Smartphones have become so technologically advanced, addressing needs of the user beyond what most of us ever imagined. There rarely seems to be a need for additional electronics, as almost everything fits in the one small device in the palm of your hand.
How did we live without these? From Internet searches, voice activated texting, and instant messaging for personal use, smartphones now have apps tailored to most professions.
In ophthalmology, one very useful tool is "Smart Phoneography", a clever term previously coined by users. The use of smartphones, in particular iPhones, for ophthalmic photography has become increasingly popular, and recently has been the topic on many podia, such as at the ASCRS 2013 meeting in San Francisco. Here, Christian Hester, Mitch Weikert and Clifford Terry presented their experiences using smart phones to capture images.
Specifically, the ability to perform slit lamp photography by pulling out your phone during clinic, without having to send a patient to another room in order for someone else take the photos, is very useful and efficient, and more convenient for your patient.
High quality pictures can be captured if your smart phone camera has a resolution of at least 5 megapixels. The iPhone 4 and above have cameras of 5 megapixels or more. The Blackberry Curve 9360 has 5 megapixels, but earlier versions have 2 or fewer. All of the Blackberry Torch versions have 5 megapixels. The older Samsung Galaxy has 5 megapixels and the Motorola Droid has 8 megapixels. The LG Optimus G and Samsung Galaxy S4 both have 13 megapixel cameras.
But more megapixels does not necessarily mean better pictures. Other factors weigh in, such as the sensor, which is actually more responsible for quality of the picture than the pixel number. Image processing also determines picture quality. Thinner phones limit the sensor size; so if photographic quality is of great importance to you, check with the manufacturer of your phone about these details.
Below is a discussion about various slit lamp adapters for cellular phones.
This was one of the first iPhone photoadapters that fits the iPhone 4, 4S or 5. This adapter fits most optical instruments, including binoculars, microscopes, telescopes and most instruments with eyepieces. There is no extra lens. The adapter requires that the iPhone be slipped in and the phone’s camera aligned with the optical axis. This adapter only works with eyepieces that are between 1 in and 1 ½ inches in diameter. It also must be able to slide over the eyepiece at least 1 inch without obstruction in order for the camera’s optics to get close enough to the eyepiece for alignment. There is a QR code on the inside of the case that links directly to a How-To video, eliminating the need for an instruction manual.
Orion SteadyPix Telescope Photoadapter - $47.99
www.telescope.com
This adapter, designed for use with telescopes, couples the original iPhone, 3G, 3GS, 4 or 4S and requires a 1.25 to 1.5 inch diameter eyepiece. The company also sells a larger clamp for bigger eyepieces.
EyePhotoDoc - $399 for iPad, $299 for iPhone
EyePhotoDoc.com
These slit lamp adapters fit the iPad 3 and iPhone 5 and can be used with the Haag-Streit BQ, Haag-Streit BM, Topcon SL-3E and Marco-2B slit lamps. The company offers a White/Blue Light Source package for an additional $70. Little information is available online regarding the specifics.
Keeler Portable Slit Lamp iPhone 4 Image Adapter - $203
www.keelerusa.com
The Keeler Portable Slit Lamp iPhone 4 Image Adapter is compatible with the Keeler PSL and Keeler PSL 1 handheld slit lamps, among others. It is designed to fit eyepieces that are 30 mm in diameter +/- 0.2 mm. All sales are final on this product.
This adapter is a universal smartphone-to-microscope device, a nice option for non-iPhones. It works with any smartphone, including iPhones and Droids between 6 ¼ inches x 2 7/8 inches (158 x 73 mm). Each SkyLight comes packaged with 6 inserts to adapt to a variety of eyepiece sizes up to 1.75 inches (4.45 cm) in diameter. All sales are final on this product.
This iPhone adapter was developed by a group of optometrists. It is compatible with the iPhone 4, 4S and 5. The website does not list specifics on allowable eyepiece size or any other details.
This Welch Allyn system is compatible with the iPhone 4 and 4S running iOS version 5.0 and above. It is designed to attach to the PanOptic Ophthalmoscope for capturing fundus photos through undilated pupils. When attached to this ophthalmoscope, you will get a 5x larger view of the fundus than a standard Welch Allyn ophthalmoscope and 25 degree field of view. Welch Allyn also has an iExaminer app that can be downloaded through the Apple app store that allows storage of the pictures.
Zarf Enterprises makes a slit lamp lens adapter for the iPhone 4, 4S, 5 and the iPod Touch 5th generation that fit Haag Streit, Topcon, Marco, Burton, CSO, Woodlyn, and Zeiss slit lamps, as well as others that have a 23.5 mm to 30 mm inside diameter lens tube. Each adapter includes an iPhone attachment and a High Optical Quality Slit Lamp Lens Adapter with their patented Anti-Rotation feature, which keeps the camera in place.
Do It Yourself Slit Lamp Adapters
Instructables - www.instructables.com
This website will instruct you on how to make your own adapter using an iPhone 4 plastic hard case, a wood backer or spacer, a seat post quick release clamp, and glue.
EyeWiki - Eyewiki.aao.org
This website will show you how to make an adapter using a shaving foam cap, the rubber disc from an empty CD stack box, and rubber based adhesive.
There also are several apps available that are designed to allow you to take a picture directly through the eyepiece, without the use of an adapter. An example of this type of app is eyeMicroscope. However, the ratings are not great. Most commenters say it does not help them with obtaining quality microscopic pictures.
Besides just the slit lamp adapter, other accessories may prove beneficial to improve the quality of the picture. Overexposure is a common problem when taking pictures through the slit lamp. This problem can be overcome with the use of diffusers, dim light or by downloading certain camera apps for the iPhone, such as Camera Awesome or ProCamera.
Eyephotodoc.com also has developed accessory flip/clip lights for slit lamp photography. This simply clips to the tower and can be adjusted for light intensity to obtain the optimal image. An updated version is their FluoroBlue and Warm White light version, which also clips to the tower and provides background illumination with the slit light. This light source is adjustable for different iris colors and is available on their website for $199.
They also sell a Barrier filter with a Velcro on/off attachment for an additional $65.
Slit lamp adapters are an upcoming trend that will no doubt become more popular. I highly recommend them as you can read in my short article that discusses my personal experience with the Magnifi.