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Smartphone ophthalmoscopy: a potential way forward for non-ophthalmology medics in the COVID-19 era
  1. Manbir Nagra1,
  2. Aris Konstantopoulos2,3,
  3. Shahina Pardhan1
  1. 1 Anglia Ruskin University Vision and Eye Research Institute, Cambridge, UK
  2. 2 School of Health and Care Professions, University of Portsmouth, Portsmouth, Hampshire, UK
  3. 3 University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Manbir Nagra, Anglia Ruskin University Vision and Eye Research Institute, Cambridge CB1 2LZ, UK; nagra.manbirk{at}

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It is acknowledged that direct ophthalmoscopy is underutilised by non-ophthalmic specialists, a view which is frequently supported by research.1–4 Omission of ophthalmoscopy is, of course, perilous as it is may lead to delayed diagnosis and treatment. Clinicians will miss the opportunity to undertake a non-invasive in vivo assessment of retinal integrity, vasculature, and the optic nerve head; thus, potentially limiting the examination of patients with suspected conditions such as malignant hypertension; raised intracranial pressure; secondary metastases; and more common ocular conditions such as diabetic retinopathy or macula degeneration.

The exact reasons for poor ophthalmoscopy uptake remain unclear, but there is indication that medics would be more inclined to embrace ophthalmoscopy if there were easier access to a working instrument.2 5 However, such rationale is somewhat at odds with more recent work where constant provision to an ophthalmoscope failed to stimulate a significant increase in usage.3 Other reasons for not undertaking ophthalmoscopy may include time constraints; an inability to see anything useful,2 which could particularly be the case with elderly patients who may have smaller pupils and hospital wards are generally well-illuminated environments; a belief that the procedure was low priority2 or a lack of confidence using the instrument, especially on undilated pupils.6 The consensus appears to be that more training is required.5 Indeed, adequate ophthalmoscopy training in UK medical students has often been a point of concern.7 8

Successful direct ophthalmoscopy …

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  • Contributors Conception: MN; drafting and critical revision: MN, AK and SP; final approval: MN, AK and SP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests A previous publication by MN contains the following statement: ‘The authors were provided two complimentary D-EYE units by the manufacturers for educational purposes; however, the manufacturers were not involved in any aspect of the study’. The publication can be found here:

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.