Smartphone Image Acquisition During Postmortem Monocular Indirect Ophthalmoscopy

Abstract

The medical usefulness of smartphones continues to evolve as third-party applications exploit and expand on the smartphones' interface and capabilities. This technical report describes smartphone still-image capture techniques and video-sequence recording capabilities during postmortem monocular indirect ophthalmoscopy. Using these devices and techniques, practitioners can create photographic documentation of fundal findings, clinically and at autopsy, without the expense of a retinal camera. Smartphone image acquisition of fundal abnormalities can promote ophthalmological telemedicine--especially in regions or countries with limited resources--and facilitate prompt, accurate, and unbiased documentation of retinal hemorrhages in infants and young children.

Assessing retinal hemorrhages with non-invasive post-mortem fundus photographs in sudden unexpected death in infancy

“…And for good reason: this invasive method has been used by few operators and is limited by the need of an endoscope that is barely used in daily practice in forensic pathology and ophthalmology. Indirect ophthalmoscopy associated with smartphone image acquisition has been previously described but the “do it yourself” association of smartphone and lens is not ergonomic and requires training and practice to be performed correctly [ 13 ]. Moreover, no case series has been shown, and data regarding the image quality with indirect ophthalmoscopy is lacking: in our personal experience, post-mortem indirect ophthalmoscopy is difficult, frequently limited by opacification of cornea and lens, whereas visibility is better with a contact camera such as the RetCam.…”

“…The relevance and the protocol of post-mortem eye removal as part of the autopsy have been well described [ 10 ]. Conversely, reports of post-mortem fundus examination are very rare and no protocol has been yet validated between endoscopy [ 11 , 12 ] or indirect ophthalmoscopy [ 13 ]. Wide field fundus camera such as RetCam (Clarity Medical Systems USA) is the gold standard for the acquisition of retinal images in suspected cases of AHT in living children [ 14 ], but this method has never been described in deceased children.…”

Fatal systemic (paradoxical) air embolism diagnosed by postmortem funduscopy

“…We believe this case report contains the first published photographs of distinctive RAE associated with fatal systemic (paradoxical) AE. These compelling retinal findings emphasize the value and importance of consistent, timely, and thorough postmortem ophthalmoscopy [78–81].…”

Hemorrhagic Retinopathy and Optic Nerve Sheath Hemorrhage Associated With Fatal Subarachnoid Hemorrhage from a Ruptured Intracranial Aneurysm Due to Segmental Fibromuscular Dysplasia

“…Postmortem monocular indirect ophthalmoscopy permits detection of RHs in a decedent's posterior fundus and portions of the peripheral retina (56,57). Adherence to valid scientific principles and documentation of the full spectrum of pediatric conditions associated with RHs is essential because comparative studies concluding that RHs are specific to abuse involve combinations of data gatherers not blinded to the participants or the study hypothesis, incorporation bias (circularity), selection bias, information bias, or misrepresentation of data (58)(59)(60)(61)(62)(63)(64)(65).…”