisted of introductions of a new device/technique (n = 13) [6][7][8][9][10][11][12][13][14][15][16][17][18], prospective diagnostic accuracy studies (n = 18) [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36], retrospective diagnostic accuracy studies (n = 5) [37][38][39][40][41], cross-sectional descriptive studies (n = 5) [42][43][44][45][46], image quality studies (n = 9) [47][48][49][50][51][52][53][54]…”

Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care

“…Smartphone-adapted SLs can now capture images that are of similar quality to traditional SL photography. The modality pairs well with both synchronous and asynchronous teleophthalmology [ 62 ]. When combined with robotic controls, a smartphone-adapted SL enables an ophthalmologist to perform a remote examination that is comparable to a traditional examination [ 48 ••].…”