Opinion and Special Articles: Amateur fundus photography with various new devices

Abstract

Times are changing in the way we secure and share patient fundus photographs to enhance our diagnostic skills in neurology. At the recent American Academy of Neurology meeting, the use of a fundus camera and smartphones to secure good-quality fundus photographs of patients presenting with headache to the emergency department (ED) was presented. We were enthusiastic to replicate the success of the Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study in our neurology department, but encountered problems in terms of cost, setup, feasibility, and portability of the device. As neurology residents, we came up with 3 easier options. We present these 3 options as our personal experience, and hope to reignite enthusiasm among neurology trainees to find their own means of performing ophthalmoscopy routinely in the hospital, as it appears that the Internet market is now thriving with many other devices to make this examination easier and more rewarding. Of the options explored above, the Handheld Fundus Camera was a clear favorite among the residents, and we have placed one in our call room for routine use. It travels to the clinic, floor, intensive care unit, and ED when needed. It has enhanced the way we approach the fundus examination and been a fun skill to acquire. We look forward to further advances that will make it possible to carry such a device in a physician's pocket.

Optic Disc Classification by Deep Learning versus Expert Neuro‐Ophthalmologists

“…Although access to fundus photographs improved the ED providers' detection rate of relevant funduscopic abnormalities from 0% with direct ophthalmoscopy to 46% on fundus photographs, 6 further image‐interpretation training of the ED providers did not substantially improve their performance 7 . Several additional studies have confirmed that ophthalmoscopy can be replaced by ocular fundus digital cameras that rapidly and easily provide high‐quality fundus photographs of the optic nerve and retina, even without pharmacologic dilation of the pupils 1,8–11 …”

“…Numerous studies based primarily in emergency departments (EDs) and outpatient clinics have shown that most nonophthalmologic health care providers are not able to reliably examine the ocular fundus 3–5 . Recent publications have emphasized that nonmydriatic ocular fundus photography can easily replace ophthalmoscopy in EDs and urgent care centers, as well as in neurologic and other adult and pediatric clinics 6–11 . These ocular fundus photographs can be interpreted on site or remotely by ophthalmologists via telemedicine 1,11 .…”

Utility of Video-Fundoscopy and Prospects of Portable Stereo-Photography of The Ocular Fundus in Neurological Patients

“…Even handheld nonmydriatic cameras are bulky and difficult to carry around at all times and are not widely used outside the ophthalmology clinic settings. [15] The cost of such cameras is another limitation of its universal use, particularly in countries with limited resources. [7] Additionally, direct ophthalmoscopy allows visualization of retinal venous pulsation, while such interpretation is impossible by viewing still photographs.…”

“…[7] Additionally, direct ophthalmoscopy allows visualization of retinal venous pulsation, while such interpretation is impossible by viewing still photographs. [16] Finally, trying to time the good fundoscopic view and capture a photo is a skill, that may take longer to acquire than performing a direct fundoscopy [15].…”

“…In 2001 PanOptic (Welch Allyn Inc., Skaneateles Falls, New York, USA) introduced its new ophthalmoscope and later developed an FDA approved smartphone adapter called iExaminer [4,15,17].…”