Gadgets in ophthalmology
Ophthalmology uses a lot of gadgets, perhaps more than any other medical speciality. Much of the ophthalmic examination requires complex instruments like slitlamp biomicroscope, ophthalmoscope, retinoscope, tonometer, autorefractor, keratometer, and so on. When they work well, these gadgets are extremely useful for the information they provide and the ease of use. The slitlamp microscope is one of the most useful multipurpose ophthalmic gadgets.
Throwing light on the slitlamp
Being the multipurpose, useful gadget that it is, the illumination of the slitlamp is what often fails. This may be due to power outage, bulb fusing, fuse blowing, loose contact, short circuit in wire or other reasons. The bulb can fuse due to the illumination being turned all the way up and forgetting to turn it off before overheating. All these can be diagnosed and solved provided that time and money is available. The rest of the slitlamp optics is quite robust and will work well. The replacement of halogen and xenon bulbs with light emitting diode (LED) lights in newer slitlamps have reduced the failure rate of the illumination system to an extent.
When things go wrong
Machines can fail any time, and this can interrupt the clinical workflow unless there is an emergency alternative. Especially in a low-resource setting, sudden power outages without backup power in common place. Or worse, the slitlamp bulb may fuse often due to a power fluctuation. Replacement bulbs are often unavailable at short notice and the busy clinician is interrupted in their workflow.
Dr MacGyver and the concept of Jugaad
Indians are very familiar with the concept of Jugaad, which is a flexible approach to problem solving that uses limited available resources in an innovative way. This is exemplified in Western pop culture by MacGyver, a fictional secret agent who uses jugaad to solve problems while thinking on his feet. Doctors in low-resource countries have learnt to MacGyver their way out of impossible situations. With smartphone slitlamp imaging, smartphone fundus photography, smartphone gonioscopy, smartphone apps for blind, and smartphone ophthalmic apps; Indian ophthalmologists have shown that smartphone jugaad and indovation run in their blood.
Dr MacGyver brings the light
In the accompanying article, the authors describe an innovative jugaad to use the smartphone LED as an illumination source for the slitlamp biomicroscope. By placing it in the position of the actual bulb, it can use all the filters and slit adjustments as the original illumination system. I suspect that this may be used for extended periods of time in low resource settings. The same concept can potentially be used for surgical microscopes in case of emergency. This reminds one of a scene in an Indian movie where a sudden power outage in an operation theatre leads to the surgery being continued under the illumination of phone flashlights. From personal experience, it is not an uncommon scenario in rural health centres in India to use smartphone illumination for suturing of skin lacerations. This may be due to lack of operating lights, available ones not working or the illumination being so poor that the smartphone LED is the brighter alternative. The role of smartphones in powering frugal innovations like this is eye opening. Being affordable, available, portable, and adaptable, smartphones are the ideal multipurpose gadget of the current times, and one will definitely see more such uses for it in the times to come.
1. Mann IC. Notes on the anatomy of the living eye, as revealed by the Gullstrand Slitlamp J Anat. 1925;59(Pt 2):155
2. Akkara J, Kuriakose A. How-to guide for smartphone slit-lamp imaging Kerala J Ophthalmol. 2019;31:64–71
3. Raju B, Raju NSD, Akkara JD, Pathengay A. Do it yourself smartphone fundus camera - DIYretCAM Indian J Ophthalmol. 2016;64:663–7
4. Kumar N, Francesco B, Sharma A. Smartphone-based Gonio-Imaging: A Novel Addition to Glaucoma Screening Tools J Glaucoma. 2019;28:e149–50
5. Akkara J, Kuriakose A. Smartphone apps for visually impaired persons Kerala J Ophthalmol. 2019;31:242–8
6. Akkara J, Kuriakose A. Innovative smartphone apps for ophthalmologists Kerala J Ophthalmol. 2018;30:138–44
7. Honavar SG. “Indovation” in ophthalmology - The potential power of frugal innovations Indian J Ophthalmol. 2019;67:447–8
8. Chang TC, Ziff M. Using smartphone flashlight as slit lamp light source Indian J Ophthalmol. 2020;68:1658–9
9. Akkara JD. Commentary: Dawn of smartphones in frugal ophthalmic innovation Indian J Ophthalmol. 2018;66:1619