Commentary: The glued intraocular lens smartphone microscope

The term glued intraocular lens[1](IOL) brings to mind the innovative technique of scleral fixated IOL that changed the landscape of secondary IOL fixation. The accompanying article[2] describes a vastly different glued IOL, one that is not about surgery or any advanced techniques, but about frugal clinical indovation. The photographs in the photo essay are taken by a smartphone without using a slit lamp or actual microscope. Instead, this young innovator glued a discarded polymethyl methacrylate (PMMA) intraocular lens to the back of a smartphone. High-volume surgical centers with trainee surgeons often have IOLs discarded due to broken haptics or slipped out of the sterile field, which can be used for this purpose. The method described provides a simple and effective option for photographing anterior segment. In addition, the attachment made is so portable and thin that it can be stored in the smartphone case itself.

This has several applications in places where slit lamps are not available or feasible. Anterior segment photographs of children and bedridden patients can be taken easily. Eye camps very rarely have slit lamps, so this can be used as a partial substitute for anterior segment evaluation.

Most commercially available smartphone macrophotography lenses cannot be stored within the smartphone case but are quite portable. We saw in a previous issue how one of those lenses can be used for photography of the optic nerve head.[3] This current modification makes that fundus photography technique much easier and more portable. There are also some smartphone macrophotography lenses that come with their own adjustable illumination, which can potentially give better photos. On the much more expensive side, there are handheld slit lamps of several different designs, some of which have the option of smartphone photography. The advantages of these are the slit illumination and cobalt blue filters. The binocular devices are larger but give stereopsis for depth perception, but has no advantage for the photographs. The monocular devices are smaller and have some designs with a fixed slit, whereas other have adjustable slit and have the option to easily attach a smartphone. We can hope that someone develops a smartphone microscope with adjustable slit illumination and filters at low cost very soon.

Thomas Larson had made a Kickstarter project for a small 150× lens to fix on the smartphone camera to convert it into a microscope.[4] This allows viewing of mounted slides to be viewed live on the smartphone screen. Manu Prakash had developed an origami paper microscope called Foldscope,[5] which has been used in a published study to look for Schistosoma blood parasites.[6] These microscopes can potentially be used for examining scrapings from corneal ulcers. A minor modification of the glued IOL microscope should be able to achieve this.

This is truly the age of smartphones in frugal ophthalmic innovation.[7] Every so often, we see advancements in this field that makes the life of an ophthalmologist easier. With the help of an ordinary slit lamp and a mid-range smartphone, this article[8] guides you to take excellent photographs of diffuse illumination, slit illumination, Descemet's membrane tears, vitreous in anterior chamber, keratic precipitates, retroillumination, specular endothelial images, 90D fundus, gonioscopy, etc., comparable to a commercial photo slit lamp. Posterior segment photographs and videos can be taken on smartphone using adapters such as DIYretcam,[9] HopeScope, MIIretcam, Jaiz Retcam, oDocs Fundus 3-D printed retcam, T3retcam,[10] Remidio Fundus-on-Phone, etc. Hope that the knowledge of these techniques enables ophthalmologists---young ophthalmology residents in particular, to take smartphone clinical photographs to ask seniors for guidance and for publication.