Smart-Device Ophthalmic Photography

Transcription

1 Smart-Device Ophthalmic Photography Austin Holmes, M.P.H. Clifford M. Terry, M.D. Financial Interest Disclosure: Unrestricted Grant From Terry Eye Institute Overview Creation of Smart-Device Photography Why Take Photos Photography Fundamentals Clinical Photography Adnexa and Conjunctiva Tear Disorders Cornea Anterior Chamber Fundus Archiving Billing Advanced Communication The Evolution of an Idea Separate room...special training Been there Done that Not Very Portable Not so quick...not so nimble The best camera is the one that s with you

2 Modern Ophthalmic Photography System Commonly Used Mobile Devices EyePhotoDoc Zarf Enterprises Tiger Lens Magnifi

3 Smart Phoneography EyeWiki Article Dr. Christian Hester, M.D. Why Photograph? Why Take Photos: Who s Who of Eyes Why Take Photos: Patient Communication Photographs help simplify the information we need to convey The Lens? Oh the white part? After all a picture is worth a thousand words

4 Several Quotes From a Journal Article Fundamental Photography Techniques Device to Use The physician's relationship with [their] patient is built on effective communication The manner in which a physician communicates information to a patient is as important as the information being communicated. Patients who understand their doctors are more likely to acknowledge health problems understand their treatment options and follow their medication schedules But the FIRST STEP is taking quality photographs! and for that we need to review some photography fundamentals Apps Photography vs. Videography Magnification Exposure Lighting Travaline JM, Ruchinskas R, D Alonzo GE. Patient-physician communication: why and how. JAOA.2005;105(1):13-18 Type of Camera What fits best for your needs! Native Camera App for Basic Photography iphone 4/5 Compact, portable Highest megapixel camera ipad 2/3 Largest screen Good for patient education Which App Should I Use??? Focus and Exposure ipad Mini Larger screen that iphone More portable than ipad

5 ProCamera for More Advanced Photography Photograph or Video? Magnification Photograph Video Focus Exposure Optical Flip to Zoom Electronic Stretch to Zoom If a picture is worth a thousand words a video is worth a thousand more but may be too expensive Magnification Magnification Exposure Depth of Field Ability to simultaneously focus on objects at different focal planes. Optical Decreased depth of field Maintains resolution Need more illumination Electronic Maintains depth of field Decreased resolution Maintains Illumination Blurry Clear 16X 10X stretched to Approximate 16X

6 Tap to set auto-exposure Auto-Exposure/ Auto-Focus Lock Lighting Lighting Fundamentals Slit-Beam Only Slit-Beam Only Main Categories 1. Slit-Beam only 2. Slit and Diffuse 3. Diffuse only Pathology Tower Position Slit-Lamp Position Diagram adapted from

7 Slit + Diffuse Slit + Diffuse Diffuse Only Single Diffuse Dual Diffuse Light/Dark Even illumination Diagram adapted from Diffuse Only The Photographers Toolbox Direct Illumination Lighting Techniques Single Diffuse Dual Diffuse 1. Coaxial vs Tangential Co-Axial Tangential 2. Corneal Cross-Section 3. Retroillumination from Fundus: Highlight Lens 4. Retroillumination from Fundus: Highlight Iris 5. Retroillumination from Iris 6. Specular Reflection 7. Sclerotic Scatter 8. Proximal Illumination Diagrams adapted from Diagrams adapted from

8 Corneal Cross-Section Retro-Illumination from Fundus Retro-Illumination from Fundus Highlight Lens Iris Transillumination Dilated Pupil Constricted Pupil Diagram adapted from Diagram adapted from Diagram adapted from Retro-Illumination from Iris Specular Reflection Sclerotic Scatter Diagram adapted from Diagram adapted from Diagram adapted from

9 Proximal Illumination Clinical Photography Adnexa and Conjunctiva 1. Adnexa and Conjunctiva 2. Tear Disorders 3. Cornea 4. Anterior Chamber 5. Posterior Chamber Lids and Lashes Palpebral Conjunctiva Bulbar Conjunctiva Diagrams adapted from Lids and Lashes Lids and Lashes MGD Saponification Dual Diffuse Light Tangential Horizontal Slit-Beam Tangential Full Open Slit-Beam

10 Image Meibomian Glands Blepharitis with Cylindrical Dandruff Demodex 50% to 100% Tea Trea Oil Treatment Palpebral Conjunctiva Bulbar Conjunctiva Bulbar Conjunctiva Co-Axial Dual Diffuse Light Diffuse + Slit Tangential Illumination

11 Tear Film Disorders / Dry Eye Evaluation AKA: How to distinguish between aqueous, oil, mucus issues Fluorescein Examination: Full Field Fluorescein Examination: Yellow Barrier Filter Videography Protocol 1. Fluorescein 2. Microsphericals 3. Tear Meniscus 4. Lid Closure Fluorescein Examination: Yellow Barrier Filter Tear Film Disorders / Dry Eye Evaluation Subjectively Measure Tear Meniscus 8.3 units Slit Beam Only 45 degree angle

12 Tear Film Disorders / Dry Eye Evaluation Microsphericals: Indication of Meibomian Gland Function Spot-test Lid Closure Evaluation SloPro App for slow motion videography Corneal Photography Ocular Surface Disorder 20% Autologous Serum Drops Peripheral Thinning Endothelial Corneal Scar Pre-Serum tx 2 Month s/p tx Proximal Illumination Tangential Retroillumination from Iris

13 Endothelial Corneal Scar RK Cuts Granular Dystrophy Corneal Cross-Section RetroIllumination from Fundus Best with Dilated Pupil Sclerotic Scatter Benefit of Performing Sclerotic Scatter EBMD Endothelial Folds Retroillumination from Iris Specular Reflection

14 Endothelial Cell Counter Cells/Flare Anterior Chamber Tangentially Applied High Intensity Pencil of Light General Iris Photography Traumatic Injury to Iris Pseudoexfoliation Coaxial Diffuse + Slit Tangential Diffuse + Slit Single Diffuse Coaxial Slit-Beam Only Tangential

15 Cortical Spoking Lens Opacity Toric Lens Slit-Beam Only Retroillumination Proximal Illumination Vitreous: Asteroid Hyalosis Retina Posterior Chamber Coloboma with 78D lens

16 External Photos Using a 20 Diopter Lens with the Duette Adapter Other Applications of Smart Device Photography Using a Fundus Camera Carl-Zeiss Surgical Scope Permanent Storage and Retrieval

17 HIPPA Compliance Protected Health Information- individually identifiable health information that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual HIPPA Compliance Do Use MRN or other non-identifying number Password protection on devices storing photographs Evernote Password Protected Store notes using patient number Easy to use Can create multiple notebooks Tag notes with keywords Information Regarding Business Associates - However, persons or organizations are not considered business associates if their functions or services do not involve the use or disclosure of protected health information Don t Use identifiable photographs. i.e Faces Use Patient Name s, Social Security Number s, DOB, or Phone Number s It is possible with some EHR s EHR Some known methods used to link photographs Direct Drop Box Billing CPT Points to Consider: Bilateral Code Photos must aid in diagnosis, treatment, and assessing disease progression Proof that digital photos exist Outside Communication Have to work with your EHR provider to determine connectivity

18 From Camera Roll Group AirDrop Wirelessly Share Photos with nearby Apple Devices AirPrint Conclusion Many possible applications of iphone Opthalmic Photography Use native camera app for simple photography and ProCamera for more advanced photography Protocol for Taking Photos 1. Determine lighting technique to use 2. Set light intensity at desired level 3. Lock exposure using photo app 4. Make fine adjustments with rheostat