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All-digital Binocular Indirect Virtual Video Ophthalmoscope

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Since the introduction of the modern self-luminous binocular indirect ophthalmoscope (BIO) in the mid-20th century, enhancements have been made primarily to improve illumination without major changes to the core optics.1,2 The optical principle of BIO uses mirrors and/or prisms to reduce the interpupillary distance (IPD) of the examiner so that the visual axes of both eyes of the examiner simultaneously receive the light rays bouncing through the patient’s pupils. Depends on what you enable. Light rays returning from the fundus are collimated by the indirect ophthalmoscope lens to form real, reverse, and lateral reverse images between the patient and examiner. Performing and anatomically interpreting BIO examinations are skills that ophthalmology trainees acquire in residency training programs.3 Traditional BIO cannot capture video or images of inspections. Video-enabled BIO devices are commercially available at higher cost, bulky, and capable of 2D capture of ophthalmoscopic video and still images with integrated digital cameras.4–6 Limitations of currently available video-enabled BIO devices include the potential for bias of the captured image from the inspector’s field of view, requiring frequent adjustments.Four Also, the lack of stereo vision of the recording as it provides a two-dimensional (2D) image rather than a stereoscopic 3D image. Here we describe the novel design of his all-digital video recording-enabled BIO prototype, which provides stereoscopic three-dimensional (3D) recording of fundus examination images with the possibility of real-time anatomical correction. .


This prospective observational pilot study was approved by the Human Research Ethics Committee of the Institute of Ophthalmology, Giza, Egypt, and was conducted in accordance with all local laws and principles of the Declaration of Helsinki. Written informed consent was obtained from all study participants. The prototype used in this study consists of a common LED light source and two parallel HIS mini-cameras 15 mm apart that are synchronized. The mini camera is connected to the processor, storage media (Samsung note-9 android smartphone in the current prototype), and virtual reality set (VISIONHMD Bigeyes H1 3D video glasses in the current prototype) (Figure 1). The synced dual cameras were configured to export captured video to a Samsung note-9 phone using a connection console (Samsung Dex Dock Station). A custom-made Android application is designed to capture inspection media from dual cameras, so that the right camera is projected on the right half of the screen and the left camera is projected on the left half of the screen, creating a side-by-side view. A side is created. stereogram. The software also allows optional real-time anatomical correction of the examination view at the touch of a button on the screen or via a wired remote shutter. The inspection media is then projected onto the virtual reality set, the image of the right camera is projected onto the right side of the virtual reality glasses and seen by the inspector’s right eye, and the left image from the left camera is projected onto the left side. A side view of the virtual reality glasses, seen in the inspector’s left eye.

Figure 1 (a) schematic and (B.) Current prototype of an all-digital binocular indirect virtual video ophthalmoscope prototype, consisting of two mini-cameras, a light source, a virtual reality set, a connected console, and a smartphone.

Prototypes were first built using the Ocular Imaging Eye Model (Ocular Instruments inc. Bellevue, WA, USA), the RetCam Digital Retinal Camera Practice Kit (Massie Research Laboratories Inc., Pleasanton, CA, USA), and the Reti Eye Model (Gulden Ophthalmics, Elkins Park, Pennsylvania, USA). LED lights are tested for safety to the human eye in terms of light intensity and spectrum. Light intensity is 3.8mW/cm2 (Safety limit is at least one order of magnitude lower than the safety limit set by ISO15004-2.2 (706 mW/cm))2)7,8 Also, the light spectrum was completely within the safe visible spectrum with no ultraviolet or infrared components.

After pupillary dilation with tropicamide 1% eye drops, binocular stereoscopic indirect ophthalmoscopy was attempted on 15 eyes of 15 patients in dim conditions, without and with digital real-time anatomical correction of the examination view. was given. Accompanying video output was attempted on another virtual reality set for the observer to view on her 10 patients and on an external monitor on 5 patients.


Using this prototype in conjunction with a +20 diopter indirect ophthalmoscopic lens, we were able to successfully test binocular, virtual, and stereoscopic indirect ophthalmoscopy on three schematic model eyes.

Binocular video stereo optometric media could be obtained in all patients (n = 15). Anatomical correction of the examination view was achieved in all patients (n = 15) (Figure 2 When Supplementary video). A secondary educational view can be streamed simultaneously to either separate virtual reality glasses (10 out of 10 patients) and a monitor screen (5 out of 5 patients) for all patients.

Figure 2 Indirect retinograms are shown (a) Optic disc ( )B.) macula, and (Ha) Peripheral retinal lesions.


The purpose of this work was to investigate the feasibility of indirect binocular ophthalmoscope using a newly designed all-digital binocular indirect ophthalmoscope that replaces the conventional optics of BIO with two parallel mini-cameras. . This reduces the examiner’s her IPD, enables virtual binocular indirect simultaneous visualization through the subject’s pupil, and achieves the goal of projecting her two images of the fundus view onto corresponding screens in the virtual reality set. Achieve. This allows the examiner to view the fundus virtually and binocularly in real time.

With traditional BIO, it is not possible to record inspections in photos or videos. His video-enabled BIO is available at a significantly higher cost, is large in size, offers 2D recording, and can be limited by the eccentricity of the camera’s view relative to the inspector’s view, which requires frequent adjustments.Four In our design, a video examination of the fundus seen by the examiner is simultaneously recorded in a stereoscopic 3D side-by-side format.

The fundus image seen by the examiner is inverted and laterally flipped with respect to the actual anatomical orientation in conventional BIO examinations.1 Using the described design, anatomical correction of the examination view can be achieved during real-time examination by digitally horizontally and vertically flipping each of the two side-by-side images of the fundus examination. The skill of anatomical interpretation of BIO images is typically acquired during residency training,3 Providing an option for an anatomically modified view may make this part of the BIO examination more convenient.

Ophthalmic trainees can observe the test results of ophthalmic examinations through an attached teaching mirror attached to the front of the conventional BIO device. These teaching mirrors provide a 2D image of her in the examiner’s field of view.9 A narrow window between the examiner and the patient allows the trainee to see, which can be inconvenient for the patient. Her video-enabled BIO allows students to view test results in 2D in real-time or post-test on a connected monitor.Five Kong et al. described using two accessory cameras in a traditional BIO to provide a 3D view to trainees.Ten This makes the BIO bulkier, heavier to wear, and does not prevent the trainee’s vision from being skewed from what the examiner saw. Our design provides ophthalmology trainees with a real-time stereoscopic 3D view of the fundus exam identical to the view seen by the examiner. Exams can also be captured in 2D or 3D for documentation and clinical teaching. Limitations of the current interim prototype include the use of commercially available and affordable mini-cameras and virtual reality headsets. This is because the purpose at this point was only to prove the concept.I think that if the mini camera can be upgraded and customized, it will be possible to achieve a better field of view and a smaller size than this.


We describe the novel design of a video-recording-enabled BIO device that replaces the traditional BIO’s complex optical system with two closely-arranged mini-cameras. Benefits of this novel design include optional real-time anatomical correction of the examiner’s view of the fundus and identical recording of the examiner’s BIO view of her option in stereoscopic 3D and 2D for clinical Enhance documentation and education.

Data sharing statement

Data used in this study are available from the corresponding author upon reasonable request.

Ethical Acknowledgment and Consent to Participate

This report was approved by the Institute of Ophthalmic Research Ethics Committee and followed the principles of the Declaration of Helsinki. Written informed consent was obtained from all participating patients.


The design described in this article is related to Dr. Omar Soliman’s pending international patent (PCT # PCT/US2021/071604).


No funds to report.


Dr. Omar Solyman initiated the launch of Eye Gadget, an ophthalmic hardware and software solution for Wadjet. The prototype design described in this article is related to Dr Omar Solyman’s pending international patent (PCT # PCT/US2021/071604). The authors report no other conflicts of interest in this work.


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