|INNOVATION IN OPHTHALMOLOGY
|Year : 2020 | Volume
| Issue : 10 | Page : 2213-2215
Smartphone-based intraocular lens microscope
Prithvi Chandrakanth, KS Chandrakanth
General Ophthalmology, Dr. Chandrakanth Malabar Nethralaya, Kozhikode, Kerala, India
|Date of Submission||04-Nov-2019|
|Date of Acceptance||30-Mar-2020|
|Date of Web Publication||23-Sep-2020|
Dr. Prithvi Chandrakanth
Chandradevi, Opp Super Petrol Pump, Behind ‘QRS’, Kannur Road, W. Naddakavu, Kozhikode - 673 011, Kerala
Source of Support: None, Conflict of Interest: None
Microscopes play an important role in the diagnosis of microorganisms and pathological lesions in ophthalmology guiding us to the appropriate management. The current trend of collecting samples and examination is mostly laboratory-based which consume time, labor, and are costly. Smartphones are being used in different fields of ophthalmology with great ubiquity. The good quality photographs obtained by smartphones along with the ease of mobility has made it possible to warrant its use in the microscopic world. This article describes a simple novel technique of preparing an intraocular lens system which can be used in conjunction with a smartphone to detect microorganisms and pathological lesions.
Keywords: Innovation, low-cost device, microscope, point of care diagnosis, smartphone photography
|How to cite this article:|
Chandrakanth P, Chandrakanth K S. Smartphone-based intraocular lens microscope. Indian J Ophthalmol 2020;68:2213-5
The microscope is the visual bridge connecting the colossal macro-universe to the micro-universe of a living organism. The introduction of the microscope in the 16th century has been a boon in the field of science which has made us realize that there is a world that is too small to be seen by the naked eye. It has become a ubiquitous tool for research in ophthalmology and provides a resolution of 250 nm and smaller. The conventional light microscopy has been modified time and again to give finer resolution, some of them being the electron and X-ray microscope, fluorescence confocal microscope, two-photon laser scanning microscope which has allowed us to map the structures of the living cell and also microorganisms.,,, The use of these microscopes in ophthalmology is largely restricted to the laboratory which is costly, time-consuming, and labor-intensive. There is growing interest to develop tools for health monitoring which can be used in a clinical setting and fields/camp setups.,, Point-of-care (POC) diagnostics are being developed by researchers to offer advantages over the conventional laboratory-based evaluation methods, providing portability, automation, faster processing time reduced sample volume and lower cost. The goal of POC is to make diagnostic testing widely accessible such as in clinics, outpatient departments, camps, ICUs, PHC's, etc., and also to make it cost-effective ultimately improving several sectors of healthcare with early detection, health maintenance, and therapeutic monitoring. POC has also been used in other fields such as identification of animal and plant pathogen, biological warfare agent detection, food quality assurance, environmental monitoring, identifying, and analyzing biological targets (nucleic acid, chemical compounds, proteins, metabolites, and biological cells) in environmental and clinical samples.,,,,,,,,
Smartphones are being used in ophthalmology to acquire anterior and posterior segment photographs with impressive details which establish it as a good tool for documentation. Smartphones are now also been used in the detection of cellular microorganisms, parasites, subcellular proteins, and nucleic acids. It is a useful POC diagnostic tool for fungal keratitis.,,,,,,,,,,
We describe in this article a technique to prepare a microscope by attaching the smartphone with an optical system made up of IOL's (expired/those which have broken haptics/unsterile/unfit for intraocular use), hence named the IOLSCOPE (Smartphone-based IOL microscope) and also how to use it as a reliable POC diagnostic tool.
| Method|| |
Preparing the IOLSCOPE [Figure 1]a
|Figure 1: (a) Materials used to prepare IOLSCOPE; i. Black chart paper strip measuring 4 cm × 2 cm, ii. Intraocular Lens - 30D four in number, iii. Micropore, iv. Paper punching machine, v. Liquid adhesive, (b) Circular opening of 5 mm made on one end of the black strip using the punching machine, (c-f) Placing the first IOL on the circular hole and the subsequent IOL's one upon the other by applying liquid adhesive, (g) Placing the optical device on the camera of the smartphone using micropore, (h) Placing the slide on a light source (torch) and taking pictures by approximating the iolscope to it|
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- A single strip of 4 cm × 2 cm black hard chart paper was cut
- A circular opening of 5 mm was made using a paper punching machine at one end. [Figure 1]b
- The intraocular lens taken here was all of power 30D. The intraocular lens was placed in the circular opening by applying liquid adhesive over the haptics of the IOL and is left to dry
- The second IOL was placed carefully above the previous IOL by applying liquid adhesive on the haptics and left to dry. The above steps were repeated to place two more IOL's. [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f
- This optical arrangement was then aligned on the smartphone camera with a micropore/cello tape [Figure 1]g
- Any prepared slide was the placed-on top of a light source (top of torchlight, white screen of a smartphone, etc.)
- The smartphone attached to the optical device was then brought near the slide and focused to get the required microscopic image from the slide [Figure 1]h
- The digital zoom of the smartphone can also be used to get even more enlarged images, although the clarity depends on the smartphone, and the camera used
- The microscopic images obtained were of good quality and can be used to identify fungal hyphae and the fungus, pathology slides, and also larvae of parasites [[Figure 2] and Videos clip 1-6].
|Figure 2: (a) Lactophenol cotton blue (LCB) stained mount of Rhizopus, (b) LCB stained mount of Aspergillus, (c) Fungal hyphae and spores (black arrow) in KOH mount, (d) Histopathology slide of Basal Cell Carcinoma (BCC), (e) Histopathology slide of Squamous Cell Carcinoma (SCC) with keratin pearl, (f) Histopathology slide of Rhinosporidisosis with multiple round sporangia, (g) H and E stained histopathology slide showing inflammatory cells, (h) Caterpillar hair showing spines along the shaft, (i) Anterior end of the first larval stage of Oestrus ovis equipped with cephalopharyngeal skeleton showing two dark sharply curved oral hooks|
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| Discussion|| |
Smartphones have revolutionized the way we see healthcare. It has proven time and again as a reliable technology for POC diagnostics. Smartphone telemedicine is being used in ophthalmology for fundus photography and also anterior segment pathologies in rural centers. Early and accurate detection of microbes helps in the diagnosis of a disease and the appropriate treatment.,,, It is often delayed and with the advent of smartphones, it is possible to have cost-effective and quick POC for diseases which overall helps us in providing a better quality of treatment to the patients. The IOLSCOPE can be used as a powerful tool for POC diagnosis by imaging microscopic organisms. It is useful especially for ophthalmologists in diagnosing fungal keratitis by imaging a KOH mounted slide. An added benefit of digital zoom helps in viewing the structures even better. The ability to take record images and can be relayed through the internet to microbiologists for an expert opinion. This device can be made by anyone with IOL's which are unsterile, expired, or those which are broken but with an intact optic. The scope of IOLSCOPE is such that it can be used not just in ophthalmology but other subspecialties such as pathology, microbiology, dermatology, etc., This is a preliminary step towards screening of disease but not a confirmatory test such as examination with a light microscope and culture-based diagnosis which continue to remain the gold standard confirmatory procedure for diagnosis.
- Dr. Thara Keloth, Department Of Pathology, Sri Manakula Vinayagar Medical College, Pondicherry
- Dr. Avinash Rajan, Department Of Microbiology, Sri Manakula Vinayagar Medical College, Pondicherry
- Dr. Naveen Nischal G, Consultant, Lalitha Eye Hospital, Khammam, Telangana
- Dr. Ramya Ravichandran, Consultant, Sri Ramana Maharishi Eye Hopsital, Tiruvanamalai, Tamil Nadu.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Anselmi F, Grier Z, Soddu M, Kenyatta N, Odame S, Sanders J, et al
. A low-cost do-it-yourself microscope kit for hands-on science education. Optics Education and Outreach V. 2018.
Keller E, Goldman R. Light Microscopy. Woodbury, NY: Cold Spring Harbor Laboratory Press; 2006. p. 8.
Bozzola JJ, Russell LD. [Electron Microscopy: Principles and Techniques for Biologists]. Sudbury MA: Jones and Bartlett Learning; 1999. p. 2-16.
Cheng PC, Jan GJ. [X-ray Microscopy: Instrumentation and Biological Applications]. Berlin Heidelberg: Springer Science and Business Media; 2012. p. 1-12.
Muller M. [Introduction to Confocal Fluorescence Microscopy]. Bellingham WA: SPIE Press; 2006. p. 1-23.
Denk W, Strickler JH, Webb WW. Two-photon laser scanning fluorescence microscopy. Science 1990;248:73-6.
Liu X, Lin T, Lillehoj P. Smartphones for cell and biomolecular detection. Ann Biomed Eng 2014;42:2205-17.
La Gerche A, Burns AT, Mooney DJ, Inder WJ, Taylor AJ, Bogaert J, et al
. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J 2012;33:998-1006.
Gervais L, de Rooij N, Delamarche E. Microfluidic chips for point-of-care immunodiagnostics. Adv Mater 2011;23:H151-76.
Görlinger K, Fries D, Dirkmann D, Weber CF, Hanke AA, Schöchl H. Reduction of fresh frozen plasma requirements by perioperative point-of-care coagulation management with early calculated goal- directed therapy. Transfus Med Hemotherapy 2012;39:104-13.
Niemz A, Ferguson TM, Boyle DS. Point-of-care nucleic acid testing for infectious diseases. Trends Biotechnol 2011;29:240-50.
Miranda BS, Linares EM, Thalhammer S, Kubota LT. Development of a disposable and highly sensitive paper-based immunosensor for early diagnosis of Asian soybean rust. Biosens Bioelectron 2013;45:123-8.
Jamal S, Agrawal YK. Advances in microfluidics: Lab-on-a-chip to point of care diagnostic devices. Adv Sci Eng Med 2013;5:385-94.
Kirsch J, Siltanen C, Zhou Q, Revzin A, Simonian A. Biosensor technology: Recent advances in threat agent detection and medicine. Chem Soc Rev 2013;42:8733-68.
Shah P, Zhu X, Li C. Development of paper-based analytical kit for point-of-care testing. Expert Rev Mol Diagn 2013;13:83-91.
Thornton C, Wills O. Immunodetection of fungal and oomycete pathogens: Established and emerging threats to human health, animal welfare and global food security. Crit Rev Microbiol 2013;41:27-51.
Zhang RQ, Liu SL, Zhao W, Zhang WP, Yu X, Li Y, et al
. A simple point- of-care microfluidic immunomagnetic fluorescence assay for pathogens. Anal Chem 2013;85:2645-51.
Vasudev A, Kaushik A, Jones K, Bhansali S. Prospects of low temperature co-fired ceramic (LTCC) based microfluidic systems for point-of-care biosensing and environmental sensing. Microfluid Nanofluidics 2013;14:683-702.
Shanmugam M, Mishra D, Madhukumar R, Ramanjulu R, Reddy S, Rodrigues G. Fundus imaging with a mobile phone: A review of techniques. Indian J Ophthalmol 2014;62:960-62.
] [Full text]
Haddock L, Kim D, Mukai S. Simple, inexpensive technique for high-quality smartphone fundus photography in human and animal eyes. J Ophthalmol 2013;2013:1-5.
Chandrakanth P, Ravichandran R, Nischal NG, Subhashini M. Trash to treasure retcam. Indian J Ophthalmol 2019;67:541-4.
] [Full text]
Raju B, Raju N, Akkara J, Pathengay A. Do it yourself smartphone fundus camera – DIYretCAM. Indian J Ophthalmol 2016;64:663-7.
] [Full text]
Myung D, Jais A, He L, Chang R. Simple, low-cost smartphone adapter for rapid, high quality ocular anterior segment imaging: A photo diary. J Mob Technol Med 2014;3:2-8.
Pujari A, Mukhija R, Singh A, Chawla R, Sharma N, Kumar A. Smartphone-based high definition anterior segment photography. Indian J Ophthalmol 2018;66:1375-6.
] [Full text]
Ahuja A, Kohli P, Lomte S. Novel technique of smartphone-based high magnification imaging of the eyelid lesions. Indian J Ophthalmol 2017;65:1015-6.
] [Full text]
Chandrakanth P, Nallamuthu P. Anterior segment photography with intraocular lens. Indian J Ophthalmol 2019;67:1690-1.
] [Full text]
Liu X, Lin TY, Lillehoj PB. Smartphones for cell and biomolecular detection. Ann Biomed Eng 2014;42:2205-17.
Zhu H, Sikora U, Ozcan A. Quantum dot enabled detection of Escherichia coli
using a cell-phone. Analyst 2012;137:2541-4.
Frean JA. Reliable enumeration of malaria parasites in thick blood films using digital image analysis. Malar J 2009;8:218.
Agarwal T, Bandivadekar P, Satpathy G, Sharma N, Titiyal JS. Detection of fungal hyphae using smartphone and pocket magnifier: Going cellular. Cornea 2015;34:355-7.
Akkara JD, Kuriakose A. Commentary: The glued intraocular lens smartphone microscope. Indian J Ophthalmol 2019;67:1692.
] [Full text]
Sarwar M, Soomro T. Impact of smartphone's on society. Eur J Sci Res 2013;98:216-26.
Rajchgot J, Coulibaly JT, Keiser J, Utzinger J, Lo NC, Mondry MK, et al
. Mobile- phone and handheld microscopy for neglected tropical diseases. PLoS Negl Trop Dis 2017;11:e0005550.
Bennett J. The social history of the microscope. J Microsc 1989;155:267-80.
Dixit S, Tanveer N, Kumar H, Diwan H. Smartphone-assisted telecytopathology: An intraobserver concordance study. Acta Cytologica 2020:1-7.
[Figure 1], [Figure 2]