PH12017050116A1

PH12017050116A1 - Portable gonioscope

Info

Publication number: PH12017050116A1
Application number: PH12017050116A
Authority: PH
Inventors: Jocelyn Therese M Remo; Jaesser T Tan
Original assignee: Jocelyn Therese M Remo; Jaesser T Tan
Priority date: 2017-11-23
Filing date: 2017-11-23
Publication date: 2019-06-10
Also published as: WO2019103631A8; WO2019103631A1

Abstract

The present invention discloses a portable gonioscopy system comprising a portable gonioscope, said gonioscope further comprising a goniolens assembly, a body further comprising a light source with a filtering means, image capturing means such as a microscope lens and a viewing lens or device capable of recording images; and said portable gonioscope being coupled to a viewing means and a recording means. This portable gonioscope provides an alternative device to slit lamp gonioscope, which allows ophthalmological examination specially in the iridocorneal angle of the eye, anywhere possible outside of a hospital, thereby bringing convenience for field works and medical missions in remote areas.

Description

A USB OTG (on-the-go) and web camera app can also be utilized to connect : the portable gonioscope 1000 to any smart device that can serve as a monitor in viewing the iridocorneal angles. The portable gonioscope 1000 may be also equipped ~ with Bluetooth and WIFI technologies for wireless connectivity between said portable o ot gonioscope 1000 and monitor, such as computer or smart devices. Due to the fragility Fut of some parts of the portable gonioscope 1000, a removal outer case is needed to 0 protect the portable gonioscope 1000. -

A person skilled in the art will instantly appreciate that the power source may be the viewing means 105 where the portable gonioscope 1000 is attached, said attachment may be through a USB port, but various alternatives may be done such as a small battery within the said portable gonioscope 1000.

The portable gonioscope 1000 is not limited by the participants’ position; hence it can be used whichever position the participants are comfortable with. An anesthetic drop is placed on the participant’s cornea, similar to current gonioscopy technique with a slit lamp. The tip of the goniolens can be instilled with lubricants eye drops or eye gel for better viewing of the angles, said tip is carefully placed parallel to the participant’s cornea without indenting the cornea. For extra stability, the 4th and

Sth fingers can be rested on the participant's cheeks. While the portable gonioscope 1000 is on the cornea using one hand, the other hand is used for manual focusing of the iridocorneal angles built-in the microscope while viewing from a laptop. Focusing using the portable gonioscope 1000 can be tricky because of small movements that may prove to be difficult in maintaining a good view of the iridocorneal angle. Once the angles are in focus, the other hand is free while the other hand keeps the portable gonioscope 1000 in place. The free hand can be used to write notes, draw angle - images or capture images or videos from the laptop using a camera viewer = application. In this example, a free application for Macintosh, digital viewer from ~

Plugable Technologies, may be used as recording means 106 in recording images and ol videos.

For its use, the portable gonioscope 1000 is basically designed as a viewing = mechanism, but of considerable application in the therapeutic purposes and as an : intra-operative device for doing a Micro-invasive Glaucoma Surgery (MIGS), or doing laser procedures such as Selective Laser Trabeculoplasty (SLT), but not limited to, in which there will be a provision for attachment of the lasers needed for these procedures.

Like gonioscopy through a slit lamp, the examiner must be very careful with movements while doing this procedure as this can cause corneal abrasions. Once the angles are recorded, the portable gonioscope 1000 is removed the eye and the cornea is checked for possible abrasions. With available images of the angles captured, this decreases the need of performing repeat gonioscopy for other ophthaimologist to recheck or verify the angle findings.

To test the portable gonioscope of the present invention, a standard slit lamp routine ophthalmology examination may be done before the procedure. Each patient is : 20 then seated upright, ensuring that the patient was relaxed, looking in front with line of vision parallel to the floor. As part of a standard gonioscopy, Proparacaine (Alcaine ®

Alcon, USA) eye drops prior to testing is instilled. A lubricant is applied on the 4- mirror goniolens to ensure the conjugation of the cornea to the lens. The portable bo

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gonioscope 1000 is placed on the cornea to capture and record images of the . iridocorneal angles.

After the procedure, participants are reexamined under the slit - lamp microscope to examine for possible corneal abrasions incurred during the ~ procedure.

The results are striking and can be seen in Figs. 5 and 6. -

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PORTABLE GONIOSCOPE = =

TECHNICAL FIELD OF THE INVENTION ~

This invention relates to a portable device for medical examinations, in o particular, eye examination devices. This invention further relates to gonioscopes. bo

BACKGROUND OF THE INVENTION 0

Gonioscopy is a very specialized field in ophthalmology, as it interests the study of the iridocorneal angle of the eye.

Despite the advances in the medical field and in modernized technologies worldwide, not much was felt in the area of gonioscopy. Ideal ophthalmological examinations require the slit lamp, which is cumbersome and requires highly specialized skills, aside from its being fixed in a place that does not allow transport for examinations outside of the clinic.

There is an increasing interest in handheld devices in the field of

Ophthalmology. Currently, portable fundus cameras, automated keratometers and refractors, handheld slit lamps, tonometers and OCT cameras are being studied and marketed globally gaining popularity especially to developing countries, where there is lack of patient access to Ophthalmologic Centers. Similarly, the use of portable devices to replace the slit lamp is no longer new in the art. For instance, Perlstein and

Galst disclosed low-power gonioscopic examination of the anterior chamber angle using X4 binocular loupes for magnification and a portable halogen-streak retinoscope as the light source focused on a gonioscopic lens [Perlstein, Seymour H.

and Jay M. Galst. 1981. A new technique for portable gonioscopy. American Journal - of Ophthalmology 91:2:263-264]. The Perlstein-Galst device was designed to examine bedridden patients and other patients with markedly increased intraocular ~ pressure to distinguish between closed- and open-angle glaucoma when a slit-lamp is ~ not available or usable for bedside examination, nursing home consultations, and in o examinations of infants, restless patients, and patients with severe cervical arthritis, by using a pair of magnifying loupes and a halogen-streak retinoscope focused on the ® anterior chamber angle which is seen through a gonioscopic lens. However, such device is so simple as it lacks image capturing and recording means, and, of equal importance, very inconvenient to use for both the ophthalmologist and the patient.

None of these allow a user to appropriately examine the iridocorneal angle as comfortable and portable as the present invention, and with outputs as clear as the present invention. Moreover, with the present medical devices, there is difficulty encountered by an ophthalmologist to examine the iridocorneal angle of the eye during outpatient or field visits and during medical missions in remote areas. Even if combining any two or more of these devices, a person skilled in the art will in no way arrive at the same image outputs of the iridocorneal angle as being offered by the present invention.

BRIEF DESCRIPTION OF THE DRAWINGS

Fig. 1 shows the gonioscopy system of the present invention.

Fig. 2 shows another embodiment of the gonioscopy system of the present invention.

Fig. 3 shows an example of a portable gonioscope. o

Fig. 4 shows another example of a portable gonioscope.

Fig. 5 shows actual images captured on iridocorneal angles before the working ~ distance and magnification adjustments. ~

Fig. 6 shows actual images captured on Iridocorneal angles after the working distance and magnification adjustments. > or

DETAILED DESCRIPTION OF THE INVENTION

The present invention shall now be described in detail.

As shown in Fig. 1, the gonioscopy system 100 comprises goniolens 101 on one end of the embodiment, where a filtering means 102, light source 103, and image capturing means 104 are attached. On the other end, a viewing means 105 and recording means 106 are attached to complete the assembly.

The goniolens 101 may be any goniolens of choice to a user. This shall be positioned in a manner that the image capturing means 104, such as microscope lens, will be able to get a good resolution and eliminate reflections of the iridocorneal angle of the eye. In order to acquire better quality images by the image capturing means 104, a filtering means 102 shall be assembled to diffuse the light coming from the light source 103.

The viewing means 105 can be a lens for direct visualization or a monitor, such as a laptop monitor, a personal computer monitor, or display screen of a mobile device, such as mobile phone or a tablet, and can be employed in real time. The recording means 106 may be an app that is integrated to the viewing means 105 where images and video clips from the actual examination to the iridocorneal angles may be ~ done for future use. The viewing means 105 and the recording means 106 may not be ~ part of the main body of the gonioscope assembly. However, for a person skilled in ~ the art, the said viewing means 105 and the recording means 106 may be integrated to - the gonioscope assembly for easier use. x

In another embodiment, a gonioscopy system is presented wherein a portable ® gonioscope 1000 comprises a goniolens assembly 1100 attached to a body 1200. Said ol body 1200 further comprising a plurality of light source 1201 whose light is being filtered by a filtering assembly 1202, and an image capturing device 1203 that allows the user to view and document the images that will be captured from the subject eye.

This portable gonioscope 1000 is in communication with a viewing means 105 and recording means 106 as described above.

Examples of the portable gonioscope according to the present invention are shown in Figs. 3 and 4. In Fig. 3, the portable gonioscope 1000 comprises a goniolens assembly 201, a body 202, and a handle 203. In Fig. 4, a USB microscope 300 (Fig. 4a) is converted to become the portable gonioscope 1000 (Fig. 4b), where the same parts goniolens assembly 201 and body 202 can be seen. However, for portable gonioscope 1000, the body 202 further comprises adjuster 204 and that the body 202 from the USB microscope 300 is slightly modified to slightly tilt to accommodate the goniolens assembly 201 and focus on the angle being observed.

In gonioscopy, the goniolens is used to overcome total internal reflection in order to view the iridocorneal angles. For the present invention, the USB microscope 300 as previously presented with a light source imitates the slit lamp microscope capabilities. In order to assemble the portable gonioscope 1000, a portable USB < capture function microscope (Unbranded, China) of a USB microscope 300 (see Fig. 4a) may be used. The goniolens is attached to the end of the said microscope. A ~ person skilled in the art may fit and use different goniolens in the goniolens assembly o 201, such as single use 4-mirror goniolens (Volk Optical Inc. Ohio USA) for viewing the iridocorneal angles. Numerous type of goniolens can be used, however, these shall o be installed in order for a user to view iridocorneal angles by focusing the portable > gonioscope 1000 at the center of the gonio prism or mirror of interest.

Light source 103 may be, as already mentioned, the same light source that is integrated in the microscope (Fig. 4a). However, light source 103 may be any light part of the light spectrum depending on the need for such modification. The light beam can be adjusted as to its shape, size and intensity.

Prior to securing the goniolens, the angulation and magnification is adjusted and focused at the center of the mirror of interest. For instance, with the current device using the 4-mirror goniolens (Volk Optical Inc. Ohio USA) the iridocorneal angle, the microscope is angulated perpendicular to the mirror or at 60 +/- 10 degrees in relation to the center of the targeted mirror for observation.

Any material that can be used as a diffuser is placed in front of the light source acting as filtering means 102. For instance, with the working prototype, multiple layers of paper placed on top of the light source 103 were used to diffuse and filter light. In this device, an adapter was used to fixate the goniolens and the microscope in place and allow fine adjustments in aligning the lenses. A focusing knob and photo clicker button were built-in the microscope to serve as the adjuster 204. Alternative to this, the knobs and buttons can be separated from the microscope. This portable - gonioscope 1000 is then attached to a laptop (Macbook Pro Retina 2015, California,

USA) to capture images and record videos. Other capable devices with monitors can ~ be used in viewing and recording the angles. Images of the iridocorneal angles can - now be viewed, captured and stored using a camera viewer mac application (Plugable >

Technologies, Washington, USA). Other webcam software and mobile applications = can be used.

The user may experience difficulty of adjusting microscope from one mirror to the other with poor stability. This can be solved by focusing and fixing the microscope on one mirror at a time. To increase magnification to better visualize iridocorneal structures, the working distance is decreased to the desired magnification.

For instance, the working distance may range from 2 to 15 mm. As seen in Figs. Sa and Sb, images of the iridocorneal angles have fair quality and magnification is adequate. After the working distance was reduced, images are more magnified producing higher quality of images of the iridocorneal angles as seen in Figs. 6a and 6b.

The portable gonioscope combines portability and affordability in viewing and capturing images and videos of the iridocorneal angles. The microscope from the

USB microscope of Fig. 4a has a magnification capacity of 20 to 1000x and can be focused within 0 to 200 millimeters and shall serve as image capturing means 104.

This microscope also has a built-in light and is powered by a laptop through the USB cable, said light serves as the light source 103. To reduce glare and eliminate reflection, any filtering material can serve as filtering means 102 and is placed on the light source 103 to evenly diffuse light and limiting lux to 200-600, or from lux 50- : 600 (see for instance, Figs. 5 and 6). The goniolens assembly 201 comprises the - center of a goniolens mirror that is targeted while assembling the portable gonioscope ~ 1000. To reduce glare, the microscope lens should be perpendicular to one of the o targeted 4-mirror goniolens. Once the mirror is in focus, it is secured with either a ro tape or adhesives. The process can be tricky as minuscule movements while securing o the goniolens to the microscope puts it out of focus. An adapter 210 can be used that . is capable of finer adjustments of the lens angulation and microscope lens working distance while the goniolens and microscope is secured in place. The assembly and adjustments are done while the microscope is powered and viewed from the computer monitor, said computer monitor serving as the viewing means 105. Once the portable gonioscope 1000 is assembled, viewing the iridocorneal angle can be done.

The shape of portable gonioscope 1000 can be but not limited to a straight or an L type design. A mirror may be included in the goniolens assembly 201 by adding it between the goniolens and the microscope lens of image capturing means 104 to bend the light to a desired angle for ease of use. The goniolens assembly 201 may be attached to the body 202 by an adapter 210 which may be a screw-type or clip-type so as to attach and replace different goniolenses for a more universal use.

Adjusting angulation, working distance and goniolens size is subject to pre- determined applications. For instance, a four-mirror goniolens has more mirrors than other goniolens but the field of view is lesser, compared to lesser mirrors that have wider views. The portable gonioscope 1000 shall have a different shape to adjust the angulation in order to accommodate the change in the field of view.

Claims

Co CLAIMS ! LC

1. A portable gonioscope to examine the iridocorneal angle of the eye, o comprising: ~ a goniolens assembly comprising pre-selected goniolens; and fd a body further comprising a filtering means to filter the light coming from a Fe light source, and an image capturing means coupled to the said light - source that captures the image generated from the goniolens assembly; o characterized in that said goniolens assembly further comprising an adapter to enable appropriate focusing of the pre-selected goniolens.

2. The portable gonioscope according to Claim 1, characterized in that said image capturing means is coupled to a viewing means.

3. The portable gonioscope according to Claim 1, further comprising a recording means coupled to said viewing means.

4. A gonioscopy system comprising: a goniolens assembly comprising pre-selected goniolens; a body further comprising a filtering means to filter the light coming from a light source, and an image capturing means coupled to the said light source that captures the image generated from the goniolens assembly; a viewing means coupled to said image capturing means; a recording means coupled to said viewing means.