DIGITAL INNOVATIONS

Digital technology that promises to expand access to ophthalmic services with devices that lower costs and expand practice beyond the well-equipped office was on display at the 2014 AAO meeting held in conjunction with SOE 2014 in Chicago.
The D-Eye is a compact adapter that attaches to an iPhone to create a portable ophthalmoscope. Developed by researchers from the University of Brescia, University of Molise and ‘Federico II’ University of Naples, Italy, it produces retinal images suitable for grading diabetic retinopathy.
Comparing results from the D-Eye with conventional slit-lamp biomicroscopy in 120 patients with diabetes, exact agreement was found in 85 per cent of eyes and agreement within one step in 96.7 per cent. In most one- and two-step disagreements, severity was graded higher by biomicroscopy.
Nine eyes were not gradable based on D-Eye images, compared with four for biomicroscopy. While not perfect, the D-Eye can be carried in a pocket and costs a fraction of an office slit-lamp, noted lead researcher Andrea Russo MD.
“The affordability of this option could make it much easier to bring eye care to non-hospital remote or rural settings, which often lack ophthalmic medical personnel,” he said.

Glaucoma screening
Researchers from the University of Iowa, the University of Maryland, Johns Hopkins University, the University of Michigan, US and the Tilganga Eye Institute in Nepal used a free peripheral vision assessment app to screen approximately 200 patients in Nepal for glaucoma using an iPad. Results from the Visual Fields Easy app were compared with those from a Humphrey SITA Standard 24-2. The two tests agreed between 51-79 per cent of the time.
Agreement was best among patients with moderate or advanced visual field loss. False positives among normal controls were an issue.
While the app is not precise enough for general vision screening, it may be useful with high-risk populations, said Chris A Johnson PhD, director of the Visual Field Reading Centre at the University of Iowa. “Although not perfect, the tablet glaucoma screening method could make a significant difference in remote locations where populations would not otherwise receive screening at all,” he said.

3D printed prostheses
Creating a facial prostheses for a patient with an exenterated eye takes weeks of effort by an ocularist skilled in matching skin and eye colours at a cost of €10,000 or more. A 3D printing device cuts that to half a day at a fraction of the cost.
Patients are scanned on both sides of their face using a mobile scanner. Software meshes the two to create a 3D facial image. The topographical information then goes to a 3D printer, which translates the data into a mask formed out of injection-molded rubber suffused with coloured pigments matching the patient's skin tone.
Developed by researchers at Bascom Palmer Eye Institute, Florida, US, the device uses nanoclay infused with pigment, potentially making the prosthesis more resistant to surface wear, said David Tse MD, who collaborated with engineers at the University of Miami to develop the technology.

Andrea Russo: 
dott.andrea.russo@gmail.com
Chris Johnson: chris-a-johnson@uiowa.edu
David Tse: dtse@med.miami.edu