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Young Ophthalmologists
Smartphoneography — Take Journal-Quality Photographs with Your iPhone
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You can obtain high-quality anterior segment photographs with your iPhone. Here’s what you need:
  1. iPhone 4 (5-megapixel camera) or iPhone 4S (8-megapixel camera)
  2. Slit lamp
  3. iPhone slit lamp adapter ($5 to $300)
  4. ProCamera iPhone app by Jens Daemgen ($2.99) or Camera Awesome app by SmugMug (free)

Step 1: Obtain and Attach an Adapter to the Slit Lamp
It is possible to obtain photographs without an adapter; however, an adapter will improve the quality and efficiency of your photography. When deciding which adapter to purchase, you should weigh the importance of cost, efficiency and versatility. Be sure to check out the “Adapters” section of the smartphoneography article posted on EyeWiki for a full review of several slit lamp adapters.

Briefly, a few options include:

  1. The cheapest: do-it-yourself. The EyeWiki article above describes how to make an adapter for less than $5.
  2. Most efficient: EyePhotoDoc. A specific adapter is manufactured for each Haag-Streit slit lamp model that allows for rapid attachment and positioning. Occasionally, the ocular needs to be pulled out a few millimeters to slide the adapter into position. 
  3. Most versatile: Orion SteadyPix Telescope Photo Adapter. This adapter was designed for a telescope; however, its adjustable clamp makes it compatible with a large number of slit lamps. In fact, I am also able to use the SteadyPix adapter to record surgical videos on my Leica M840 operating microscope. At first though, it will take you at least several minutes to properly align the three separate adjustable parts of the adapter.  

Step 2: Optimize Lighting
The importance of lighting cannot be overemphasized. Lighting can be divided into two sources: 1) external illumination and 2) slit-beam illumination.

While it is only necessary to use one illumination source at a time, using both simultaneously will allow you to obtain the best pictures. I prefer to use a narrow, medium-intensity slit beam while my assistant or patient directs the light from a transilluminator towards the pupillary axis.

Keep in mind that there is a tendency for images to whiteout due to overexposure. The easiest solution for the iPhone is to download a camera app that allows you to control the exposure (see step 3 below for more details). Another solution to address overexposure is to use a dimmer light setting on the slit lamp or a diffuser. Be sure to check out the “Lighting” section of the smartphoneography EyeWiki article for a description on how to optimize your lighting.

Step 3: Take the Photograph With an iPhone Camera App
To obtain the best photograph possible, you will need to be able to control the exposure, point of focus and zoom. The ProCamera app ($2.99) by Jens Daemgen and the Camera Awesome app (free) by SmugMug are both available at Apple’s App Store and work quite well. I prefer the ProCamera app because it allows you to control exposure in video mode, which is critical for preventing overexposure when recording surgical videos. Be sure to check out the “Apps and Software” section of the smartphoneography EyeWiki article for more information, including pictures and videos, on how to use the iPhone apps.

As with any skill, it will take time — likely a few weeks — in order to perfect your ophthalmic photography skills. My recommendation is to photograph one eye a day and compare your new photograph to your old photographs. You will quickly learn which techniques work best for you.

 

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About the author: Christian C. Hester, MD, is a fellow in cornea, refractive and anterior segment surgery at Baylor College of Medicine’s department of ophthalmology and a member of the Academy’s YO Committee.

 
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