The cost factor
High cost is one of the major problems limiting access to health care. A lot of the expense associated with health care is due to expensive equipment and patented medications. Medical personnel can do little to address the high cost of newer gadgets necessary in this age of hi-tech medicine.
The gold standard
Documentation of the retinal fundus in a poorly cooperative infant is much more difficult than in a cooperative adult. Documentation of infant fundus is important for screening, follow-up, and teleophthalmology. Indirect ophthalmoscopy is considered the gold standard for screening infant fundus and RetCam (Natus USA, formerly Clarity, MSI, USA) is considered the gold standard for documentation.
Ease of use
Whether to document retinopathy of prematurity (ROP) or retinoblastoma or retinal hemorrhages, a contact fundus camera, such as the RetCam, RetCam Shuttle (Natus USA, formerly Clarity, MSI, USA), or 3nethra Neo, (Forus Health, Bengaluru, India) makes it easier to get a clearly focused retinal photograph. It reduces movement of the eyeball and the camera as compared to a non-contact method.
It is, however, possible to take infant fundus photos of sufficient quality for ROP screening using a portable noncontact fundus camera as shown by Prakalapakorn et al. Even a desktop model fundus camera can be used by holding the infant in a “flying baby” position on the examiner's forearm. Patel et al. and Yusuf et al. from the Oxford Eye Hospital showed that ultra-widefield retinal imaging of infants can be carried out by this method with a scanning LASER ophthalmoscope.
However, all these methods are expensive, so smartphone-based frugal innovations such as smartphone-based fundus imaging (SBFI) came to the rescue. DIYretcam (Biju Raju, Cochin, India), MIIretcam (Ashish Sharma, Coimbatore, India), T3retcam(Prithvi Chandrakanth, Calicut, India), Jaiz Retcam (Jaitra Gowder, Bengaluru, India), Paxos Scope(Digisight technologies, San Francisco, CA, USA), MIYretcam (Anubhav Goyal, Cochin, India), HopeScope (Biju Raju, Cochin, India) are some of the smartphone-based frugal fundus cameras, which can take infant fundus photos. Wintergerst et al. showed the potential of low-cost noncontact SBFI for infant fundus screening. Most of these are Indian “jugaad” Innovations, thus termed Indovations.
The authors of the accompanying innovative article show a method to bring some of the advantages of SBFI and contact fundus camera together by using a nasal endoscope. Although more work is needed to make this easy to use, it is indeed a good proof of concept in the field of contact SBFI. This frugal Indovation is definitely the beginning of a new branch in the evolution of fundus imaging.
1. Vinekar A, Rao SV, Murthy S, Jayadev C, Dogra MR, Verma A, et al A novel, low-cost, wide-field, infant retinal camera, “Neo”: Technical and safety report for the use on premature infants Trans Vis Sci Tech. 2019;8:2
2. Prakalapakorn SG, Freedman SF, Hutchinson AK, Wallace DK, Stinnett SS, Riggins JW, et al Evaluating a portable, noncontact fundus camera for retinopathy of prematurity screening by nonophthalmologist health care workers Oph Retina. 2018;2:864–71
3. Patel CK, Fung THM, Muqit MMK, Mordant DJ, Brett J, Smith L, et al Non-contact ultra-widefield imaging of retinopathy of prematurity using the Optos dual wavelength scanning laser ophthalmoscope Eye. 2013;27:589–96
4. Yusuf IH, Barnes JK, Fung THM, Elston JS, Patel CK. Non-contact ultra-widefield retinal imaging of infants with suspected abusive head trauma Eye (Lond). 2017;31:353–63
5. Akkara JD. Commentary: Dawn of smartphones in frugal ophthalmic innovation Indian J Ophthalmol. 2018;66:1619
6. Raju B, Raju NSD, Akkara JD, Pathengay A. Do it yourself smartphone fundus camera––DIYretCAM Indian J Ophthalmol. 2016;64:663–7
7. Sharma A, Subramaniam SD, Ramachandran K, Lakshmikanthan C, Krishna S, Sundaramoorthy SK. Smartphone-based fundus camera device (MII Ret Cam) and technique with ability to image peripheral retina Eur J Ophthalmol. 2016;26:142–4
8. Chandrakanth P, Ravichandran R, Nischal N, Subhashini M. Trash to treasure Retcam Indian J Ophthalmol. 2019;67:541–4
9. Raju B, Raju NSD, Akkara JD, Pathengay A. Smartphone-based fundus documentation in retinopathy of prematurity Indian J Ophthalmol. 2019;67:1909
10. Wintergerst MWM, Petrak M, Li JQ, Larsen PP, Berger M, Holz FG, et al Non-contact smartphone-based fundus imaging compared to conventional fundus imaging: A low-cost alternative for retinopathy of prematurity screening and documentation Sci Rep. 2019;9:1–8
11. Bhaduri A, Das S, Bansal S, Shree N. Smartphone wide field fundus photography in retinoblastoma with a nasal endoscope Indian J Ophthalmol. 2020;68:1255–6
12. Akkara JD, Kuriakose A. Commentary: Seeing the big picture: Panoramic smartphone fundus imaging sans accessories Indian J Ophthalmol. 2019;67:949–50