Rapid Office-Based Diagnosis of Demodex Using an Innovative Smartphone-Aided Intraocular Lens Tool.

ABSTRACT: Demodex is an important pathogen causing eyelid and eyelash diseases. This article describes a quick, efficient, cost-effective office-based imaging of demodex with the help of an intraocular lens (IOL) and smartphone-aided innovated tool. Eyelid photography of a 56-year-old man with suspected demodex infestation was obtained using a 20-diopter (D) IOL over the smartphone camera called as Anterior Segment Photography using IOL (ASPI). A video or photograph of the epilated eyelash was taken using four 30-D IOLs attached to the smartphone camera to form an optical system called IOLSCOPE, which clearly detected the demodex parasite. The importance of ASPI and IOLSCOPE for the rapid office-based diagnosis of demodex pathogen in peripheral health centers devoid of slitlamp and microscopes has been emphasized here.

Office-Based Rapid Diagnosis and Management of External Ophthalmomyiasis Via Smartphone-Aided Innovative Tools in an Under-Resourced Setting.

PURPOSE: To evaluate the use of smartphone-based innovative tools named Anterior segment photography with intraocular lens (ASPI) and smartphone based intraocular lens microscope (IOLSCOPE) to demonstrate, treat, and diagnose the patients of ophthalmomyiasis caused by Oestrus ovis. METHODS: A retrospective interventional case series of six patients infested with O. ovis presenting in a rural health center with symptoms of burning, itching, watering, and foreign body sensation diagnosed with ophthalmomyiasis. Diagnosis and treatment were performed using an innovative imaging technique that is, an optical system formed by intraocular lens (IOL) and smartphone. RESULTS: The smartphone-based ASPI clearly detected and removed the moving larvae from the ocular surface, followed by microbiological diagnosis of O.ovis larvae with the help of an IOLSCOPE. CONCLUSION: The importance of ASPI and IOLSCOPE for the management of ophthalmomyiasis in peripheral health centers devoid of slitlamp and microscopes has been emphasized here.

The Glowport - Illuminated vitrectomy trocar cannulas.

ABSTRACT: The use of small-gauge trocar cannulas during transconjunctival sutureless pars plana vitrectomy (PPV) facilitates the smooth transition of instruments into the posterior segment and reduces trauma. However, room lighting is routinely dimmed during PPV, thereby making cannula visualization difficult and hence compromising efficient instrument exchange. We report the use of a frugal, fluorescent "glow-in-the-dark" ring placed over vitrectomy cannulas to visualize the cannula entry, thereby providing a smooth and efficient instrument exchange. We 3D-printed phosphorescent rings of optimum inner diameter to comfortably fit around the trocar cannula (The Glowport). Two such rings are fitted into the two trocar cannulas prior to surgery initiation. The cannulas are then passed via sclerostomy as performed in routine PPV. The light from the fiberoptic endo-illuminator is focused over the rings for approximately 5 seconds to activate the photoluminescence. Under mesopic conditions, the fluorescence provides visualization of the cannula entry and helps in the facilitation of smooth entry and exchange of instruments into the globe for performing vitreoretinal surgical procedures, which helps in reducing ocular touch errors as well as surgical time. The Glowport is a frugal device retrofitted onto the trocar cannulas and helps in the smooth entry and exchange of instruments under darkroom conditions, which are required in vitreoretinal surgery.

The Slitscope.

Slit lamp biomicroscope is the right hand of an Ophthalmologist. Even though precise, its bulky design and complex working process are limiting constraints, making it difficult for screening at outreach camps, which are an integral part of this field for the purpose of eliminating needless blindness. The torchlight is the main tool used for screening. Recently, the integration of smartphones with instruments and the digitization of slit lamp has been explored, to provide simple and easy hacks. By bringing the slit of the slit lamp to traditional torchlight, we have created "The Slitscope". It combines the best of both worlds as a simple innovative do-it-yourself novel technique for precise cataract screening. It is especially useful in peripheral centers, vision centers, and outreach camps. We present two prototypes which can also be 3D printed.

Universal slit-lamp-mounted mobile adapter with 20 D lens for fundus photography: "Litter to glitter".

Fundus photography is an arduous task as it involves using 90 D in one hand and a smartphone attached on an eyepiece of a slit-lamp biomicroscope in the other hand. Similarly, with a 20 D lens, the filming distance is adjusted by moving the lens or mobile forward or backward, which makes it difficult to adjust and focus the image in busy ophthalmology outpatient departments (OPDs). Moreover, fundus camera costs thousands of dollars. Authors describe a novel technique of performing fundus photography with a 20 D lens and a universal slit-lamp-mounted mobile adapter made from trash. By the use of this simple, yet frugal innovation, primary care physicians or ophthalmologists without a fundus camera can easily snap a fundus photo and subject it to digital analysis by retina specialists across the world. This will help in simultaneous ocular examination and fundus photos taken via mounted 20 D on a slit lamp itself and also reduce the need for unnecessary retina referrals to tertiary eye care centers.

EYESPIRATOR- A novel do-it-yourself suction device.

Surgery, by nature, involves blood loss. Thus, suction plays an important role in ensuring a clean operating view and ease of access. In ophthalmology, there is a void for an efficient and flexible suction apparatus that is yet to be filled. Our innovation, the Eyespirator, is made using recycled or inexpensive parts, is easy to assemble, and can serve as a cost-effective alternative to the current apparatus under use. It helps to overcome the difficulties caused by large instruments and non-pliable suction tips, unregulated generation of vacuum, and high pressures generated causing trauma to the delicate structures, and can prove to be of immense use in fields such as ophthalmology where the small surgical field is a big challenge. It creates a vacuum by using a simple water pump and is regulated by a foot pedal. This can be deployed even in rural settings, and small modifications can allow its usage in a wide variety of surgical fields.

Smartphone co-aided cobalt blue anterior segment with intraocular lens photography.

In this report, we have utilized a smartphone-based innovative tool named anterior segment photography with an intraocular lens (ASPI) with a cobalt blue filter on the smartphone flash for photographing fluorescein-stained corneas. An intraocular lens along with a cobalt blue filter was attached to the smartphone camera to achieve this purpose. The filter could block out all wavelengths of light except the blue wavelength (450-490 nm) emerging from the smartphone camera. A pilot study was conducted on 27 eyes of 25 patients where images of various corneal pathologies were obtained using ASPI blue light imaging. The images were clear and highly magnified and could be used for documentation, teleconsultation for expert opinion, education, and monitoring of disease progression. ASPI-aided blue light imaging could be easily fabricated and is a frugal inexpensive device, which is used by different ophthalmic personnel to obtain fluorescein-stained corneal images.

PHACOSIT: A sitting phacoemulsification technique for patients unable to lie down flat during cataract surgery.

Phacoemulsification is routinely performed with the patient lying supine on the surgical table with his or her head flat and facing the overhead microscope. This routine technique can be a challenge in medical conditions such as kyphosis, scoliosis, orthopnea, Meniere's disease, and CNS abnormality. Some cardiovascular and respiratory conditions make the patients breathless when they lie down, whereas other neurological and spinal problem patients are also equally uncomfortable. The only reasonable solution to conduct surgery on a patient who cannot lie down flat on the operating table is to position them face to face in a sitting position. We describe an innovative phacoemulsification technique in a sitting position called "phacosit" in an 80-year-old wheelchair-bound female patient who was denied cataract surgery by other eye surgeons owing to her medical condition.

The Gimbalscope - A novel smartphone-assisted retinoscopy technique.

The authors describe a novel technique of performing retinoscopy assisted with a smartphone (gimbalscope). We found this technique of digital retinoscopy to be useful for demonstrating and documenting retinoscopic reflexes and in addition as an easy teaching tool. This technical report explains the assembly of our smartphone-assisted retinoscope and provides examples of the range of normal and abnormal reflexes that can be captured.

Slit-lamp based intraocular lens microscope - A novel technique of rapid office-based microscopy.

The emergence of smartphone-based imaging devices has been a boon in the field of ophthalmology, especially in obtaining high-quality ocular images. They can be specialized and utilized for imaging-specific regions of the eye. Among the multitude of applications of smartphone-based imaging, one of the upcoming major use is to image the microbiological world. Previous few reports have described attaching magnifying lenses of various types to the smartphone camera and transforming it into a microscope for imaging fungal hyphae and ocular surface parasites. We describe a novel technique of attaching the smartphone-based intraocular lens microscope (IOLSCOPE) to the slit lamp, thereby utilizing the slit lamp joystick for moving the smartphone over the concerned slide specimen to make it steady and obtain images of high resolution. This innovative do-it-yourself novel modification is especially useful in peripheral centers, vision centers, and local clinics for immediate screening and identification of microbial pathogens such as fungi and ocular surface parasites.

Smartphone Gonioscopy With a Magnifying Intraocular Lens: A Cost-effective Angle Imaging Device.

Gonioscopy is an important part of glaucoma diagnosis and management. Imaging and documentation of the anterior chamber angle has been previously performed using slit-lamp-assisted photography or using smartphones with or without an attached macro lens. Smartphones have transformed ophthalmic imaging by virtue of their availability, easy use, and portability. In this report, the authors aim to demonstrate gonio-imaging using a smartphone attached with an intraocular lens which behaves like a macro lens. With the patient in a sitting position or in the supine position, a goniolens is placed on the patient's cornea. A smartphone with a 10 D intraocular lens attachment over its camera is used to take images or videos of the anterior chamber angle with high magnification. This imaging modality is cost-effective and can be used for screening and photographic documentation of the angle, and can be of immense benefit, especially in primary health care centers.

Potpourri of retinopathies in rare eye disease - A case series.

This case series describes the ocular and retinal manifestations of rare eye diseases in systemic syndromes. This observational case series consists of five patients with varied ophthalmic manifestations and documentation of imaging in rare pediatric and adult retinopathies. Two patients had Kearns Sayre syndrome (KSS) based on the classical triad of external ophthalmoplegia, pigmentary retinopathy, and onset before 20 years of age. In one patient of KSS, the mitochondrial retinopathy was seen in an asymmetric pattern, and the second patient presented with KSS after being mis-diagnosed as myasthenia gravis elsewhere. A case of Senior Loken syndrome in pediatric age is described in this series with varied ophthalmic manifestations ranging from retinitis pigmentosa to orbital abscess. This series also enlightens features of Hallervorden Spatz syndrome presenting with bull's eye maculopathy and a case of spino-cerebellar ataxia type 7 presenting with pigmentary retinopathy.

Innovative intra-operative rapid detection test for visualisation of mucor.

In this manuscript, we report a rapid intra-operative detection test for visualisation of mucor, with the use of the Smartphone-based intraocular lens microscope (IOLSCOPE). IOLSCOPE helps not only in detecting tissue affected by mucor, but also makes sure that the surgeon does not leave any fungus behind; similar to the principles employed by a 'Frozen section' in conventional general surgery. In the technique proposed by us, we have used an undigested tissue sample, to quickly diagnose mucor, intra-operatively. Thus, in view of tackling the COVID-19 and mucor duplet, IOLSCOPE can be considered by ophthalmologists and otorhinolaryngologists for its rapid screening property, convenience of ease, good quality images and cost effectiveness.

Smartphone-based intraocular lens microscope.

Microscopes play an important role in the diagnosis of microorganisms and pathological lesions in ophthalmology guiding us to the appropriate management. The current trend of collecting samples and examination is mostly laboratory-based which consume time, labor, and are costly. Smartphones are being used in different fields of ophthalmology with great ubiquity. The good quality photographs obtained by smartphones along with the ease of mobility has made it possible to warrant its use in the microscopic world. This article describes a simple novel technique of preparing an intraocular lens system which can be used in conjunction with a smartphone to detect microorganisms and pathological lesions.

Trash to treasure Retcam.

Digital fundus imaging is being used in diagnosis, documentation, and sharing of many retinal diseases and hence forms an essential part of ophthalmology. The use of smartphones for the same has been ever increasing. There is a need for simpler devices to couple the 20D lens and smartphone so as to take fundus photographs which can help in fundus documentation. This article describes a simple inexpensive technique of preparing a smartphone fundus photography device (Trash To Treasure (T3) Retcam) from the used materials in the clinics within minutes. This article will also review the optical principles of the T3 Retcam and describe the step-by-step method to record good-quality retinal image/videos. This inexpensive device is made by recycling and modifying the plastic hand sanitizer bottle in the clinics/hospitals which can be used for documenting, diagnosing, screening, and academic purposes.