New Age Cost-Effective Teleophthalmology with Innovative Frugal Ophthalmic Imaging - Anterior Segment Photography with Intraocular Lens (ASPI) and Trash to Treasure Retcam (T3R)

Dear Editor,

In recent years, telemedicine has become the need of the hour, especially after the COVID-19 pandemic. A recent survey of ophthalmologists by the All India Ophthalmological Society has depicted a surge in attitude towards incorporating telemedicine in their practice.[¹] A bare minimum teleophthalmology set-up would require an anterior segment and posterior segment imaging system. The major barriers that doctors face in teleophthalmology are the high cost of investment, poor image quality, lack of trained staff and software and hardware related issues.[^2,3] The cost required to start a telemedicine set-up may vary from 10 lakhs to 30 lakhs, depending on the type of equipment involved.

One alternative and effective method of teleophthalmology that we have proposed is the utilisation of frugal imaging techniques, such as anterior segment photography with an intraocular lens (ASPI) [Figure 1] and Trash To Treasure RetCam (T3 RetCam) [Figure 2], which tackles the majority of the barriers involved.[^4,5,6,7,8] This method is highly cost-effective, provides good images as well as video quality and does not require a skilled worker with extra training. The data is collected by a smartphone, which has ease of handling. Via these systems, it is possible to reach even the least accessible areas, with ease of data transfer (smartphone to smartphone), with not having to worry about safe transport of hardware, which would be a major concern for more complex devices. The data can also be integrated with electronic medical record (EMR) systems. The smarter way moving forward would be to adopt newer technologies into teleophthalmology practice and reduce organisational burden.[^7,9] Not just telemedicine, but community outreach programmes can also be made effortless with these innovations. As the burden for skilled workers reduces because of the shallow learning curve, even people other than ophthalmologists and optometrists can handle these devices to retrieve data.[⁶]

Figure 1: Image showing the ASPI images taken for teleconsultation. (a) amniotic membrane graft, (b) eyelid papilloma, (c) pyogenic granuloma, (d) traumatic anterior dislocation of crystalline lens with folds of Descemet's membrane, (e) microspherophakia, (f) iris pearls, (g) limbal dermoid, (h) haptic in anterior chamber, (i) ocular surface squamous neoplasia and (j) tube in the sulcus

Figure 2: (a) Photograph of the telemedicine consultation set.up. Image showing various T3R fundus images captured for teleconsultation: (b) neuroretinitis, (c) choroidal neovascular membrane scar, (d) lens cortical matter in vitreous, (e) superotemporal branch retinal vein occlusion, (f) retinochoroidal coloboma, (g) cherry red spot in central retinal artery occlusion, (h) posterior dislocated lens, (i) peripheral exudative haemorrhagic chorioretinopathy, (j) optic atrophy, (k) dry ARMD, (l) macular hole, (m) macular dystrophy, (n) non.proliferative diabetic retinopathy, (o) macular scar, (p) morning glory syndrome and (q) retinal detachment

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.