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From using your smartphone to a traditional stand-alone camera, here’s how you can make digital photography part of your practice.

In today’s world of dynamic technology, if your practice has not incorporated digital equipment into the day-to-day operations, you may find your patients leaving for a more “advanced” experience elsewhere. Updating or upgrading your practice to provide digital photography is simple, and the cost may be accomplished for far less than you’d expect.

The Pictor Plus handheld camera from Volk is an alternative to a smartphone adaptor.

RETINAL CAMERAS
Digital retinal cameras have come a long way from the days of Polaroid or slide pictures. Full-size retinal cameras to smartphone-based adaptors allow you to have a large selection based upon your budget and the size of your practice. Most of these devices are non-mydriatic cameras that can come in handy at times.

The easiest and probably the simplest approach would be to add a handheld adaptor to your smartphone and then transfer the image to your electronic medical records or computer. Several examples of these adaptors are the Volk iNview iPhone Fundus Phone Camera, the D-Eye Portable Ophthalmosocpe from Digital Eye Center and the Welch Allyn iExaminer, which works with the company’s PanOptic Ophthalmoscope. To transfer the images, you would pair WiFi or Bluetooth with an app such as AirMore or Reflector, allowing all your images to be saved to a file on your desktop.

If you aren’t interested in a smartphone adapter, you might consider using a  digital handheld retinal camera. These devices are more expensive than the smartphone adaptor, and the megapixels may not be as large. Examples of these devices are the VISUSCOUT 100 from Carl Zeiss Meditec, Inc., the GENESIS-D and GENESIS-Df from Kowa Company Ltd., the FC-40 from Digital Eye Center and the Pictor Plus from Volk. You transfer the images from these handheld cameras using a WiFi/app or a USB drive.

Moving up the ladder with respect to size and cost are the standalone digital retinal cameras. DRS from CenterVue; TRC-NW8, TRC-NW8F Plus and TRC-NW400 from Topcon; the CR-2 AF and CR-2 PLUS AF digital non-mydriatic retinal cameras from Canon USA, Inc.; and VISUCAM from Carl Zeiss Meditec are just a few examples.

Welch Allyn iExaminer is a retinal camera you attach to your smartphone.

Obviously, the footprint on these devices is larger and you would need to make space for them, but the quality and functionality of these instruments go well beyond what handheld devices can achieve. The quality of the megapixel can exceed 20 megapixels, and the images can get well beyond the 30- to 40-degree limit of handheld cameras. Also, in most instances, the ability to view images is simplified by using the manufacturer’s viewing software.

Several manufacturers have developed retinal cameras that include ocular coherence tomography. These instruments cost anywhere from $45,000 to $85,000, but they offer the ability to bill for both retinal photography and OCT when appropriate (but not on the same day). For this reason, I recommend them if you can afford them. Examples of these are the Topcon 3D OCT-1 Maestro, the Cirrus photo 600 and Cirrus photo 800 from Zeiss, and the iVue and iFusion from Optovue, Inc. In the case of the iVue and iFusion, the instruments can be on the same table sharing the same computer.

VIEWING SOFTWARE
Topcon’s IMAGEnet Connect software, Canon’s imageSPECTRUM and Zeiss’s FORUM allow you to view digital images, not only from your devices but from other devices as well. This allows you to view different images, such as a retinal image, a visual field report and an OCT of the same patient at the same time. Imagine the simplicity of explaining to a glaucoma patient the retinal image of nerve fiber layer (NFL) dropout with the corresponding visual defect and the depressed NFL on the OCT scan.

The CR-2 AF is a digital non-mydriatic retinal camera from Canon U.S.A.

SLIT LAMP CAMERAS
As with digital retinal cameras, the simplest and least expensive option for obtaining digital photographs of the anterior segment is to use a smartphone adaptor. By simply attaching the adaptor/smartphone over the eyepiece, you are ready to take a picture or video.

There are many adaptors available on the market, such as EyePhotoDoc, Tiger Lens and the Canton Optics’ CTA-100 Digital Eyepiece Adapter. The price for these adaptors varies from less than $100 to more than $500. You can transfer the images from your smartphone to your electronic medical records/computer via an app and wireless connection. One highlight of this setup is portability; you can use these devices in any examination room.

If using a smartphone is out of the question, you can mount a digital single-lens reflex, or DSLR, camera to your slit lamp. To achieve this, you would need to purchase a beam-splitter, camera adaptor, camera and preferably a foot-switch, which enables you to take a picture with the press of your foot. It is relatively easy to set up and easy to operate. This is the setup we currently use in our office. We view and store the digital images on the desktop in the exam rooms and show these to the patient as we explain our findings. We then transfer the selected images to the patient’s medical record and complete the interpretation and report. TTI Medical is the company we used to purchase this complete setup for a few thousand dollars.

The EyeRes-IS system from TelScreen is another slit lamp digital imaging system that can provide high resolution digital images and videos. However, instead of a DSLR it uses a Hitachi digital sensor along with a computer and 19-inch flat-screen monitor.

Most manufacturers of slit lamps, including Marco, Topcon, Zeiss, Haag-Streit and Veatch, have their own digital cameras or camera adaptors.

Many slit lamp cameras or adaptors allow you to obtain a retinal image as well. Although the view will not be the same as that of many of the retinal cameras discussed above, you can get good quality digital images for an inexpensive price.

Mark Perry, OD, practices with Vision Health Institute, Orlando, FL.

WHERE TO FIND IT:
Canon U.S.A.
800.970.7227 | USA.Canon.com
Canton Optics
86.21.68555555 | ChinaCanton.com
Carl Zeiss Meditec, Inc.
800.342.9821 | Meditec.Zeiss.com/USA
CenterVue, Inc.
408.988.8404 | CenterVue.com
Digital Eye Center
305.771.4562 | DigitalEyeCenter.com
EyePhotoDoc
714.871.9221 | EyePhotoDoc.com
Kowa American Corp.
800.966.5692 | Kowa-USA.com
Optovue Inc.
866.344.8948 | Optovue.com
TelScreen
800.769.4933 | TelScreen.com
Topcon Medical Systems, Inc.
800.223.1130 | TopconMedical.com
TTI Medical
800.322.7373 | TTIMedical.com
Volk Optical, Inc.
800.345.8655 | Volk.com
Welch Allyn
800.535.6663 | WelchAllyn.com

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