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   Table of Contents      
OPHTHALMOLOGY PRACTICE
Year : 2003  |  Volume : 51  |  Issue : 3  |  Page : 269-272

Ophthalmic photography using a digital camera.


Sankara Nethralaya, Medical and Vision Research Foundation, Chennai, Tamil Nadu, India

Correspondence Address:
R Fogla
Sankara Nethralaya, Medical and Vision Research Foundation, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


PMID: 14601858

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  Abstract 

Purpose: To report the application of a digital camera for ophthalmic photography in routine clinical use.
Methods: A digital camera (Nikon Coolpix 995) was used both for external macrophotography of the eye and ocular adnexa, and slitlamp photography of the anterior segment of the eye. Results: We were able to take external macrophotographs under high magnification of the eye and ocular adnexa. Slitlamp photography could be performed under diffuse, slit beam, and retroillumination. The structures of the angle, the optic disc and surrounding retina could be photographed using appropriate lenses. The attachment to the operating microscope allowed intra-operative photography. It could also be attached to the laboratory microscope to capture images of various histopathology and microbiology slides. Conclusions: A digital camera is a versatile instrument for ophthalmic photography. It is easy to use in routine clinical practice and provides good quality photographs.

Keywords: Ophthalmic photography, digital camera


How to cite this article:
Fogla R, Rao SK. Ophthalmic photography using a digital camera. Indian J Ophthalmol 2003;51:269-72

How to cite this URL:
Fogla R, Rao SK. Ophthalmic photography using a digital camera. Indian J Ophthalmol [serial online] 2003 [cited 2019 Nov 20];51:269-72. Available from: http://www.ijo.in/text.asp?2003/51/3/269/14667

Photography is an important component of ophthalmology. It is useful both for research and teaching.

Most of the imaging equipment in ophthalmic use is for retinal photography and fluorescein angiography. Anterior segment photography is usually performed using the slitlamp biomicroscope as it provides both high magnification and slit beam illumination. Many sophisticated products using computers and imaging technology are currently available commercially for ophthalmic photography.[1],[2] The latest digital cameras offer many advantages over the standard 35 mm equipment, and allow instant availability of results besides adjustment of image parameters.

We describe the use of a digital camera - Nikon Coolpix 995 (Nikon Corporation, Tokyo, Japan), both for external photography and for anterior segment photography using the slitlamp biomicroscope.


  The Camera Top


We used the Nikon Coolpix 995. The camera has a high density 3.34 million pixels CCD chip which gives a maximum image resolution of 2048 x 1536 pixels. This is essential for good quality colour prints. It has 4x zoom facility and allows autofocus control during photography. The object of interest can be seen through the optical viewfinder or on the 1.8 inch LCD screen [Figure - 1]d. The digital image is stored instantly on the removable compact flash card in the camera. These flash cards are available as 16 / 32 / 64 / 128 Mb capacity. A 64 Mb card will allow storage of up to 40 high resolution images before being transferred to the computer.


  Photography Top


The Nikon coolpix 995 with digital zoom and macro facility is extremely useful in external eye photography. Its focal length ranges from 8.0 ~ 32.0mm (35mm format equivalent to 32 - 152mm). The usual settings include camera in auto mode (continuous autofocus), flashlight on the "on" mode and the object of interest viewed on the LCD monitor. When taking extreme close-ups, the macro close-up mode should be switched on and the zoom should not be beyond the middle position. The ambient room illumination should be good enough to allow the subject to be viewed clearly on the LCD monitor. It is also possible to record video for a duration of forty seconds with this camera in the manual mode. This can be used to 1) record conditions like essential blepharospasm, nystagmus, and 2) record small procedures like cover test, and extraocular movements. CT scan or MRI plates placed on the viewbox, visual field reports, ultrasonography printouts, can also be photographed with good results.

For slitlamp photography the camera must be attached to the eyepiece of the slitlamp biomicroscope. By connecting the camera to the eye piece lens, one can capture what is actually visualised. The size (diameter) of the camera lens and the slitlamp eyepiece are identical. We have utilised the plastic container of the Kodak film roll (for regular 35 mm camera) to create an adapter for attachment of the camera to the slitlamp eye- piece. The container is cut at a length of 8mm from its open end [Figure - 1]a. This plastic cylinder now can be fitted onto the eye piece of the slitlamp biomicroscope [Figure - 1]b and the camera lens on the other side [Figure - 1]c. As there is no platform to hold the camera, it needs to be supported with one hand during photography [Figure - 1]d. The illumination of the slitlamp is sufficient for photography, hence a flashlight is not needed. The subject can be viewed on the LCD monitor. Sometimes it is useful to have an assistant hold the eyelids open so that the both hands of the photographer are free to adjust the slitlamp into position. Although photographs can be taken with any slitlamp biomicroscope, the best results have been achieved using the Topcon slitlamp (Topcon Model No SL-3F, Japan). This has a maximum beam height of 14 mm, which covers the entire corneal diameter. The camera settings include camera in auto mode (continuous autofocus), flashlight on the "off" mode and the object of interest viewed on the LCD monitor.

A variety of photographs can be taken using diffuse illumination, direct illumination, and retroillumination [Figure - 2] a-j. We are currently using the camera to record posterior capsule changes following implantation of different types of intraocular lens. With increasing experience one can also image the structures of the angle, using Goldmann three mirror goniolens [Figure - 2] k. The optic disc and the posterior pole can also be imaged in a cooperative subject using the + 78 diopter fundus lens [Figure - 2]l.

The camera can also be attached to the eyepiece of the microscope (main or the side tube i.e. observation eye piece) (Leica M500) after removing the rubber cuff attached to the eyepiece. This would allow the assistant to capture intraoperative images at various stages of the surgery. It can also be attached to the eyepiece of a laboratory microscope to take photographs of histopathology and microbiology slides [Figure - 3][Figure - 4].


  Discussion Top


Clinical ocular photography is essential to document interesting cases, assess treatment outcomes and collect data for teaching and research. The use of Nikon digital camera (Coolpix 950) for ophthalmic photography was first reported in 2000.[3] We used the newer model of the digital camera - Coolpix 995, with greater resolution capacity, for ophthalmic photography. One big advantage of a digital camera is its small size which makes it possible to easily carry it along in the outpatient department, operation room, and the emergency clinics. Although initially it takes a little practice to capture good quality photographs, one can master the technique in a short time. At very high magnification it may be difficult to get a sharp image of the eye due to constant shift of point of focus. It is difficult to get images of the retina mainly due to instability with the handheld lenses. This can be overcome to some extent with the use of a contact lens such as the Goldmann lens. Excessive movement either of the patient or the operator can cause blurring of the images which sometimes may be difficult to detect on the small LCD screen. Hence it is essential to record a series of 4 - 5 images and select the best one when they are viewed on the larger monitor of the computer. Once the data is transferred to the computer the images can be catalogued using commercially available software such as Canto Cumulus (ver 5.0.10, Canto, Germany). These photographs can be printed as 5" x 7" prints without any loss of quality at a reasonable cost.

Currently slitlamp based digital workstations cost approximately US $ 30,000. Compared to this a digital camera like the Nikon Coolpix 995 costs only approximately US $800. At 1/40th the cost of a commercially available digital workstation, this digital camera is definitely a useful companion to the ophthalmologist.

 
  References Top

1.
Hildred RB. Alternative imaging in ophthalmology. The digital darkroom - Part 1. Eye News 1999;6:18-19.  Back to cited text no. 1
    
2.
Hildred RB. Alternative imaging in ophthalmology. Old ideas - new technology - Part 2. Eye News 1999;6:16-24.  Back to cited text no. 2
    
3.
Kwan A. A simple slit lamp digital photographic system. Eye News 2000;6:18-21.  Back to cited text no. 3
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]


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