|Year : 2020 | Volume
| Issue : 7 | Page : 1256-1257
Commentary: Bringing frugal Indovation to eyes of babies
John D Akkara1, Anju Kuriakose2
1 Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly; Department of Glaucoma, Westend Eye Hospital, Cochin, Kerala, India
2 Department of Retina, Aravind Eye Hospital, Chennai, Tamil Nadu, India
|Date of Web Publication||25-Jun-2020|
Dr. John D Akkara
Department of Glaucoma, Westend Eye Hospital, Kacheripady, Cochin - 682018, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Akkara JD, Kuriakose A. Commentary: Bringing frugal Indovation to eyes of babies. Indian J Ophthalmol 2020;68:1256-7
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.
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