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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 35

Smartphone stereoscopic imaging: Inexpensive 3d telemedicine


Oculab Aguascalientes Ophthalmic Ancillary Center, Aguascalientes, Mexico

Date of Submission14-Aug-2020
Date of Acceptance09-Sep-2020
Date of Web Publication10-Dec-2020

Correspondence Address:
Jorge-Emmanuel Morales-Leon
Torre Médica Quality, Ecuador St 103, CP 20230 Aguascalientes
Mexico
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/pajo.pajo_39_20

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  Abstract 


Purpose: The purpose of this study is to present a novel method of capturing and viewing stereoscopic ophthalmological pictures using the inexpensive smartphone technology applied to a common slit lamp. To assess the best perceived method for viewing this images when reconstructed.
Methods: We adapted two smartphones using a fixation device for each slit-lamp ocular. By obtaining simultaneous images of each ocular, we reconstructed them in different formats. Images from a trabeculectomy bullae, corneal transplant, and glaucomatous optic nerve (GON) were rated by five independent ophthalmologists in terms of perceived image quality from 1 to 5.
Results: All of the images obtained were three dimensional and of very good quality (grading 4.04 ± 0.84) in a scale from 1 to 5. Parallel-eyed images were graded with a mean of 4.5 ± 0.5, and anaglyph images were graded 3.58 ± 0.86, which was statistically lower than for parallel-eyed format (P = 0.002).
Mean image quality was lower for the optic nerve and higher for the penetrating keratoplasty (PK) image, but grades did not differ significantly for the three different pictures (bullae vs. PK P = 0.18; PK vs. GON P = 0.07; bullae vs. GON P = 0.59).
Conclusions: It is possible to obtain the quality stereoscopic images by combining the smartphone technology and fixation devices.

Keywords: Anaglyph, ophthalmic photography, optic nerve, smartphones, stereoscopy


How to cite this article:
Morales-Leon JE, Díaz-De-León LR. Smartphone stereoscopic imaging: Inexpensive 3d telemedicine. Pan Am J Ophthalmol 2020;2:35

How to cite this URL:
Morales-Leon JE, Díaz-De-León LR. Smartphone stereoscopic imaging: Inexpensive 3d telemedicine. Pan Am J Ophthalmol [serial online] 2020 [cited 2021 Apr 21];2:35. Available from: https://www.thepajo.org/text.asp?2020/2/1/35/303001




  Introduction Top


Three-dimensional images allow viewers to appreciate depth and form by reproducing stereopsis through different methods of reconstruction. In ophthalmology, stereoscopic images let observers watch pictures with an image that is as close to reality as the original examination.

Purpose

To present a novel method of capturing and viewing stereoscopic ophthalmological pictures of ocular surface and fundoscopy using the smartphone technology applied to a common slit lamp.

To assess image quality perception for two methods of reconstruction: stereoscopic and anaglyph.


  Methods Top


Two smartphones were adapted into a slit lamp [Figure 1] using a fixation device (Eyecapp.www.eyecapp.com, Mexico City, Mexico), one for each ocular.
Figure 1: Smartphone assembly

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A smartphone was mounted in an upright traditional way, and the second smartphone was mounted upside down in order to fit into the second ocular. Using a smartphone application called i3DSteroid (Creator: Spmaker, Apple App Store), both devices were connected through Bluetooth, in order to obtain simultaneous images of the ophthalmological exploration. The application software reconstructs the image pair in different formats (parallel-eyed, cross-eyed, anaglyph, lenticular, and wiggling format). Images from sequential patients were taken. Pictures from a trabeculectomy bullae [Figure 2], a penetrating keratoplasty (PK) [Figure 3], and a glaucomatous optic nerve (GON) of a dilated-pupil eye [Figure 4] were obtained.
Figure 2: Stereoscopic trabeculectomy bullae

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Figure 3: Stereoscopic penetrating keratoplasty

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Figure 4: Stereoscopic glaucomatous optic neuropathy

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Image quality was rated by five ophthalmologists, ranging from 1 to 5 (bad, regular, good, very good, or excellent) in terms of quality perception, using two methods of three-dimensional (3D) image reconstruction from all of the available methods in the i3d steroid application: parallel-eyed and color anaglyph. Parallel-eyed format images were viewed through a stereoscope tabletop prism viewer (AMERICAN EDUCATIONAL, AMAZON US) [Figure 5] in a smartphone landscape format, and color anaglyph images [Figure 6] were viewed using a red/blue cardboard lens and viewed in a portable tablet monitor.
Figure 5: American educational stereoglasses and cardboard blue/red

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Figure 6: Anaglyph trabeculectomy bullae

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Examiners evaluated images on three different days grading all of the images everyday. Means and standard deviations were obtained using Microsoft Excel. Mean differences were calculated using the paired t-test.


  Results Top


All of the images obtained were 3D and of very good quality (grading 4.04 ± 0.84). [Table 1] shows mean grades and standard deviations for each image. Parallel eyed images were colorful but could only be viewed in a single size smartphone landscape format and using the tabletop viewer. Image quality was graded with a mean of 4.5 ± 0.5 for this format. Anaglyph images were more difficult to evaluate in terms of color but could be viewed in a much bigger format and with a mean grade of 3.58 ± 0.86 which was statistically lower than for parallel-eyed format (P = 0.002) according to [Table 2].
Table 1: 1–5 quality grading

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Table 2: 1–5 quality grading

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Mean image quality was lower for the optic nerve and higher for the PK image, but grades did not differ significantly for the three different pictures (bullae vs. PK P = 0.18; PK vs. GON P = 0.07; bullae vs. GON P = 0.59).

We were able to adapt this system to almost every kind of slit lamp available in our hospital (slit lamps and surgical microscope) and to send and receive the images through Internet taken with that method and viewing them in 3D.


  Discussion Top


3D images allow viewers to appreciate depth and form by reproducing stereopsis through different methods of reconstruction. In ophthalmology, stereoscopic images let observers watch pictures with an image that is as close to reality as the original examination.

In the case of glaucoma, stereoscopic photographs are still the gold standard for evaluating the optic nerve.[1] Simultaneous stereophotographs have afforded the best stereoscopic effect (depth resolution) and the best reproducibility, but they have been sometimes replaced for optical coherence tomography, scanning laser polarimetry, and retinal tomography. This may be due to the technical difficulty of obtaining simultaneous imaging bringing low reproducibility to the sequential imaging that can be obtained through the technician or other changing fixation techniques.[2] Despite that difficulty, stereoscopic evaluation has still been used for many of the trials and multicentric studies in glaucoma that require expert evaluation.[3],[4],[5]

Smartphones have been widely used in ophthalmology,[6],[7] but this novel method allows for simultaneous stereoscopic ocular imaging and its simple adaptation to many conditions may be a solution for telemedicine scenarios.


  Conclusions Top


It is possible to obtain very good quality stereoscopic imaging of the anterior and posterior segment by combining the smartphone technology.

By using two simple smartphone adapters attached to slit-lamp oculars, we can obtain reality-simile images of ophthalmic examination for different clinical applications.

Acknowledgments

To Cruise Ophthalmic for fabricating the fixation device later known as Eyecapp. To my colleagues who evaluated images, Karla Dueñas Angeles, Curt Hartleben Matkin, Celia Elizondo Olascoaga and Eduardo Cornu Melgoza. This idea was presented as a poster at the ARVO ISIE conference in Orlando, Fl May 2014 by the same author.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mackenzie PJ, Cioffi GA. Is There Still a Role for Stereo Disc Photography in the Diagnosis and Management of Glaucoma? Available from: http://www.healio.com/ophthalmology/curbside-consultation/%7B37950f62-6d9e-4e2b-8a78-a4ec4436f0f5%7D/is-there-still-a-role-fo. [Last accessed on 2014 Jul 6]  Back to cited text no. 1
    
2.
Rosenthal AR, Kottler MS, Donaldson DD, Falconer DG. Comparative reproducibility of the digital photogrammetric procedure utilizing three methods of stereophotography. Invest Ophthalmol Vis Sci 1977;16:54-60.  Back to cited text no. 2
    
3.
Budenz DL, Anderson DR, Feuer WJ, Beiser JA, Schiffman J, Parrish RK 2nd, et al. Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study. Ophthalmology 2006;113:2137-43.  Back to cited text no. 3
    
4.
Varma R, Steinmann WC, Scott IU. Expert agreement in evaluating the optic disc for glaucoma. Ophthalmology 1992;99:215-21.  Back to cited text no. 4
    
5.
Deleón-Ortega JE, Arthur SN, McGwin G Jr, Xie A, Monheit BE, Girkin CA. Discrimination between glaucomatous and nonglaucomatous eyes using quantitative imaging devices and subjective optic nerve head assessment. Invest Ophthalmol Vis Sci 2006;47:3374-80.  Back to cited text no. 5
    
6.
Lord RK, Shah VA, San Filippo AN, Krishna R. Novel uses of smartphones in ophthalmology. Ophthalmology 2010;117:1274-000.  Back to cited text no. 6
    
7.
Low DK, Pittaway AP. The “iPhone” induction-A novel use for the Apple iPhone. Paediatr Anaesth. 2008;18:573-4.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2]



 

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