Binocular indirect virtual video ophthalmoscope

Binocular indirect virtual video ophthalmoscope

an introduction

For the reason that introduction of the fashionable self-illuminating oblique ophthalmoscope (BIO) within the mid-Twentieth century, enhancements have been directed primarily at bettering illumination with out considerably altering the underlying optical system.1And the2 The optical precept of BIO relies on decreasing the examiner’s inter-pupillary distance (IPD) by way of mirrors and/or prisms to permit the examiner’s optic axes of each eyes to concurrently obtain gentle rays that bounce off the affected person’s pupil. The sunshine rays coming from the fundus are collimated by the lens of oblique ophthalmoscope to kind an actual, laterally inverted and reflection between the affected person and the examiner. Taking and anatomically decoding a BIO check is a talent that ophthalmological trainees develop throughout their residency coaching applications.3 Conventional BIOs can not seize inspection movies and pictures. Video-enabled BIO units are commercially accessible at the next value, are bigger and permit 2D video and nonetheless photos to be captured for ophthalmoscopic examination by way of a built-in digital digital camera4-6 Limitations of the presently accessible video BIO {hardware} embody the power to switch the captured picture from the examiner’s standpoint which requires frequent changes4 and the dearth of stereoscopic view of the recordings as a result of they supply two-dimensional (2D) photos reasonably than stereoscopic 3D photos. Right here, we describe a novel design of an all-digital video recording BIO prototype that gives stereoscopic three-dimensional (3D) recording of the fundoscopy picture with real-time anatomical correction functionality.


This observational pilot examine was permitted by the Human Analysis Ethics Committee of the Analysis Institute of Ophthalmology, Giza, Egypt, and was carried out in accordance with all native legal guidelines and in compliance with the tenets of the Declaration of Helsinki. Written knowledgeable consent was obtained from all examine individuals. The prototype used on this examine consisted of a generic LED gentle supply and two synchronized 15 mm microcameras spaced facet by facet. The tiny cameras are linked to a processor and storage media (Samsung note-9 android smartphone in present prototype) and a digital actuality suite (VISIONHMD Bigeyes H1 3D video glasses, in present prototype) (Figure 1). The synchronized twin cameras are configured to export captured video to a Samsung note-9 by way of a linked controller (Samsung Dex Dock Station). A devoted android app is designed to seize inspection media from the twin digital camera in order that the suitable digital camera is displayed on the suitable half of the display screen and the left digital camera is on the left half of the display screen to create a stereoscopic picture facet by facet. The software program additionally permits elective real-time anatomical correction of the scan view by touching a monitor button or by way of a wired distant shutter. The examination media is then projected onto the VR set in order that the suitable digital camera picture is projected onto the suitable facet of the VR goggles and seen by the examiner’s proper eye and the left picture from the left digital camera is projected onto the left facet of the VR goggles and seen by the examiner’s left eye.

Figure 1 (a) schematic diagram and (B) The current prototype of an all-digital lens indirect virtual video ophthalmoscope that features a configuration of two small cameras, a light source, a virtual reality set, a connected controller, and a smartphone.

The prototype was first tested and modified on three different schematic eyes including the Optical Imaging Eye Model (Ocular Instruments inc. Bellevue, WA, USA), RetCam Digital Retinal Camera Practice Kit (Massie Research Laboratories Inc., Pleasanton, CA, USA), and the Reti Eye Model (Gulden Ophthalmics, Elkins Park, PA, USA). LED light has been tested for safety for the human eye in terms of light intensity and spectrum. The light intensity was 3.8 mW/cm2 (The safe limits are at least one order of magnitude lower than the safety limit specified by ISO15004-2.2 of 706 mW/cm2)7And the8 The sunshine spectrum is totally dipped within the protected seen spectrum with no UV or IR build-up.

Oblique stereotactic ophthalmoscopy was then tried on 15 eyes of 15 sufferers in a dim gentle situation after pupil dilation utilizing tropicamide 1% eye drop with out and with real-time digital anatomical correction of the examination technique. Lateral video output to a different VR was tried that observers have been set to view in 10 sufferers and to an exterior monitor in 5 sufferers.


Microscopic, digital, oblique stereoscopic ophthalmoscopic examination may be examined on the three schematic mannequin eyes utilizing this prototype along with a +20 diopter oblique ophthalmic lens.

Media of stereoscopic videomicroscopy ophthalmoscopes could possibly be obtained in all sufferers (n = 15). Anatomical correction of scan width was carried out in all sufferers (n = 15) (Figure 2 And the Supplementary video). An academic facet view may be broadcast concurrently in all sufferers both to a different set of VR glasses (10 sufferers out of 10) and to a monitor (5 sufferers out of 5).

Figure 2 Indirect retinal imaging showing (a) the optic disc, (B) macular and (cPeripheral retinal diseases.


The aim of this work was to investigate the feasibility of an indirect ophthalmoscope using a newly designed fully digital indirect ophthalmoscope that replaces the conventional optical system of BIO by two small side-by-side cameras. This achieves the goal of reducing the examiner’s IPD and allowing simultaneous indirect binocular virtualization by having the subject’s pupil and projection of two fundus view images on the screen corresponding to the virtual reality set. This allows the examiner to see the fundus virtually and speculum in real time.

Traditional BIOs cannot record scans in photos or videos. Video-enabled BIOs are available at a significantly higher cost, are bulkier in size, provide 2D recordings and may be limited by optimizing the camera view relative to the examiner’s viewpoint requiring frequent adjustments.4 In our design, the video examination of the fundus seen by the examiner is concurrently recorded in a side-by-side stereoscopic 3D format.

The fundus picture seen by the examiner is inverted and reversed laterally relative to the true anatomical orientation in a standard BIO scan.1 Utilizing our described design, anatomical correction of the examination view throughout real-time examination may be achieved by digitally inverting horizontally and inverting vertically every of the 2 adjoining fundus examination photos. Though the talent of anatomical interpretation of a BIO picture is often mastered throughout years of residency coaching,3 Offering an anatomically appropriate viewing choice could make this a part of the BIO scan extra handy.

Ophthalmology trainees can monitor the outcomes of an ophthalmoscopic examination with an connected instructing mirror connected to the entrance of the standard BIO units. These academic mirrors present a two-dimensional picture of the examinees’ standpoint9 It may be seen by the trainee in a slim window between the examiner and the affected person which can be uncomfortable for the affected person. In video-enabled BIOs, trainees can view 2D examination ends in actual time or post-examination on a linked monitor.5 Kong et al. describe the usage of two cameras connected to a standard BIO to offer trainees with a 3D view.10 This makes the BIO heavier, heavier in place and doesn’t stop a good view of the trainees from the standpoint seen by the examiner. Our design offers ophthalmic trainees with a real-time stereoscopic 3D view of an ophthalmoscope that’s an identical to the view seen by the examiner. Examination may also be recorded in 2D or 3D for documentation and for scientific schooling. Limitations of the present tentative prototype embody the usage of inexpensive, commercially accessible small cameras and digital actuality headsets since our objective at this level was solely a proof of idea. We expect the show may be made higher than this and the gadget may be extra compact if the small cameras may be upgraded and customized.


We describe a novel design of a video recording-enabled BIO that replaces the advanced optical system of a standard BIO with two small cameras adjoining facet by facet. Benefits of this new design embody elective real-time anatomical correction of the examiner’s fundus perspective and elective mirror recording of the examiner’s BIO show in 3D and 2D stereoscopic picture that may improve scientific documentation and schooling.

Information sharing assertion

The information used on this examine can be found from the corresponding creator on cheap request.

Moral approval and consent to take part

This report was permitted by the Analysis Ethics Committee of the Institute of Ophthalmological Analysis and adopted the tenets of the Declaration of Helsinki. Written knowledgeable consent was obtained from all collaborating sufferers.

Thanks and appreciation

The design described on this article is related to a pending worldwide patent by Dr. Omar Suleiman (PCT # PCT/US2021/071604).


No funding to report.


Dr. Omar Suleiman initiated the launch of Wadjet’s ophthalmic {hardware} and software program options: the Eye Gadget. The prototype design described on this article is related to a global patent pending by Dr. Omar Suleiman (PCT # PCT/US2021/071604). The authors report no different conflicts of curiosity on this work.


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