Abstract

This study is to test the feasibility of using trans-pars-planar illumination for ultra-wide field pediatric fundus photography. Fundus examination of the peripheral retina is essential for clinical management of pediatric eye diseases. However, current pediatric fundus cameras with traditional trans-pupillary illumination provide a limited field of view (FOV), making it difficult to access the peripheral retina adequately for a comprehensive assessment of eye conditions. Here, we report the first demonstration of trans-pars-planar illumination in ultra-wide field pediatric fundus photography. For proof-of-concept validation, all off-the-shelf optical components were selected to construct a lab prototype pediatric camera (PedCam). By freeing the entire pupil for imaging purpose only, the trans-pars-planar illumination enables a 200° FOV PedCam, allowing easy visualization of both the central and peripheral retina up to the ora serrata. A low-cost, easy-to-use ultra-wide field PedCam provides a unique opportunity to foster affordable telemedicine in rural and underserved areas.

© 2019 Optical Society of America under the terms of the OSA Open Access Publishing Agreement

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2018 (1)

B. Wang, D. Toslak, M. N. Alam, R. V. P. Chan, and X. Yao, “Contact-free trans-pars-planar illumination enables snapshot fundus camera for nonmydriatic wide field photography,” Sci. Rep. 8(1), 8768 (2018).
[Crossref]

2016 (5)

E. H. Wood, A. A. Moshfeghi, E. D. Nudleman, and D. M. Moshfeghi, “Evaluation of Visunex Medical’s PanoCamTM LT and PanoCamTM Pro wide-field imaging systems for the screening of ROP in newborn infants,” Expert Rev. Med. Devices 13(8), 705–712 (2016).
[Crossref]

R. Liegl, A. Hellstrom, and L. E. Smith, “Retinopathy of prematurity: the need for prevention,” Eye Brain 8, 91–102 (2016).
[Crossref]

P. K. Shah, V. Prabhu, S. S. Karandikar, R. Ranjan, V. Narendran, and N. Kalpana, “Retinopathy of prematurity: Past, present and future,” World J Clin Pediatr 5(1), 35–46 (2016).
[Crossref]

M. F. Chiang, “Retinopathy of Prematurity: Imaging in retinopathy of prematurity: where are we, and where are we going?” Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 20(6), 474–476 (2016).
[Crossref]

D. Toslak, D. Thapa, Y. Chen, M. K. Erol, R. V. Paul Chan, and X. Yao, “Trans-palpebral illumination: an approach for wide-angle fundus photography without the need for pupil dilation,” Opt. Lett. 41(12), 2688–2691 (2016).
[Crossref]

2015 (4)

P. Tejada-Palacios, L. Zarratea, M. Moral, and J. de la Cruz-Bertolo, “Comparative study of RetCamRetCam II vs. binocular ophthalmoscopy in a screening program for retinopathy of prematurity,” Arch. Soc. Esp. Oftalmol. 90(8), 373–378 (2015).
[Crossref]

W. M. Fierson and A. Capone, “Telemedicine for evaluation of retinopathy of prematurity,” Pediatrics 135(1), e238–e254 (2015).
[Crossref]

S. Sızmaz, Y. Yonekawa, and M. T. Trese, “Familial Exudative Vitreoretinopathy,” Turkish Journal of Ophthalmology 45(4), 164–168 (2015).
[Crossref]

C. Rodriguez-Galindo, D. B. Orbach, and D. VanderVeen, “Retinoblastoma,” Pediatr. Clin. North Am. 62(1), 201–223 (2015).
[Crossref]

2014 (1)

G. E. Quinn, G. S. Ying, E. Daniel, P. L. Hildebrand, A. Ells, A. Baumritter, A. R. Kemper, E. B. Schron, and K. Wade, “Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity,” JAMA Ophthalmol 132(10), 1178–1184 (2014).
[Crossref]

2013 (4)

L. H. Li, N. Li, J. Y. Zhao, P. Fei, G. M. Zhang, J. B. Mao, and P. J. Rychwalski, “Findings of perinatal ocular examination performed on 3573, healthy full-term newborns,” Br. J. Ophthalmol. 97(5), 588–591 (2013).
[Crossref]

H. Blencowe, J. E. Lawn, T. Vazquez, A. Fielder, and C. Gilbert, “Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010,” Pediatr. Res. 74(S1), 35–49 (2013).
[Crossref]

W. M. Fierson, O. American Academy of Pediatrics Section on, O. American Academy of, O. American Association for Pediatric, Strabismus, and O. American Association of Certified, “Screening examination of premature infants for retinopathy of prematurity,” Pediatrics 131(1), 189–195 (2013).
[Crossref]

C. Patel, T. Fung, M. Muqit, D. Mordant, J. Brett, L. Smith, and E. Adams, “Non-contact ultra-widefield imaging of retinopathy of prematurity using the Optos dual wavelength scanning laser ophthalmoscope,” Eye 27(5), 589–596 (2013).
[Crossref]

2010 (1)

R. S. Maldonado, J. A. Izatt, N. Sarin, D. K. Wallace, S. Freedman, C. M. Cotten, and C. A. Toth, “Optimizing hand-held spectral domain optical coherence tomography imaging for neonates, infants, and children,” Invest. Ophthalmol. Visual Sci. 51(5), 2678–2685 (2010).
[Crossref]

2009 (2)

P. P. Bonomo, “Pars plana and ora serrata anatomotopographic study of fetal eyes,” Acta Ophthalmol. 67(2), 145–150 (2009).
[Crossref]

C. Dhaliwal, E. Wright, C. Graham, N. McIntosh, and B. W. Fleck, “Wide-field digital retinal imaging versus binocular indirect ophthalmoscopy for retinopathy of prematurity screening: a two-observer prospective, randomised comparison,” Br. J. Ophthalmol. 93(3), 355–359 (2009).
[Crossref]

2008 (2)

E. DeHoog and J. Schwiegerling, “Optimal parameters for retinal illumination and imaging in fundus cameras,” Appl. Opt. 47(36), 6769–6777 (2008).
[Crossref]

A. H. Skalet, G. E. Quinn, G. S. Ying, L. Gordillo, L. Dodobara, K. Cocker, A. R. Fielder, A. L. Ells, M. D. Mills, C. Wilson, and C. Gilbert, “Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project,” Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 12(3), 252–258 (2008).
[Crossref]

2007 (1)

C. A. Lemley and D. P. Han, “An age-based method for planning sclerotomy placement during pediatric vitrectomy: a 12-year experience,” Trans. Am. Ophthalmol. Soc. 105, 86–89 (2007).

2006 (1)

O. D. Saugstad, “Oxygen and retinopathy of prematurity,” J. Perinatol. 26(S1), S46–S50 (2006).
[Crossref]

2004 (1)

C. Gliss, J. M. Parel, J. T. Flynn, H. Pratisto, and P. Niederer, “Toward a miniaturized fundus camera,” J. Biomed. Opt. 9(1), 126–131 (2004).
[Crossref]

2003 (1)

C. L. Shields, M. Materin, and J. A. Shields, “Panoramic imaging of the ocular fundus,” Arch. Ophthalmol. 121(11), 1603–1607 (2003).
[Crossref]

2002 (1)

J. Walsh, J. S. Garcia, J. Nieto, R. Rosen, P. Garcia, and S. Fradin, “Wide-Angle Digital Fundus Photography: Panoret 1000 vs RetCam 120,” Invest. Ophthalmol. Visual Sci. 43, 4370 (2002).

1998 (1)

T. W. Olsen, S. Y. Aaberg, D. H. Geroski, and H. F. Edelhauser, “Human sclera: thickness and surface area,” Am. J. Ophthalmol. 125(2), 237–241 (1998).
[Crossref]

1997 (1)

R. J. Hairston, A. M. Maguire, S. Vitale, and W. R. Green, “Morphometric analysis of pars plana development in humans,” Retina (Philadelphia Pa.) 17, 135–138 (1997).

1996 (1)

J. C. Chen, “Sutureless pars plana vitrectomy through self-sealing sclerotomies,” Arch. Ophthalmol. 114(10), 1273–1275 (1996).
[Crossref]

1991 (1)

A. Vogel, C. Dlugos, R. Nuffer, and R. Birngruber, “Optical properties of human sclera, and their consequences for transscleral laser applications,” Lasers Surg. Med. 11(4), 331–340 (1991).
[Crossref]

1987 (1)

S. J. Isenberg, J. W. McCarty, and R. Rich, “Growth of the conjunctival fornix and orbital margin in term and premature infants,” Ophthalmology 94(10), 1276–1280 (1987).
[Crossref]

1977 (1)

R. Rönnerstam, “Fundus examination using transscleral illumination,” Albrecht von Graefes Arch. Klin. Exp. Ophthalmol. 201(3), 295–296 (1977).
[Crossref]

1910 (1)

A. Gullstrand, “Neue methoden der reflexlosen ophthalmoskopie,” Berichte Deutsche Ophthalmologische Gesellschaft 36, 326 (1910).

Aaberg, S. Y.

T. W. Olsen, S. Y. Aaberg, D. H. Geroski, and H. F. Edelhauser, “Human sclera: thickness and surface area,” Am. J. Ophthalmol. 125(2), 237–241 (1998).
[Crossref]

Adams, E.

C. Patel, T. Fung, M. Muqit, D. Mordant, J. Brett, L. Smith, and E. Adams, “Non-contact ultra-widefield imaging of retinopathy of prematurity using the Optos dual wavelength scanning laser ophthalmoscope,” Eye 27(5), 589–596 (2013).
[Crossref]

Alam, M. N.

B. Wang, D. Toslak, M. N. Alam, R. V. P. Chan, and X. Yao, “Contact-free trans-pars-planar illumination enables snapshot fundus camera for nonmydriatic wide field photography,” Sci. Rep. 8(1), 8768 (2018).
[Crossref]

Baumritter, A.

G. E. Quinn, G. S. Ying, E. Daniel, P. L. Hildebrand, A. Ells, A. Baumritter, A. R. Kemper, E. B. Schron, and K. Wade, “Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity,” JAMA Ophthalmol 132(10), 1178–1184 (2014).
[Crossref]

A. R. Kemper, L. A. Prosser, K. C. Wade, M. X. Repka, G. S. Ying, A. Baumritter, and G. E. Quinn, “A Comparison of Strategies for Retinopathy of Prematurity Detection,” Pediatrics137(1), e20152256(2016).
[Crossref]

Birngruber, R.

A. Vogel, C. Dlugos, R. Nuffer, and R. Birngruber, “Optical properties of human sclera, and their consequences for transscleral laser applications,” Lasers Surg. Med. 11(4), 331–340 (1991).
[Crossref]

Blencowe, H.

H. Blencowe, J. E. Lawn, T. Vazquez, A. Fielder, and C. Gilbert, “Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010,” Pediatr. Res. 74(S1), 35–49 (2013).
[Crossref]

Bonomo, P. P.

P. P. Bonomo, “Pars plana and ora serrata anatomotopographic study of fetal eyes,” Acta Ophthalmol. 67(2), 145–150 (2009).
[Crossref]

Brett, J.

C. Patel, T. Fung, M. Muqit, D. Mordant, J. Brett, L. Smith, and E. Adams, “Non-contact ultra-widefield imaging of retinopathy of prematurity using the Optos dual wavelength scanning laser ophthalmoscope,” Eye 27(5), 589–596 (2013).
[Crossref]

Bye, L.

L. Bye, N. Modi, and M. Stanford, “Anatomy,” in Basic sciences for ophthalmology (OUP Oxford, 2013), p. 51.

Capone, A.

W. M. Fierson and A. Capone, “Telemedicine for evaluation of retinopathy of prematurity,” Pediatrics 135(1), e238–e254 (2015).
[Crossref]

Chan, R. V. P.

B. Wang, D. Toslak, M. N. Alam, R. V. P. Chan, and X. Yao, “Contact-free trans-pars-planar illumination enables snapshot fundus camera for nonmydriatic wide field photography,” Sci. Rep. 8(1), 8768 (2018).
[Crossref]

Chen, J. C.

J. C. Chen, “Sutureless pars plana vitrectomy through self-sealing sclerotomies,” Arch. Ophthalmol. 114(10), 1273–1275 (1996).
[Crossref]

Chen, Y.

Chiang, M. F.

M. F. Chiang, “Retinopathy of Prematurity: Imaging in retinopathy of prematurity: where are we, and where are we going?” Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 20(6), 474–476 (2016).
[Crossref]

Cocker, K.

A. H. Skalet, G. E. Quinn, G. S. Ying, L. Gordillo, L. Dodobara, K. Cocker, A. R. Fielder, A. L. Ells, M. D. Mills, C. Wilson, and C. Gilbert, “Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project,” Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 12(3), 252–258 (2008).
[Crossref]

Cotten, C. M.

R. S. Maldonado, J. A. Izatt, N. Sarin, D. K. Wallace, S. Freedman, C. M. Cotten, and C. A. Toth, “Optimizing hand-held spectral domain optical coherence tomography imaging for neonates, infants, and children,” Invest. Ophthalmol. Visual Sci. 51(5), 2678–2685 (2010).
[Crossref]

Daniel, E.

G. E. Quinn, G. S. Ying, E. Daniel, P. L. Hildebrand, A. Ells, A. Baumritter, A. R. Kemper, E. B. Schron, and K. Wade, “Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity,” JAMA Ophthalmol 132(10), 1178–1184 (2014).
[Crossref]

de la Cruz-Bertolo, J.

P. Tejada-Palacios, L. Zarratea, M. Moral, and J. de la Cruz-Bertolo, “Comparative study of RetCamRetCam II vs. binocular ophthalmoscopy in a screening program for retinopathy of prematurity,” Arch. Soc. Esp. Oftalmol. 90(8), 373–378 (2015).
[Crossref]

DeHoog, E.

Dhaliwal, C.

C. Dhaliwal, E. Wright, C. Graham, N. McIntosh, and B. W. Fleck, “Wide-field digital retinal imaging versus binocular indirect ophthalmoscopy for retinopathy of prematurity screening: a two-observer prospective, randomised comparison,” Br. J. Ophthalmol. 93(3), 355–359 (2009).
[Crossref]

Dlugos, C.

A. Vogel, C. Dlugos, R. Nuffer, and R. Birngruber, “Optical properties of human sclera, and their consequences for transscleral laser applications,” Lasers Surg. Med. 11(4), 331–340 (1991).
[Crossref]

Dodobara, L.

A. H. Skalet, G. E. Quinn, G. S. Ying, L. Gordillo, L. Dodobara, K. Cocker, A. R. Fielder, A. L. Ells, M. D. Mills, C. Wilson, and C. Gilbert, “Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project,” Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 12(3), 252–258 (2008).
[Crossref]

Driscoll, A. K.

B. E. Hamilton, M. J. Osterman, A. K. Driscoll, and L. M. Rossen, “Births: provisional data for 2017,” (Department of Health and Human Service, 2018).

Edelhauser, H. F.

T. W. Olsen, S. Y. Aaberg, D. H. Geroski, and H. F. Edelhauser, “Human sclera: thickness and surface area,” Am. J. Ophthalmol. 125(2), 237–241 (1998).
[Crossref]

Ells, A.

G. E. Quinn, G. S. Ying, E. Daniel, P. L. Hildebrand, A. Ells, A. Baumritter, A. R. Kemper, E. B. Schron, and K. Wade, “Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity,” JAMA Ophthalmol 132(10), 1178–1184 (2014).
[Crossref]

Ells, A. L.

A. H. Skalet, G. E. Quinn, G. S. Ying, L. Gordillo, L. Dodobara, K. Cocker, A. R. Fielder, A. L. Ells, M. D. Mills, C. Wilson, and C. Gilbert, “Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project,” Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 12(3), 252–258 (2008).
[Crossref]

Erol, M. K.

Fei, P.

L. H. Li, N. Li, J. Y. Zhao, P. Fei, G. M. Zhang, J. B. Mao, and P. J. Rychwalski, “Findings of perinatal ocular examination performed on 3573, healthy full-term newborns,” Br. J. Ophthalmol. 97(5), 588–591 (2013).
[Crossref]

Fielder, A.

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L. H. Li, N. Li, J. Y. Zhao, P. Fei, G. M. Zhang, J. B. Mao, and P. J. Rychwalski, “Findings of perinatal ocular examination performed on 3573, healthy full-term newborns,” Br. J. Ophthalmol. 97(5), 588–591 (2013).
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Supplementary Material (1)

NameDescription
» Visualization 1       Video fundus photography: The video is 12 s. The first 6 s video was recorded with the optic disc at the center of the field of view; and later 6 s was obtained by slightly tilting the imaging probe relative to the ocular axis to reach the peripheral

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Figures (3)

Fig. 1.
Fig. 1. (A) Optical layout of the prototype PedCam. All off-the-shelf optical components were used for this prototype. (B) Photographic illustration of the prototype PedCam for fundus imaging. (C) Light spectrum, normalized intensity of the light source and ISO 15004-2: 2007 aphacic photochemical hazard weighting function. (D) Trans-pars-planar illuminator was used to create diffused and homogenized illumination inside the eye, the contact OL, consisting of a meniscus lens contacted to the cornea and a condensing lens, is used to produce an aerial retinal image at ∼3 mm from the last surface of the lens set. (E) The relay optics in Fig. 3(A), consisting of a bi-convex lens I, a planoconcave lens II and another bi-convex lens III, working with the camera lens together to relay the aerial retinal image to the camera sensor.
Fig. 2.
Fig. 2. (A) Representative fundus images captured with the prototype PedCam from the left eye of a patient with zone III stage 2 ROP. (B) Schematic diagram of the eye showing the location of the pars plana, ora serrata, peripheral retina, and equator of the globe. (C) Schematic diagram of the left ocular fundus, illustrating retinal zones for ROP classification. (D) Representative fundus images captured with the prototype PedCam from the left eye of a patient with plus disease, zone II stage 2 ROP in the nasal region and zone II stage 3 ROP in the temporal region, with trans-pars-planar illumination light delivered from the temporal (D1) and nasal (D2) sides, respectively.
Fig. 3.
Fig. 3. Fundus images of a patient previously diagnosed with retinoblastoma. (A) Central view of the fundus captured with the prototype PedCam2 in Fig. 1(A). Treated retinoblastoma lesion surrounded by photocoagulation scars was observed below the optic disc. (B) Vortex vessels, ora serrata and pars plana were observed by slightly tilting the axis of the imaging system for peripheral imaging. (C) Fundus image of the same eye captured by clinical Retcam. (D) Overlapping illustration of two images captured by the 200° prototype PedCam and 130° clinical Retcam.

Equations (1)

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t = 10 J  /  c m 2 0.117 m W × 30 %  /  5.48 m m 2 = 4.3 h o u r s

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