We reported on the innovative D-EYE digital ophthalmoscope a few weeks ago, and now shipping of the portable retinal imaging system has begun. The device promises easy imaging of the retina using a simple smartphone attachment, for relatively low cost. D-EYE sent us a review unit for the iPhone 6, and we’ve been testing it out to see just how it performs. Are you an ophthalmologist? Family doctor? Student? Lover of all medical gadgets? (Of course you are!) Read on to see what we think!
We’re gonna give you the juicy bits first. The big questions everyone’s asking are: what do the images/videos look like, and how easy is it to use? Here’s a sample video I took within the first 5 minutes of opening the box, blindly on my own undilated eye (yes, the first thing I did was take a retina selfie – I feel your judgements already). I put it together, launched the downloaded app, and with a click of a few buttons to select for the corrective optics of my eyes, I was blindly rotating the D-EYE in front of my eye, wondering what it would image. When I checked the recorded video, I was blown away that I could pick up vasculature and my own optic disc… (make sure you have HD quality selected)
Assessing friends and family proved to be just as easy, and after a few volunteers, I learned to orient the system and track down the disc almost instantly.
I wanted a professional’s opinion, so I met up with Dr. David Yan, an ophthalmologist specializing in glaucoma surgery at the University of Toronto (note: he has no association with D-EYE). I gave him the system to play with and within a few seconds, he was able to image another medical student’s optic disc as well as the macula. Oh, and I’ll mention that this was in a fully-lit OR, without pupil dilating drops.
“The problem with the traditional direct ophthalmoscopes is how close you have to get to the patient’s face; this device solves that problem, and the image quality is still very reasonable. It is not as good as the image obtained with a traditional direct ophthalmoscope in the hands of a highly trained eye surgeon, but for a general practitioner, this may be a far more practical and efficient device, as it is far less operator and patient dependent.” Essentially, he’s echoed what Dr. Andrea Russo, the inventor of the D-EYE told me in his interview.
With the D-EYE, I saw patients with diabetic retinopathy, macular degeneration, and post-laser photocoagulation scars, all through undilated pupils.
And a clip of what the D-EYE can image on a dilated eye:
Of note: when I’m a patient at the doctor’s office and am being prodded at with bright lights in my eyes and people’s faces oh-too-close to mine, I’ve often wondered what’s on the other side of the lens, especially when they mutter an inquisitory “Hmm” or even “Everything looks good!” Now, playing the other role, I felt that another huge plus for the D-EYE was the capability to instantly show patients what their retinas look like. I only used it with a few patients, but they all seemed to appreciate being more included in their care.
Compared with traditional direct ophthalmoscopes, I feel much more comfortable with the D-EYE. The familiar phone interface, a large display, easy maneuverability across the fundus with fingertip precision, and recording of images to show my preceptor make it leaps and bounds more preferable over the awkward traditional direct ophthalmoscopes.
Okay, so we know the D-EYE works (and very well, at that). Now I want to talk about design and usability. The D-EYE device is composed of two pieces: a screwed-on bumper that encloses your smartphone, and the D-EYE lens itself. Both look and feel like a high quality product. The solid construction and a sleek matte black finish give it the gravitas of a professional medical device.
Magnets attach the lens onto the bumper+phone, and the two are aligned according to two pins on the bumper that insert into respective slots in the lens.
It works well to connect the two pieces, but putting the pins on the bumper, and not the lens attachment is a poor design decision. I (and probably millions of others) like to keep my phone in my pocket. There, these bumper pins either stab into my leg, or poke out of my pocket awkwardly, threatening to rip if I accidentally bump into something. I’ve already ripped a few threads just from a few half days of use. The bumper is removable, but to have to screw it on and off every time is a hassle. According to Dr. Russo, this was done to make the D-EYE versatile and usable across multiple phones, and future versions will have a fix.
The D-EYE lens redirects the light from the phone’s flash and projects it coaxially to the lens, allowing the retina to reflect its image back to be picked up – this is the direct ophthalmoscopy aspect. Both the bumper and the device feel solidly constructed and connect with ease. While the connection feels sturdy enough to withstand being accidentally flung across a busy emergency room, there was a bit of wiggle room on my iPhone 6 – enough to cause a constant (but easily correctable) problem during operation. Because the device wasn’t flush against the phone, the flash’s light leaked onto the rear of the D-EYE lens, causing glare and difficulty with imaging. However, the problem was easily rectified by pressing and holding down the D-EYE onto the phone itself during an exam. When I contacted D-EYE about this, they mentioned that they were working on a fix to ship soon: a simple sealing sticker that would block the glare. Sounds good to me!
Overall, the D-EYE is a great device. It’s got a few hiccups in the hardware design, but still much easier to use compared to traditional direct ophthalmoscopes. Its ease of imaging, recording, portability, and potential for strengthening doctor-patient relationship should make it a solid addition to any student’s, GP’s, or ophthalmologist’s bag.