TechTool review – D-Eye the ophthalmoscope for iPhones
The app has undergone some important changes since I was first given this product. It now has the option of fast secure login with touch-id. The home screen gives you access to your previous examinations, adding a new patient but also importantly a glossary of ophthalmic conditions with a picture library of those diseases as an aide memoire.
Additionally the app has given the user the ability to use automatic features of focus and lighting during an examination or over-riding these and going manual. Certain lighting and iris colour can require you to go manual and this option has made my own examinations more successful.
Uses and product testing:
What diseases can you find with the D-eye:
- Hypertensive retinopathy
- Retinal haemorrhages / detachments / Pigmentosa
- Vitreous Detachment
- Branch or central retinal vein occlusions
- Central retinal artery occlusion
What does the literature say:
- In the Journal of Hypertension September 2016 they found the following when the d-eye was compared to a traditional ophthalmoscope:
- In 41 consecutive patients with hypertension no abnormalities were detected on the retina with a traditional ophthalmoscope by emergency physicians.
- With the D-eye the emergency physicians reviewed the same patients and detected 17 patients with abnormalities (the gold standard was done by ophthalmologists who detected 19 patients with abnormalities).
- How does the imaging compare to a slit lamp exam in diabetic retinopathy?
- Overall exact agreement between the 2 methods was observed in 204 of 240 eyes (85%) (simple κ = 0.78; CI 0.71-0.84) and agreement within 1 step (DM is graded by 5 steps) was observed in 232 eyes (96.7%). Compared to biomicroscopy, the sensitivity and specificity of smartphone ophthalmoscopy for the detection of clinically significant macular oedema were 81% and 98%, respectively. [Reference]
Below is the D-eye company video and two test runs I did in suboptimal conditions. Firstly with my partner at home and second with a co-worker in our bright office, with patients I dilated their pupils and had comparable results to the d-eye product literature.
How much does it cost?
- $435 AUD.
- There are alternative products on the market but are currently going through crowdfunding and they are pitching at a similar price.
- It is possible to convert your iPhone with the panoptic from Welch Allyn but the case is $230 AUD or $1700 AUD for the case and a panoptic head.
Room for Improvement
- I suspect like the large majority of the population you will be waiting for it to be compatible with other models of phones.
- A case that is easier to attach and detach without the use of an Allen key (in development). It also means you have to do away with your hard waterproof casing while you use the device as it requires close proximity to the camera.
- To complete my ophthalmic testing the app would benefit from Ishihara plates and visual acuity testing.
I had grand plans to use this in a specific eye and ear institution, show you videos of diseases using the d-eye but while some of us are visionaries others our blinded to advances in medical education (excuse the puns, I had to put them in somewhere). However, this has meant instead of feverish product testing for 4 hours I have intermittently been using the device in my own emergency department for the past 6 months. These are my final thoughts:
- The device is easy to attach (magnetic)
- The app is easy to login, record, and specialists can review your images remotely
- Version 2.0 of the app allows for better visualisation in patients with a darker iris. My tip is to dilate the pupil and use in a low light setting (too light and too dark ambient lighting produces poorer results).
- It requires practise, like most things in medicine there is a technique and after 10+ examinations I found myself automatically using the D-eye instead of the ophthalmoscope attached to the wall which invariably has a bulb that is not working and poorer image quality.
- Its flexibility is where it comes into its own, I’ve used it in the trauma and paediatric setting and for those in remote or 3rd world medicine where blindness is a leading curable co-morbidity this setup could save thousands.