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Homemade slit lamp photography systems: versatile, convenient
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A few years ago, Primary Care Optometry News published an article by Matt Kelleman, OD, a practitioner from Milltown, N.J., on homemade slit lamp photography. This subject also comes up frequently in popular Web postings for eye care professionals. The objective of these systems is to allow doctors to digitally capture the variety of interesting anterior segment conditions. They are becoming more popular as optometrists learn about the excellent results achieved and the ease of putting them together.
Recently an abstract study was posted online by Rajesh Fogla, DNB, FRCS (Ed), MMed, which concluded, “A digital camera is a versatile instrument for ophthalmic photography. It is easy to use in routine clinical practice and provides good quality photographs.”
In his study, Dr. Fogla sought to analyze the routine clinical use of a digital camera for ophthalmic photography. He used a Nikon Coolpix 995 for external macro-photography of the eye and ocular adnexa and slit lamp photography of the anterior segment, according to the abstract. He stated that it was possible to take external macro-photographs under high magnification of the eye and ocular adnexa and to perform slit lamp photography under diffuse, slit beam and retro-illumination.
Dr. Fogla also found that different lenses could be used to photograph the structures of the angle, the optic disc and surrounding retina and that an attachment to an operating microscope allowed for intraoperative photography.
Composition of slit lamp systems
Primary Care Optometry News recently checked back with Dr. Kelleman on his current use of this type of system. He now has a Sony 107 single chip CCD camera that “is connected to a 70 (to the slit lamp)/30 (to the CCD) splitter,” he said in an interview. “The output from the camera goes to the Snappy capture device, which converts the video signal to a language that can be ‘understood’ by the Snappy software on the computer. The Snappy device also sends the video signal to a TV/VCR via readily available RCA cables.”
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Dr. Kelleman commented that he has yet to find software that responds as well or has better resolution than the Snappy software. The software is only available second-hand in locations such as on-line markets, he said.
Primary Care Optometry News spoke to a few other eye care professionals who have constructed such systems and use them in their daily practice. Adrian Bruce, BScOptom, PhD, FAAO, senior optometrist, Victorian College of Optometry and senior fellow, Department of Optometry and Vision Sciences, the University of Melbourne in Australia, said, “We have two slit lamp types in use for homemade digital imaging. One is a Zeiss SL120 video slit lamp, and the others are Haag-Streit BC900 video slit lamps.
“We then use Apple Macintosh personal computers with video capture to digitize the image so that it can be displayed on the computer, saved or printed,” he continued. He said this option provides good low-light performance and live image preview and facilitates digital movie capture.
Stephen P. Byrnes, OD, FAAO, of Londonderry, N.H., has several ways of creating video at the slit lamp. His methods include using a beam splitter that records to a Sony mini DV video camera. “This is a good system when I want to videotape anterior segment pathology,” he said.
Dr. Byrnes also uses either a Sony mini DV camcorder or Panasonic digital video camera with a close-up lens and yellow filter attached to document or study gas-permeable contact lens fits. To document anterior segment problems back to and including the vitreous, he will use a Canon or Sony digital camera to take pictures through the slit lamp. “I hold the camera in line with the eye piece and take the picture while looking at the image on the camera screen,” he said.
Milton M. Hom, OD, FAAO, a private practitioner from Azusa, Calif., and a Primary Care Optometry News Editorial Board member, has a system that contains elements he pieced together with advice from colleagues Shelley I. Cutler, OD, FAAO, and Walter Mayo, OD, FAAO. His system includes a BioVID camera (LW Scientific, Lawrenceville, Ga.) with sleeves to attach to the slit lamp ocular. A cable then connects the camera to a video to capture images. He uses the Apple iPhoto program to edit the video and pull stills.
“The nice thing about this set-up is that it is totally portable,” he said. “Everything fits in a small bag.”
Dr. Bruce also uses the Apple Macintosh computers for their versatility, both in photography and video, and also because they offer good support for video image and movie capture. He estimated that a practitioner can put together a complete system for slightly more than $1,000. “That’s an amazing value these days,” he said. “If you work in multiple practices or like to take your work home, you could substitute a portable laptop computer for an extra $500.
“Our goals in putting together the homemade systems were low cost, ease of use, in-house support and flexibility,” Dr. Bruce continued. “Even today, there are few commercial systems that offer the ability to record movies, whereas the homemade systems have done that right from the start.”
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Ronald K. Watanabe, OD, FAAO, a professor at the New England College of Optometry, attributes his system to Dr. Byrnes. It includes a standard digital video camera with a spectacle trial lens added to the front of the camera lens, typically a +5 D to +8 D lens to provide additional magnification, he said. To capture fluorescein pattern videos, Dr. Watanabe adds a Wratten yellow filter to the front. “You can either purchase accessory lens or filter rings and attach the plus lens and Wratten filter to it or tape the lens and filter to the front,” he said.
Putting the system to work
Dr. Watanabe positions the patient at the slit lamp, then uses a cobalt blue filter with the aperture open as wide as possible to provide as much light as possible. “You can move the oculars and light tower to the side so you are not obstructed,” he said. “Then, I put the camera in front of the patient and start shooting.”
Depending on magnification and lens power, you will be about 4 to 6 inches away from the patient, Dr. Watanabe continued. “Once the video is captured, it can be downloaded into your computer and edited as desired,” he said.
Although Dr. Watanabe also uses the system primarily for teaching, “it also comes in handy to educate patients on how their lenses work and why specialty GP fitting can be such a challenge.”
John Spaeth, OD, owner of S&L Optics, is another proponent of slit lamp photography who not only uses a system in his own practice, but also provides systems for other eye care practitioners. “I use the system myself each day to show patients eye conditions and to document them into the patient’s chart,” he said. “I can pause the tape at any point to show the patient the condition.”
Dr. Kelleman also shared how he puts his system into practice. “Until I purchased a retinal camera, the Snappy system was used to image all optic nerves in stereo,” he said. “Now the Snappy is only used for anterior segment documentation. The TV/VCR is used for all exams. I show the sit lamp exam while I am filling data on the exam form prior to the retinal examination.” Dr. Kelleman added, “While the quality of retinal cameras is far superior for posterior imaging, anterior segment and live video are a real benefit with the homemade digital imaging systems.”
According to Dr. Hom, “For videotaping interesting cases, I like digital video better than stills because you can pick out the best frame and use it for a still.”
Dr. Bruce also uses the images he captures for lectures and publications. The images have been used for education purposes in the Bruce and Loughnan anterior eye disease textbook [Bruce AS, Loughnan MS. Anterior Eye Disease and Therapeutics A-Z. Oxford: Butterworth-Heinemann; 2003]. Video stills can be found in the Hom and Bruce contact lens textbook [Hom M, Bruce AS (eds.). Manual of Contact Lens Fitting and Prescribing with CD-ROM, 3rd edition. Boston: Butterworth-Heinemann Elsevier; 2005].
Dr. Bruce added that using a Macintosh digital imaging system is easy because the video camera method gives a live preview of what you are about to capture.
“The most common reasons for digital image capture in our practice are in contact lens practice or with anterior eye disease,” he added. “The imaging helps explain to patients what is happening with their eyes, emphasizes what the management is aiming to achieve, provides a better clinical record than a hand-drawing, is used in referral letters and also helps in teaching students.”
| Eyepiece adaptor on display | ||||||
| LAS VEGAS —Transamerican Technologies International (TTI) Medical exhibited at last month’s Vision Expo West the Accu-Beam Digital Camera Eyepiece Adaptor. The adaptor was displayed connecting the Nikon Coolpix 4300 to a Haag Streit 900BM style slit lamp.
Researchers and clinicians have recognized that vascular endothelial growth factor (VEGF) is crucial for the successful treatment of acute neovascularization, Dr. Puliafito told attendees at a symposium on anti-VEGF therapies. The adaptor is available from TTI alone or in a complete package with the Coolpix 4300 and an AC adaptor. The company recommends also using an external illuminator to capture the slit image and background field. TTI also makes a vertical mount beam splitter for Zeiss, Topcon, Marco, CSO and Haag-Streit 900BQ slit lamps. For Your Information: | ||||||
For Your Information:
- Matthew Kelleman, OD can be reached at 36 No. Main St., Milltown, NJ 08850; (732) 828-2246; fax (732) 828-0119; ihelpyouseewell@msn.com.
- Adrian Bruce, BScOptom, PhD, FAAO, is the senior optometrist at the Victorian College of Optometry and senior fellow, Department of Optometry and Vision Sciences, the University of Melbourne. He can be reached at the Corner of Keppel and Cardigan Sts., Carlton 3053, Australia; (61) 3-9349-7445; fax: (61) 3-9349-7499; adrianbruce@mac.com.
- Stephen P. Byrnes, OD, FAAO, can be reached at Londonderry Professional Park, PO Box 579, Londonderry, NH 03053; (603) 434-4449; byrnes579@aol.com.
- Milton M. Hom, OD, FAAO, practices in Azusa, Calif., and is a member of the Primary Care Optometry News Editorial Board. He can be reached at 1131 E. Alosta, Azusa, CA 91702; (626) 963-7100; e-mail: eyemage@mminternet.com.
- Ronald K. Watanabe, OD, FAAO can be reached at the New England College of Optometry, 424 Beacon St., Boston, MA 02115; (617) 236-6249; fax: (617) 369-5056; watanaber@neco.edu.
- John Spaeth, OD, is the owner of S&L Optics. He can be reached at 4945 Yorba Ranch Rd., Ste. E, Yorba Linda, CA 92887; (888) 977-2020; sloptics@aol.com.