Patent Description:
These images are produced either with pharmacological pupil dilation, known as mydriatic fundus imaging, or without pharmacological pupil dilation, known as non-mydriatic fundus imaging. Because pupil dilation is inversely related, in part, to the amount of ambient light, non-mydriatic fundus imaging usually occurs in low lighting environments. Medical professionals can also use fundus imaging apparatus to detect or monitor other diseases, such as hypertension, glaucoma, and papilledema. <CIT>, in the name of Su Wei, describes various examples of an eye imaging apparatus. In some of the described examples, the eye imaging apparatus comprises a light source, an image sensor, a hand-held computing device, and an adaptation module. The adaptation module comprises a microcontroller and a signal processing unit configured to adapt the hand-held computing device to control the light source and the image sensor. The eye imaging apparatus may be used in an eye imaging medical system. The images of the eye may be captured by the eye imaging apparatus, transferred to an image computing module, stored in an image storage module, and displayed in an image review module.

In one aspect, an apparatus for producing a fundus image as recited in claim <NUM> includes: a processor and a memory; an illumination component including a light source and operatively coupled to the processor; a camera including a lens and operatively coupled to the processor, wherein the memory stores instructions that, when executed by the processor, cause the apparatus to: execute an automated script for capture of the fundus image; and allow for manual capture of the fundus image.

In another aspect, a method for capturing one or more images of a fundus of a patient as recited in claim <NUM> includes: capturing specific images of the fundus using an apparatus; automatically uploading the specific images of the fundus to an over read service; and receiving feedback on a quality of one or more of the specific images of the fundus.

The following figures, which form a part of this application, are illustrative of described technology and are not meant to limit the scope of the claims in any manner, which scope shall be based on the claims appended hereto.

<FIG> is a schematic block diagram illustrating an example system <NUM> for recording and viewing an image of a patient's fundus. In this example, the system <NUM> includes a patient P, a fundus imaging system <NUM>, a computing device <NUM> including an image processor <NUM>, a camera <NUM> in communication with the computing device <NUM>, a display <NUM> in communication with the computing device <NUM> and used by clinician C, and a network <NUM>. An embodiment of the example fundus imaging system <NUM> is shown and described in more detail below with reference to <FIG>.

The fundus imaging system <NUM> functions to create a set of digital images of a patient's P eye fundus. As used herein, "fundus" refers to the eye fundus and includes the retina, optic nerve, macula, vitreous, choroid and posterior pole.

In this example, one or more images of the eye are desired. For instance, the patient P is being screened for an eye disease, such as diabetic retinopathy. The fundus imaging system <NUM> can also be used to provide images of the eye for other purposes, such as to diagnose or monitor the progression of a disease such as diabetic retinopathy.

The fundus imaging system <NUM> includes a handheld housing that supports the system's components. The housing supports one or two apertures for imaging one or two eyes at a time. In embodiments, the housing supports positional guides for the patient P, such as an optional adjustable chin rest. The positional guide or guides help to align the patient's P eye or eyes with the one or two apertures. In embodiments, the housing supports means for raising and lowering the one or more apertures to align them with the patient's P eye or eyes. Once the patient's P eyes are aligned, the clinician C then initiates the image captures by the fundus imaging system <NUM>.

One technique for fundus imaging requires mydriasis, or the dilation of the patient's pupil, which can be painful and/or inconvenient to the patient P. Example system <NUM> does not require a mydriatic drug to be administered to the patient P before imaging, although the system <NUM> can image the fundus if a mydriatic drug has been administered.

The system <NUM> can be used to assist the clinician C in screening for, monitoring, or diagnosing various eye diseases, such as hypertension, diabetic retinopathy, glaucoma and papilledema. It will be appreciated that the clinician C that operates the fundus imaging system <NUM> can be different from the clinician C evaluating the resulting image.

In the example embodiment <NUM>, the fundus imaging system <NUM> includes a camera <NUM> in communication with an image processor <NUM>. In this embodiment, the camera <NUM> is a digital camera including a lens, an aperture, and a sensor array. The camera <NUM> lens is a variable focus lens, such as a lens moved by a step motor, or a fluid lens, also known as a liquid lens in the art. The camera <NUM> is configured to record images of the fundus one eye at a time. In other embodiments, the camera <NUM> is configured to record an image of both eyes substantially simultaneously. In those embodiments, the fundus imaging system <NUM> can include two separate cameras, one for each eye.

In example system <NUM>, the image processor <NUM> is operatively coupled to the camera <NUM> and configured to communicate with the network <NUM> and display <NUM>.

The image processor <NUM> regulates the operation of the camera <NUM>. Components of an example computing device, including an image processor, are shown in more detail in <FIG>, which is described further below.

The display <NUM> is in communication with the image processor <NUM>. In the example embodiment, the housing supports the display <NUM>. In other embodiments, the display connects to the image processor, such as a smart phone, tablet computer, or external monitor. The display <NUM> functions to reproduce the images produced by the fundus imaging system <NUM> in a size and format readable by the clinician C. For example, the display <NUM> can be a liquid crystal display (LCD) and active matrix organic light emitting diode (AMOLED) display. The display can be touch sensitive.

The example fundus imaging system <NUM> is connected to a network <NUM>. The network <NUM> may include any type of wireless network, a wired network, or any communication network known in the art. For example, wireless connections can include cellular network connections and connections made using protocols such as <NUM>. 11a, b, and/or g. In other examples, a wireless connection can be accomplished directly between the fundus imaging system <NUM> and an external display using one or more wired or wireless protocols, such as Bluetooth, Wi-Fi Direct, radiofrequency identification (RFID), or Zigbee. Other configurations are possible.

<FIG> illustrates components of an example fundus imaging system <NUM>. The example fundus imaging system <NUM> includes a variable focus lens <NUM>, an illumination LED <NUM>, an image sensor array <NUM>, a fixation LED <NUM>, a computing device <NUM>, and a display <NUM>. Each component is in electrical communication with, at least, the computing device <NUM>. Other embodiments can include more or fewer components.

In one of the embodiments, the variable focus lens <NUM> is a liquid lens. A liquid lens is an optical lens whose focal length can be controlled by the application of an external force, such as a voltage. The lens includes a transparent fluid, such as water or water and oil, sealed within a cell and a transparent membrane. By applying a force to the fluid, the curvature of the fluid changes, thereby changing the focal length. This effect is known as electrowetting.

Generally, a liquid lens can focus between about -<NUM> diopters to about +<NUM> diopters. The focus of a liquid lens can be made quickly, even with large changes in focus. For instance, some liquid lenses can autofocus in tens of milliseconds or faster. Liquid lenses can focus from about <NUM> to infinity and can have an effective focal length of about <NUM> or shorter.

In another embodiment of example fundus imaging system <NUM>, the variable focus lens <NUM> is one or more movable lenses that are controlled by a stepping motor, a voice coil, an ultrasonic motor, or a piezoelectric actuator. Additionally, a stepping motor can also move the image sensor array <NUM>. In those embodiments, the variable focus lens <NUM> and/or the image sensor array <NUM> are oriented normal to an optical axis of the fundus imaging system <NUM> and move along the optical axis. An example stepping motor is shown and described below with reference to <FIG>.

The example fundus imaging system <NUM> also includes an illumination light-emitting diode (LED) <NUM>. The illumination LED <NUM> can be single color or multi-color. For example, the illumination LED <NUM> can be a three-channel RGB LED, where each die is capable of independent and tandem operation.

Optionally, the illumination LED <NUM> is an assembly including one or more visible light LEDs and a near-infrared LED. The optional near-infrared LED can be used in a preview mode, for example, for the clinician C to determine or estimate the patient's P eye focus without illuminating visible light that could cause the pupil to contract or irritate the patient P.

The illumination LED <NUM> is in electrical communication with the computing device <NUM>. Thus, the illumination of illumination LED <NUM> is coordinated with the adjustment of the variable focus lens <NUM> and image capture. The illumination LED <NUM> can be overdriven to draw more than the maximum standard current draw rating. In other embodiments, the illumination LED <NUM> can also include a near-infrared LED. The near-infrared LED is illuminated during a preview mode.

The example fundus imaging system <NUM> also optionally includes a fixation LED <NUM>. The fixation LED <NUM> is in communication with the computing device <NUM> and produces a light to guide the patient's P eye for alignment. The fixation LED <NUM> can be a single color or multicolor LED. For example, the fixation LED <NUM> can produce a beam of green light that appears as a green dot when the patient P looks into the fundus imaging system <NUM>. Other colors and designs, such as a cross, "x" and circle are possible.

The example fundus imaging system <NUM> also includes an image sensor array <NUM> that receives and processes light reflected by the patient's fundus. The image sensor array <NUM> is, for example, a complementary metal-oxide semiconductor (CMOS) sensor array, also known as an active pixel sensor (APS), or a charge coupled device (CCD) sensor.

The image sensor array <NUM> has a plurality of rows of pixels and a plurality of columns of pixels. In some embodiments, the image sensor array has about <NUM> by <NUM> pixels, about <NUM> by <NUM> pixels, about <NUM> by <NUM> pixels, about <NUM> by <NUM> pixels, or about <NUM> by <NUM> pixels.

In some embodiments, the pixel size in the image sensor array <NUM> is from about four micrometers by about four micrometers; from about two micrometers by about two micrometers; from about six micrometers by about six micrometers; or from about one micrometer by about one micrometer.

The example image sensor array <NUM> includes photodiodes that have a light-receiving surface and have substantially uniform length and width. During exposure, the photodiodes convert the incident light to a charge. The image sensor array <NUM> can be operated as a global reset, that is, substantially all of the photodiodes are exposed simultaneously and for substantially identical lengths of time.

The example fundus imaging system <NUM> also includes a display <NUM>, discussed in more detail above with reference to <FIG>. Additionally, the example fundus imaging system <NUM> includes a computing device <NUM>, discussed in more detail below with reference to <FIG>.

<FIG> is an embodiment of a method <NUM> for imaging a patient's fundus using a fundus imaging system. In the embodiment shown, the lighting is optimally dimmed prior to execution, although lowering the lighting is optional. The embodiment shown includes a set depth of field operation <NUM>, a set number of zones operation <NUM>, an illuminate lighting operation <NUM>, an adjust lens focus operation <NUM>, a capture image operation <NUM>, repeat operation(s) <NUM>, a show images operation <NUM> and a determine representative image operation <NUM>. Other embodiments can include more or fewer steps.

The embodiment of method <NUM> begins with setting a depth of field operation <NUM>. In embodiments, the variable focus lens <NUM> is capable of focusing from about -<NUM> diopters to about +<NUM> diopters. Set depth of field operation <NUM> defines the lower and upper bounds in terms of diopters. For example, the depth of field range could be set to about -<NUM> to + <NUM> diopters; about -<NUM> to about +<NUM> diopters; about -<NUM> to about +<NUM> diopters; about -<NUM> to about +<NUM> diopters; about - <NUM> to about +<NUM> diopters; or about -<NUM> to about +<NUM> diopters. Other settings are possible. The depth of field can be preprogrammed by the manufacturer. Alternatively, the end user, such as the clinician C, can set the depth of field.

As shown in <FIG>, the next operation in embodiment of method <NUM> is setting the number of zones operation <NUM>. However, zones operation <NUM> can occur before or concurrent with field operation <NUM>. In zones operation <NUM>, the depth of field is divided into equal parts, where each part is called a zone. In other embodiments, the zones are not all equal. The number of zones is equal to the number of images captured in capture image operation <NUM>.

For example, when the depth of field is from -<NUM> to +<NUM> diopters, the focus of the variable focus lens can be changed by <NUM> diopters before each image capture. Thus, in this example, images would be captured at -<NUM>, -<NUM>, -<NUM>, +<NUM>, +<NUM> and + <NUM> diopters. Or, images could be captured at -<NUM>, -<NUM>, <NUM>, +<NUM> and +<NUM> diopters, thereby capturing an image in zones -<NUM> to -<NUM> diopters, - <NUM> to -<NUM> diopters, -<NUM> to +<NUM> diopters, +<NUM> to +<NUM> diopters and +<NUM> to +<NUM> diopters, respectively. In that instance, the depth of focus is about +/- <NUM> diopters. Of course, the number of zones and the depth of field can vary, resulting in different ranges of depth of field image capture.

In embodiments, both depth of field and number of zones are predetermined. For example, -10D to + 10D and <NUM> zones. Both can be changed by a user.

After the depth of field and number of zones are set, the next operation in embodiment of method <NUM> is the image capture process, which includes illuminate lighting operation <NUM>, adjust lens focus operation <NUM> and capture image operation <NUM>. As shown in <FIG>, the lighting component is illuminated (lighting operation <NUM>) before the lens focus is adjusted (lens focus operation <NUM>). However, lens focus operation <NUM> can occur before or concurrent with lighting operation <NUM>.

The illumination LED <NUM> is illuminated in lighting operation <NUM>. The illumination LED <NUM> can remain illuminated throughout the duration of each image capture. Alternatively, the illumination LED <NUM> can be turned on and off for each image capture. In embodiments, the illumination LED <NUM> only turns on for the same period of time as the image sensor array <NUM> exposure time period.

Optionally, lighting operation <NUM> can additionally include illuminating a near-infrared LED. The clinician C can use the illumination of the near-infrared LED as a way to preview the position of the patient's P pupil.

The focus of variable focus lens <NUM> is adjusted in lens focus operation <NUM>. Autofocusing is not used in embodiment of method <NUM>. That is, the diopter setting is provided to the lens without regard to the quality of the focus of the image. Indeed, traditional autofocusing fails in the low-lighting non-mydriatic image capturing environment. The embodiment of method <NUM> results in a plurality of images at least one of which, or a combination of which, yields an in-focus view of the patient's P fundus.

Additionally, the lack of autofocusing enables the fundus imaging system <NUM> to rapidly capture multiple images in capture image operation <NUM> at different diopter ranges. That is, variable focus lens <NUM> can be set to a particular diopter range and an image captured without the system verifying that the particular focus level will produce an in-focus image, as is found in autofocusing systems. Because the system does not attempt to autofocus, and the focus of the variable focus lens <NUM> can be altered in roughly tens of milliseconds, images can be captured throughout the depth of field in well under a second, in embodiments. Thus, in the embodiment of method <NUM>, the fundus imaging system <NUM> can capture images of the entire depth of field before the patient's P eye can react to the illuminated light. Without being bound to a particular theory, depending on the patient P, the eye might react to the light from illumination LED <NUM> in about <NUM> milliseconds.

The image sensor array <NUM> captures an image of the fundus in capture image operation <NUM>. As discussed above, the embodiment of method <NUM> includes multiple image captures of the same fundus at different diopter foci. The example fundus imaging system <NUM> uses a global reset or global shutter array, although other types of shutter arrays, such as a rolling shutter, can be used. The entire image capture method <NUM> can also be triggered by passive eye tracking and automatically capture, for example, <NUM> frames of images. An embodiment of example method for passive eye tracking is shown and described in more detail with reference to <FIG>, below.

After the fundus imaging system <NUM> captures an image of the fundus, the embodiment of method <NUM> returns in loop <NUM> to either the illuminate lighting operation <NUM> or the adjust lens focus operation <NUM>. That is, operations <NUM>, <NUM> and <NUM> are repeated until an image is captured in each of the preset zones from zones operation <NUM>. It is noted that the image capture does not need to be sequential through the depth of field. Additionally, each of the images does not need to be captured in a single loop; a patient could have one or more fundus images captured and then one or more after a pause or break.

After an image is captured in each of the zones (capture image operation <NUM>) in embodiment of method <NUM>, either the images are displayed in show images operation <NUM> or a representative image is determined in operation <NUM> and then the image is displayed. Show images operation <NUM> can include showing all images simultaneously or sequentially on display <NUM>. A user interface shown on display <NUM> can then enable the clinician C or other reviewing medical professional to select or identify the best or a representative image of the patient's P fundus.

In addition to, or in place of, show images operation <NUM>, the computing device can determine a representative fundus image in operation <NUM>. Operation <NUM> can also produce a single image by compiling aspects of one or more of the images captured. This can be accomplished by, for example, using a wavelet feature reconstruction method to select, interpolate, and/or synthesize the most representative frequency or location components.

The fundus imaging system <NUM> can also produce a three-dimensional image of the fundus by compiling the multiple captured images. Because the images are taken at different focus ranges of the fundus, the compilation of the pictures can contain three-dimensional information about the fundus.

In turn, the image or images from operation <NUM> or <NUM> can be sent to a patient's electronic medical record or to a different medical professional via network <NUM>.

<FIG> illustrates an embodiment of example fundus imaging system <NUM>. The embodiment <NUM> includes a housing <NUM> that supports an optional fixation LED <NUM>, an objective lens <NUM>, fixation LED mirrors <NUM>, variable focus lens assembly <NUM>, display <NUM>, printed circuit board <NUM>, step motor <NUM>, image sensor array <NUM>, and illumination LED <NUM>. Also shown in <FIG> are light paths L that include potential light paths from optional fixation LED <NUM> and incoming light paths from outside the fundus imaging system <NUM>. The illustrated components have the same or similar functionality to the corresponding components discussed above with reference to <FIG> above. Other embodiments can include more or fewer components.

The housing <NUM> of example fundus imaging system <NUM> is sized to be hand held. In embodiments, the housing <NUM> additionally supports one or more user input buttons near display <NUM>, not shown in <FIG>. The user input button can initiate the image capture sequence, at least a portion of which is shown and discussed with reference to <FIG>, above. Thus, the fundus imaging system <NUM> is capable of being configured such that the clinician C does not need to adjust the lens focus.

Fixation LED <NUM> is an optional component of the fundus imaging system <NUM>. The fixation LED <NUM> is a single or multi-colored LED. Fixation LED <NUM> can be more than one LED.

As shown in <FIG>, pivoting mirrors <NUM> can be used to direct light from the fixation LED <NUM> towards the patient's pupil. Additionally, an overlay or filter can be used to project a particular shape or image, such as an "X", to direct the patient's focus. The pivoting mirrors <NUM> can control where the fixation image appears in the patient's view. The pivoting mirrors <NUM> do not affect the light reflected from the patient's fundus.

The embodiment of example fundus imaging system <NUM> also includes a variable focus lens assembly <NUM>. As shown in <FIG>, the variable focus lens assembly <NUM> is substantially aligned with the longitudinal axis of the housing <NUM>. Additionally, the variable focus lens assembly <NUM> is positioned between the objective lens <NUM> and the image sensor array <NUM> such that it can control the focus of the incident light L onto the image sensor array.

The example printed circuit board <NUM> is shown positioned within one distal end of the housing <NUM> near the display <NUM>. However, the printed circuit board <NUM> can be positioned in a different location. The printed circuit board <NUM> supports the components of the example computing device <NUM>. A power supply can also be positioned near printed circuit board <NUM> and configured to power the components of the embodiment of example fundus imaging system <NUM>.

Step motor <NUM> is an optional component in the example embodiment <NUM>. Step motor <NUM> can also be, for example, a voice coil, an ultrasonic motor, or a piezoelectric actuator. In the example embodiment <NUM>, step motor <NUM> moves the variable focus lens assembly <NUM> and/or the sensor array <NUM> to achieve variable focus. The step motor <NUM> moves the variable focus lens assembly <NUM> or the sensor array <NUM> in a direction parallel to a longitudinal axis of the housing <NUM> (the optical axis). The movement of step motor <NUM> is actuated by computing device <NUM>.

The example image sensor array <NUM> is positioned normal to the longitudinal axis of the housing <NUM>. As discussed above, the image sensor array <NUM> is in electrical communication with the computing device. Also, as discussed above, the image sensor array can be a CMOS (APS) or CCD sensor.

An illumination LED <NUM> is positioned near the variable focus lens assembly <NUM>. However, the illumination LED <NUM> can be positioned in other locations, such as near or with the fixation LED <NUM>.

<FIG> illustrates an alternate embodiment of initiate retinal imaging step <NUM> using passive eye tracking. The initiate retinal imaging step <NUM> operates to image the fundus of the patient P using passive eye tracking. In the initiate retinal imaging step <NUM>, the fundus imaging system <NUM> monitors the pupil/fovea orientation of the patient P. Although the initiate retinal imaging step <NUM> is described with respect to fundus imaging system <NUM>, the initiate retinal imaging step <NUM> may be performed using a wearable or nonwearable fundus imaging system, such as a handheld digital fundus imaging system.

Initially, at step <NUM>, the pupil or fovea or both of the patient P are monitored. The fundus imaging system <NUM> captures images in a first image capture mode. In the first image capture mode, the fundus imaging system <NUM> captures images at a higher frame rate. In some embodiments, in the first image capture mode, the fundus imaging system <NUM> captures images with infra-red illumination and at lower resolutions. In some embodiments, the infra-red illumination is created by the illumination LED <NUM> operating to generate and direct light of a lower intensity towards the subject. The first image capture mode may minimize discomfort to the patient P, allow the patient P to relax, and allow for a larger pupil size without dilation (non-mydriatic).

Next, at step <NUM>, the computing device <NUM> processes at least a portion of the images captured by the fundus imaging system <NUM>. The computing device <NUM> processes the images to identify the location of the pupil or fovea or both of the patient P. Using the location of the pupil or fovea or both in one of the images, a vector corresponding to the pupil/fovea orientation is calculated. In some embodiments, the pupil/fovea orientation is approximated based on the distance between the pupil and fovea in the image. In other embodiments, the pupil/fovea orientation is calculated by approximating the position of the fovea relative to the pupil in three dimensions using estimates of the distance to the pupil and the distance between the pupil and the fovea. In other embodiments, the pupil/fovea orientation is approximated from the position of the pupil alone. In yet other embodiments, other methods of approximating the pupil/fovea orientation are used.

Next, at step <NUM>, the pupil/fovea orientation is compared to the optical axis of the fundus imaging system <NUM>. If the pupil/fovea orientation is substantially aligned with the optical axis of the fundus imaging system <NUM>, the process proceeds to step <NUM> to capture a fundus image. If not, the process returns to step <NUM> to continue to monitor the pupil or fovea. In some embodiments, the pupil/fovea orientation is substantially aligned with the optical axis when the angle between them is less than two to fifteen degrees.

Next, at step <NUM>, fundus images are captured by triggering the embodiment of example thru focusing image capturing method <NUM>. In embodiments, five images are captured at step <NUM>. In some embodiments, the fundus image is captured in a second image capture mode. In some embodiments, in the second image capture mode, the fundus imaging system <NUM> captures images with visible illumination and at higher resolutions. In some embodiments, the visible illumination is created by the illumination LED <NUM> operating to generate and direct light of a higher intensity towards the subject. In other embodiments, the higher illumination is created by an external light source or ambient light. The second image capture mode may facilitate capturing a clear, well-illuminated, and detailed fundus image.

In some embodiments, after step <NUM>, the initiate retinal imaging step <NUM> returns to step <NUM> to continue to monitor the pupil/fovea orientation. The initiate retinal imaging step <NUM> may continue to collect fundus images indefinitely or until a specified number of images have been collected. Further information regarding passive eye tracking can be found in <CIT>, titled Ophthalmoscope Device.

<FIG> is an embodiment of example use <NUM> of fundus imaging system <NUM>. In the embodiment of example use <NUM>, a clinician positions the fundus imaging system (operation <NUM>), initiates image capture (operation <NUM>), positions the fundus imaging system over the other eye (operation <NUM>), initiates image capture (operation <NUM>), and views images (operation <NUM>). Although the example use <NUM> is conducted without first administering mydriatic pharmaceuticals, the example use <NUM> can also be performed for a patient who has taken a pupil-dilating compound. The embodiment of example use <NUM> can also include lowering the lighting. The embodiment of example use <NUM> is conducted using the same or similar components as those described above with reference to <FIG>. Other embodiments can include more or fewer operations.

The embodiment of example use <NUM> begins by positioning the fundus imaging system (operation <NUM>). In embodiments, the clinician first initiates an image capture sequence via a button on the housing or a graphical user interface shown by the display. The graphical user interface can instruct the clinician to position the fundus imaging system over a particular eye of the patient. Alternatively, the clinician can use the graphical user interface to indicate which eye fundus is being imaged first.

In operation <NUM>, the clinician positions the fundus imaging system near the patient's eye socket. The clinician positions the aperture of the system flush against the patient's eye socket such that the aperture, or a soft material eye cup extending from the aperture, seals out most of the ambient light. Of course, the example use <NUM> does not require positioning the aperture flush against the patient's eye socket.

When the fundus imaging system is in position, the system captures more than one image of the fundus in operation <NUM>. As discussed above, the system does not require the clinician to manually focus the lens. Additionally, the system does not attempt to autofocus on the fundus. Rather, the clinician simply initiates the image capture, via a button or the GUI, and the fundus imaging system controls when to capture the images and the focus of the variable focus lens. Also, as discussed above at least with reference to <FIG>, the system can initiate image capture using passive eye tracking.

The patient may require the fundus imaging system to be moved away from the eye socket during image capture operation <NUM>. The clinician can re-initiate the image capture sequence of the same eye using the button or the GUI on the display.

After capturing an image in each of the specified zones, the fundus imaging system notifies the clinician that the housing should be positioned over the other eye (operation <NUM>). The notification can be audible, such as a beep, and/or the display can show a notification. In embodiments, the system is configured to capture a set of images of only one eye, wherein the example method <NUM> proceeds to view images operation <NUM> after image capture operation <NUM>.

Similar to operation <NUM>, the clinician then positions the fundus imaging system near or flush with the patient's other eye socket in operation <NUM>. Again, when the system is in place, an image is captured in every zone in operation <NUM>.

After images have been captured of the fundus in each pre-set zone, the clinician can view the resulting images in operation <NUM>. As noted above with reference to <FIG>, the images can be post-processed before the clinician views the images to select or synthesize a representative image. Additionally, the fundus images can be sent to a remote location for viewing by a different medical professional.

<FIG> is a block diagram illustrating physical components (i.e., hardware) of a computing device <NUM> with which embodiments of the disclosure may be practiced. The computing device components described below may be suitable to act as the computing devices described above, such as wireless computing device and/or medical device of <FIG>. In a basic configuration, the computing device <NUM> may include at least one processing unit <NUM> and a system memory <NUM>. Depending on the configuration and type of computing device, the system memory <NUM> may comprise, but is not limited to, volatile storage (e.g., random access memory), non-volatile storage (e.g., read-only memory), flash memory, or any combination of such memories. The system memory <NUM> may include an operating system <NUM> and one or more program modules <NUM> suitable for running software applications <NUM>. The operating system <NUM>, for example, may be suitable for controlling the operation of the computing device <NUM>. Furthermore, embodiments of the disclosure may be practiced in conjunction with a graphics library, other operating systems, or any other application program and is not limited to any particular application or system. This basic configuration is illustrated in <FIG> by those components within a dashed line <NUM>. The computing device <NUM> may have additional features or functionality. For example, the computing device <NUM> may also include additional data storage devices (removable and/or non-removable) such as, for example, magnetic disks, optical disks, or tape. Such additional storage is illustrated in <FIG> by a removable storage device <NUM> and a non-removable storage device <NUM>.

As stated above, a number of program modules and data files may be stored in the system memory <NUM>. While executing on the at least one processing unit <NUM>, the program modules <NUM> may perform processes including, but not limited to, generate list of devices, broadcast user-friendly name, broadcast transmitter power, determine proximity of wireless computing device, connect with wireless computing device, transfer vital sign data to a patient's EMR, sort list of wireless computing devices within range, and other processes described with reference to the figures as described herein. Other program modules that may be used in accordance with embodiments of the present disclosure, and in particular to generate screen content, may include electronic mail and contacts applications, word processing applications, spreadsheet applications, database applications, slide presentation applications, drawing or computer-aided application programs, etc..

For example, embodiments of the disclosure may be practiced via a system-on-a-chip (SOC) where each or many of the components illustrated in <FIG> may be integrated onto a single integrated circuit. Such an SOC device may include one or more processing units, graphics units, communications units, system virtualization units and various application functionality all of which are integrated (or "burned") onto the chip substrate as a single integrated circuit. When operating via an SOC, the functionality, described herein, may be operated via application-specific logic integrated with other components of the computing device <NUM> on the single integrated circuit (chip). Embodiments of the disclosure may also be practiced using other technologies capable of performing logical operations such as, for example, AND, OR, and NOT, including but not limited to mechanical, optical, fluidic, and quantum technologies.

The computing device <NUM> may also have one or more input device(s) <NUM> such as a keyboard, a mouse, a pen, a sound or voice input device, a touch or swipe input device, etc. The output device(s) <NUM> such as a display, speakers, a printer, etc. may also be included. The aforementioned devices are examples and others may be used. The computing device <NUM> may include one or more communication connections <NUM> allowing communications with other computing devices. Examples of suitable communication connections <NUM> include, but are not limited to, RF transmitter, receiver, and/or transceiver circuitry; universal serial bus (USB), parallel, and/or serial ports.

The term computer readable media as used herein may include non-transitory computer storage media. The system memory <NUM>, the removable storage device <NUM>, and the non-removable storage device <NUM> are all computer storage media examples (i.e., memory storage. ) Computer storage media may include RAM, ROM, electrically erasable read-only memory (EEPROM), flash memory or other memory technology, CD-ROM, digital versatile disks (DVD) or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other article of manufacture which can be used to store information and which can be accessed by the computing device <NUM>.

Although the example medical devices described herein are devices used to monitor patients, other types of medical devices can also be used. For example, the different components of the CONNEX™ system, such as the intermediary servers that communication with the monitoring devices, can also require maintenance in the form of firmware and software updates. These intermediary servers can be managed by the systems and methods described herein to update the maintenance requirements of the servers.

Embodiments of the present invention may be utilized in various distributed computing environments where tasks are performed by remote processing devices that are linked through a communications network in a distributed computing environment.

The block diagrams depicted herein are just examples. There may be many variations to these diagrams described therein without departing from the scope of the disclosure. For instance, components may be added, deleted or modified.

While embodiments have been described, it will be understood that those skilled in the art, both now and in the future, may make various improvements and enhancements can be made.

As used herein, "about" refers to a degree of deviation based on experimental error typical for the particular property identified. The latitude provided the term "about" will depend on the specific context and particular property and can be readily discerned by those skilled in the art. The term "about" is not intended to either expand or limit the degree of equivalents which may otherwise be afforded a particular value. Further, unless otherwise stated, the term "about" shall expressly include "exactly," consistent with the discussions regarding ranges and numerical data. Concentrations, amounts, and other numerical data may be expressed or presented herein in a range format. It is to be understood that such a range format is used merely for convenience and brevity and thus should be interpreted flexibly to include not only the numerical values explicitly recited as the limits of the range, but also to include all the individual numerical values or sub-ranges encompassed within that range as if each numerical value and sub-range is explicitly recited. As an illustration, a numerical range of "about <NUM> percent to about <NUM> percent" should be interpreted to include not only the explicitly recited values of about <NUM> percent to about <NUM> percent, but also include individual values and sub-ranges within the indicated range. Thus, included in this numerical range are individual values such as <NUM>, <NUM> and <NUM> and sub-ranges such as from <NUM>-<NUM>, from <NUM>-<NUM>, and from <NUM>-<NUM>; etc. This same principle applies to ranges reciting only one numerical value. Furthermore, such an interpretation should apply regardless of the breadth of the range or the characteristics being described.

Referring now to <FIG>, another example fundus imaging system <NUM> is shown. The embodiment <NUM> is similar to the fundus imaging system <NUM> described above.

The fundus imaging system <NUM> includes a housing <NUM> that supports a display <NUM> at a first end and an opposite end <NUM> configured to engage an eye of the patient. As described herein, the fundus imaging system <NUM> can be used to implement one or more of the described methods for imaging of the fundus.

Yet another embodiment of an example fundus imaging system <NUM> is shown in <FIG>. In this example, the body of the fundus imaging system <NUM> can be formed of two or more materials overmolded upon one another. For example, a first polymeric material can be used to form the main body, and a second, softer polymeric material can be overmolded onto the first material to form bumper and/or grip areas, as depicted in <FIG>. These overmolded areas provide a softer and slip-resistant surface for easier grapping and holding of the fundus imaging system <NUM>. The multiple gripping surfaces allow the clinician C to decide how best to hold the fundus imaging system <NUM> in use.

Referring now to <FIG>, the fundus imaging system <NUM> is shown in use on the patient. The fundus imaging system <NUM> is placed with an end (e.g., opposite end <NUM>) adjacent to or touching the patient's face surrounding the desired eye socket.

Specifically, an end <NUM> of an example eye cup <NUM>, shown in <FIG>, is positioned at the end <NUM> of the fundus imaging system <NUM> or <NUM>. An opposite end <NUM> is positioned again the eye socket surrounding the eye for which imaging will occur. In this example, the eye cup <NUM> is formed of a polymeric material that is flexible in an accordion-like manner. This allows the fundus imaging system <NUM> or <NUM> to be moved by the clinician C towards and away from the patient's eye while still maintaining contact with the patient's face. Other configurations are possible.

In another example system <NUM> for recording and viewing an image of a patient's fundus shown in <FIG>, the system <NUM> is cloud-based (e.g., includes a plurality of servers with storage accessible from a large network such as the Internet) and allows for communication and storage of fundus images across LANs, WANs, and the Internet. In this example, a device <NUM>, which is identical and/or similar to the systems <NUM>, <NUM> described above, can be used to capture an image, associate that image with a patient, review the image, and annotate the image as desired.

Upon completion, the image can be uploaded to a cloud system <NUM> using a batch or more instant configuration. When uploaded, the image can be tagged with device and patient information, such as a barcode associated with the patient and/or a patient picture. The cloud system <NUM> can be configured to provide patient lists and to accept or reject an image based upon given criteria, such a patient name and quality of image. The cloud system <NUM> can also be used to provide notifications, such as image availability, to the clinician C and/or patient. In addition, the cloud can forward the image and patient information to an EMR <NUM> for storage.

In addition, the cloud system <NUM> can be used to provide a portal to allow for access to images by a device <NUM> of the clinician C and/or patient device <NUM> using a computing device such as a personal computing device, tablet, and/or mobile device. This can allow the images to be viewed, manipulated, etc. The cloud system <NUM> can be used to capture clinician C annotations and diagnoses. In addition, the cloud system <NUM> can be configured to interface with other third parties, such as insurance companies to allow for billing.

The systems <NUM>, <NUM> can be configured to operate in both manual and automatic modes when interfacing with the cloud system <NUM>. The automatic mode includes one or more scripts that automate certain processes for the systems <NUM>, <NUM>. See <FIG> described below. These processes include automation of image focus and capture (acquisition) and output to the cloud for storage. In the manual mode, the various processes can be manually controlled by the clinician C, such as focus on the fundus, capture of one or more images at desired times, and then uploading of the image(s) to the cloud. See <FIG> described below.

A notification scheme is used for charging of the systems <NUM>, <NUM>. In these examples, the systems <NUM>, <NUM> are wireless and include a rechargeable battery pack, such as a lithium-ion battery or similar battery. In this example, a bi-color LED is used to indicate a status of charging of the battery pack when placed in a charging cradle <NUM>. The LED is left off if charging is not occurring - this is the default state. When the systems <NUM>, <NUM> are charging (e.g., when plugged into a dock), the LED is illuminated a solid amber to indicate charging of the battery and a solid green when the battery charging is completed. If an error occurs during charging, the LED flashes an amber color. Other configurations are possible.

Different example operating states for the fundus imaging systems <NUM>, <NUM> are possible. For a clinician that gathers the images from the patient, the systems <NUM>, <NUM> can be used to select a patient, adjust the eye cap, take an image, determine a quality of the image, and review the status of an image capture process. In addition, various other features, such as adjustment of connectivity (e.g., WiFi) and cleaning of the device can be accomplished. Additional details on some of these processes are provided below.

Further, a physician (sometimes the same individual who captured the images or a different individual, such as an individual located at a remote location) can review the results of the image captures and develop/review a report based upon the same. <NUM> described below.

Example processes are performed in the cloud system <NUM> based upon each individual or service within the system. For the clinician capturing the images, the cloud system <NUM> can be used to add new patients, schedule the procedure, and check the status of the procedure. For the physician reviewing the images, the cloud system <NUM> can be used to check status, review the images, and generate/review a report based upon review of the images. Notifications can also be created and sent to, for example, the clinician or patient.

The systems <NUM>, <NUM> can be used to transmit scheduling and/or image information to and from the cloud system <NUM>. The EMR <NUM> is in communication with the cloud system <NUM> to transmit and store image and diagnoses information for each patient. Other configurations are possible.

An over read service <NUM> is also shown in <FIG>. The over read service <NUM> can interact with the cloud system <NUM> to provide additional resources for analyzing the images, including reading of images and generating of reports. Other functions of the example system <NUM> include capture and forwarding of images to the cloud and communication between the cloud and the EMR <NUM> for storage thereof.

For example, in one embodiment, the device <NUM> is used to capture one or more fundus images. After capture, the device <NUM> is returned to the charging cradle <NUM>. Upon placement of the device <NUM> into the cradle <NUM>, the captured images are automatically transferred to the cloud system <NUM>. This transfer can be automated, so that no further action is required by the user to transfer the images from the device <NUM> to the cloud system <NUM>.

Upon submission to the cloud system <NUM>, the images can be automatically reviewed for quality. The images can also be automatically forwarded to the over read service <NUM> for review. One or more clinicians can thereupon review the images and provide feedback from the over read service <NUM> back to the cloud system <NUM>. At this point, the cloud system <NUM> can provide notification to the devices <NUM>, <NUM> regarding the information from the over read service <NUM>.

An example method for using the systems <NUM>, <NUM> to capture fundus images includes preliminary tasks such as the capturing of patient vitals and education of the patient on the procedure are done. Once this is done, the system <NUM>, <NUM> is powered on and the patient is selected on the device. The eye cup is then positioned on the patient and one or more images are captured using automated and/or manual processes. The images can then be checked. If accepted, the images are saved and/or uploaded to the cloud. The system <NUM>, <NUM> can be powered off and returned to its cradle for charging. A physician can thereupon review the images, and the clinician C or patient can be notified of the results.

In an example method for obtaining a good quality image of the fundus using the systems <NUM>, <NUM>, after an image is captured, the clinician can accept or reject the image. If rejected, a script can be executed that provides manual or automated instructions on how to capture a desired image quality. The clinician thereupon gets another opportunity to capture an image and then to accept or reject it. If the image is accepted, automated processes can be used to determine a quality of the image. If accepted, further scripting can occur. If not, the clinician can be prompted to take another image.

An example method is provided to allow for capture of images even when the system <NUM>, <NUM> loses connectivity with the cloud. In such an instance, automated quality checks may not be provided, and the clinician may be prompted as such. The clinician can then decide whether or not to accept the image without the quality check or to cancel the procedure. In addition, the system <NUM>, <NUM> can be used to trouble shoot connectivity issues, as described further below.

An example method for allowing the clinician to select the patient on the system <NUM>, <NUM> includes a work list that is provided that identifies patients based upon one or more given criteria, such as the clinician, location, time of day, etc. The clinician is thereupon able to select the patient and confirms the proper patient has been selected, such as by comparing a code with one worn by the patient for from a picture of the patient. Thereupon, after selection of the patient, one or more images can be captured and stored. The captured images are associated with the selected patient.

In a similar manner, an example method allows the clinician to assure that the proper patient is selected. Upon power-up of the system <NUM>, <NUM>, unique information is sent to the cloud, such as the system's serial number. The could looks-up the serial number and returns a list of patients associated with that system. The clinician can thereupon select the patient from the list or manually enter the patient into the system <NUM>, <NUM> if the patient is not on the work list.

A user interface allows the user to pick between a selection of patients, examinations, review, and settings. If a patient is selected, the system <NUM>, <NUM> proceeds with imaging of the fundus using an automated and/or manual process. Icons are used to represent different contexts on the user interfaces of the system <NUM>, <NUM>.

The following example workflows/methods are implemented by the systems <NUM>, <NUM>. Additional details regarding these workflows can also be found with reference to FIGs. <NUM>-<NUM>.

An example method for automatic examination and image capture starts when the clinician selects the examination icon on the system <NUM>, <NUM>. Upon initiation, the clinician is presented with an interface that allows for automatic acquisition of the fundus image. This can be accomplished in three stages, including pre acquisition, acquisition, and post-acquisition. During pre-acquisition, the clinician selects the patient and configures the system as desired. During acquisition, the image is captured using automated or manual processes. Finally, post-acquisition, quality checks are performed and the clinician can save the image(s) if desired. See <FIG> described further below.

An example method for adjusting certain settings of the system <NUM>, <NUM> includes, for example, brightness and focus, which can be selected automatically or manually manipulated by the clinician.

An example method for manually acquiring an image is similar to the method described above, except the acquisition of the images is done manually by the clinician. This is accomplished by the clinician manually indicating when an image is to be taken. Upon capture, the image can be verified manually or automatically.

An example method for navigating one or more captured images includes a user interface that is used to scroll through the captured images in a sequence. Upon review, the images can be submitted, if desired.

An example method for selecting a patient from a worklist starts upon selection of the patient icon from the interface for the system <NUM>, <NUM>. A list of patients is presented to the clinician in the worklist. The clinician can select a patient from the list to be presented with additional information about that patient, such as full name, date of birth, and patient ID. If any unsaved images exist, those images are associated with the selected patient. If not, a new examination routine is executed to allow for capture of images to be associated with the selected patient.

An example method allows for the clinician to manually enter new patient information into the system <NUM>, <NUM>. This includes patient name, date of birth, and/or patient ID. Once entered, the patient information can be associated with captured images.

An example method allows the clinician to search for a specific patient using such parameters as patient name, date of birth, and/or patient ID. Once found, the clinician selects the patient for further processing.

An example method for refreshing the patient worklist includes assuming there is connectivity (e.g., to the cloud), the clinician selecting a refresh button to manually refresh the list with the most current patient names. The system <NUM>, <NUM> is also programmed to periodically refresh the list automatically at given intervals and at other given periods, such as upon startup or shutdown. Other configurations are possible.

An example method allows a clinician to review a patient test on the system <NUM>, <NUM>. Upon selection of a patient, the clinician can review patient summary information (e.g., full name, date of birth, and patient ID) and previous examination summary information, such as items from the examination and image quality scores, which indicate how good the image quality was from those examinations.

An example method for saving images allows, after acquisition, the clinician to review the images in sequence. For each image in the workspace, the image is quality-checked and the status of the image is displayed to the clinician. The clinician uses the user interface to review each acquired image and to save or discard the image.

An example method labeling eye position allows the clinician to select upon five eye positions, including off (default), left eye optic disc centered, left eye macula centered, right eye macula centered, and right eye optic disc centered.

An example method allows for manual adjustment of settings for image acquisition. In this example, the clinician has access to various settings that can be adjusted manually, such as PET and focus and brightness. See <FIG> described below.

An example method for adding images includes, once an image is captured, the clinician manually adding the image to a workspace if desired. Once added, the image can be reviewed and stored, if desired. In this example, up to four images can be added to a workspace for review. Other configurations are possible. See <FIG> described below.

An example method for entering advanced settings such settings as volume, time, date, etc. can be accessed upon entering of a password or access code by the clinician. In one method, an access code is needed to change certain settings, and an advanced settings code is needed to change other advance settings. Other configurations are possible.

In an example method for selecting network connectivity, a plurality of WiFi networks are shown, and the clinician can select one for connection thereto. Upon successful connection, the system <NUM>, <NUM> can communicate with the cloud.

In an example method for image inspection, once an image is selected, it is displayed to the clinician for review. The user can discard the image or move forward with image capture, as desired.

In an example method for discard of an image, a number of discards is tallied. If over a threshold amount (e.g., <NUM>, <NUM>, <NUM>, <NUM>, etc.), a warning can be given that further image acquisition could be uncomfortable for the patient.

In an example method for returning to a home screen, a home button is provided on each interface. When selected, the home screen interface is shown, allowing the clinician to make initial selections like patient list, examination, review, and settings.

If the home button is selected when there are unsaved images, the clinician is first prompted to save or discard the images before returning to the home screen. In this example, the method includes displaying a prompt with a save button to allow the clinician to save the images. Once saved, the home screen is displayed.

In an example method for docking the system <NUM>, <NUM>, the system <NUM>, <NUM> is placed in a charging cradle. Upon connection with the cradle, an icon indicating a USB connection is displayed on the dock and/or the system <NUM>, <NUM>. If acquisition is complete, the screen is turned off and sleep is instituted without a certain time period (e.g., one minute). If acquisition is not complete, the clinician is prompted to complete acquisition.

In an example method for assuring that all items for an examination have been received or overridden, if items are missing, the save button is disabled. However, the clinician can select the override button and, in certain contexts, allow for saving of data without all required items (e.g., a skipped indication) being present.

In an example method for updating software on the system <NUM>, <NUM>, software can be uploaded from a removable storage medium (e.g., SD card) during boot to update the software on the system <NUM>, <NUM>. In other examples, software can be downloaded, such as from the cloud.

In another example for waking the system <NUM>, <NUM> from sleep, the user can press the home button to wake the system. Upon wake, a login screen can be presented, requiring the clinician to enter an access code to use the system <NUM>, <NUM>.

In some examples a method is provided for training purposes. In this embodiment, training information can be accessed from the home screen. The training can provide user interface information that trains the user on the configuration and use of the system <NUM>, <NUM>.

Referring now to <FIG>, in some example, the system <NUM> allows for messaging to the clinician who is capturing the fundus images. For example, the cloud system <NUM> and/or the clinicians working as part of the over read service <NUM> can directly message the clinician capturing the fundus images regarding such as issues as image quality.

For example, <FIG> shows a method <NUM> that allows the over read service to message the clinician obtaining the fundus images with the device <NUM>. Such messages can be addressed using various methods, such as device name, device ID (serial number / MAC address), device IP address, etc. In this example, one or more messages are provided by the over read service <NUM> to the cloud system <NUM>. At operation <NUM>, the device <NUM> connects to the cloud system <NUM> using a known protocol, such as TCP/IP. At operation <NUM>, a determination is made regarding whether or not a message is waiting for the device <NUM>. If so, control is passed to operation <NUM>, and a determination is made regarding whether or not a particular graphical user interface (e.g., a home screen) is being displayed on the device <NUM>. If so, control is passed to operation <NUM>, and a message is presented to the clinician on the graphical user interface.

At <FIG>, one example of such a message <NUM> is shown. The message <NUM> can be displayed so as to get the attention of the clinician operating the device <NUM>, such as by popping up, color, sound, etc. The message <NUM> can provide information regarding the quality of the images that have been captured by the device <NUM>. For example, if the images are not of a sufficient quality for the over read service <NUM>, the over read service <NUM> can send a message to the device <NUM>. The clinician C can read the message, as well as information about how to remedy the situation (e.g., the message could provide information such as "Clean a certain part of the lens, etc.).

In addition to the messaging between the device <NUM> and the cloud system <NUM> described above, the cloud system <NUM> can be used to store various information associated with the examination of a given patient. For example, as the fundus images are captured, the clinician C can adjust various settings associated with the device <NUM>, such as brightness, focus, etc. Once a desired set of settings is identified for a particular patient, these settings can be stored in the cloud system <NUM> (e.g., in a database) and/or the EMR <NUM> and associated with the patient. When the patient returns for a subsequent examination, the device <NUM> can be configured to automatically access the settings for the device <NUM> by downloading the settings from the cloud system <NUM>. In this manner, the device <NUM> can be automatically configured according to those settings for subsequent capture of the patient's fundus images.

Referring now to <FIG>, an example workflow <NUM> for automatically capturing fundus images using the device <NUM> is shown. The workflow <NUM> is automatically performed by the device <NUM> to provide a standardized fundus examination. The workflow <NUM> includes a selection stage <NUM>, a pre-acquisition stage <NUM>, an acquisition stage <NUM>, and a post-acquisition stage <NUM>.

At the selection stage <NUM>, the clinician C is presented with a menu of options, including an examination icon. The clinician C selects the examination icon to initiate the workflow <NUM>.

At the pre-acquisition stage <NUM>, the clinician C is presented by the device <NUM> with options to start the workflow <NUM> or to perform a manual capture of fundus images (see <FIG>). The clinician C selects the "Start" button <NUM> to begin the workflow <NUM> (or can select the manual capture icon <NUM> to manually capture images as described further below.

At the acquisition stage <NUM>, the device <NUM> automatically captures the desired fundus images from the patient P. The image capture can include one or more tones indicating the capture of images, along with automated quality checks on the images. An example of such a process for automating the capture of fundus images is described in <CIT>.

Finally, at the post-acquisition stage <NUM>, the clinician C can review the captured images. The clinician C can perform such actions as discarding images and/or adding images, as described further below.

For example, the clinician C can decide to discard one or more of the fundus images. In one example, the clinician C is provided with various options. If one option is selected (e.g., a "Close" icon <NUM>), the device <NUM> returns to the pre-acquisition stage <NUM>. If another option is selected (e.g., a trash icon <NUM>), the device <NUM> returns to the acquisition stage <NUM> to allow for the immediate retake of the fundus image(s). Other configurations are possible.

In another example, clinician C can add images for the patient P. In this example shown in <FIG>, a user interface includes a control <NUM> that allows the clinician C to add images by returning the device <NUM> to the pre-acquisition stage <NUM>. At that point, the device <NUM> can be used to capture further fundus images that are associated with the patient P.

In addition, other workflows can be performed by the device <NUM>. For example, the workflow <NUM> can be a default workflow for the device <NUM>, but the device <NUM> can be configured to perform a modified workflow depending on which over read service <NUM> is used. For example, a particular over read service <NUM> may be defined requirements for such parameters as: number of fundus images; type of fundus images (e.g., left, right, macula entered, optic disc centered, etc.); order of capture sequence.

In some examples, the workflow for the device <NUM> is defined by one or more scripts. The scripts can be downloaded from the cloud system <NUM> to allow for the modification of the functionality of the device <NUM>. A particular script can be selected by the clinician C to modify the workflow for the device <NUM>. In addition, the device <NUM> can be programmed to automatically select a script based upon such parameters as clinician C preference, over read service, etc..

In addition to the automated workflow <NUM>, other configurations are possible. For example, as part of the automated capture of fundus images, the clinician C can select to manually capture one or more fundus images. Specifically, during the pre-acquisition stage <NUM> or the acquisition stage <NUM>, the clinician C can select one of the manual capture icons <NUM>, <NUM> to have the device <NUM> capture an image. Other configurations are possible.

Referring now to <FIG>, in some examples, the pre-acquisition stage <NUM> allows the user to pre-select an eye position and fixation target before taking fundus image(s). In this example, controls <NUM> are provided that allow the clinician C to select eye position (e.g., left, right, macula entered, optic disc centered, etc.) before images are either automatically (by selecting "start") and/or manually (by selecting "manual") captured using the device <NUM>.

When manually capturing images, the device <NUM> is programmed as depicted in <FIG> to assist the clinician C with aiming the device <NUM> for capturing the fundus image(s). In this example, a circular element <NUM> guides the clinician C with the initial approach of the device <NUM> to the eye. A diamond element <NUM> thereupon provides the user with adjustment guidance once the device <NUM> is in the correct proximity to the patient P's eye. Specifically, when the device <NUM> is focused in the inner eye, a retina reflection will appear in the view. The clinician C can thereupon use micro adjustments of the barrel of the camera to move the reflection into the diamond element <NUM>. Once in position, the device <NUM> will automatically trigger a capture of the image.

Referring now to <FIG>, the device <NUM> provides the clinician C with a readily discernable indication of image quality after the image is captured. As shown in <FIG>, the device <NUM> provides an indicator <NUM> that indicates the quality of the captured fundus image. In this example, color (e.g., red is bad, yellow is passable, green is good) is used, along with a signification of quality (e.g., check mark is passable). In addition, the indicator <NUM> includes a quality score, such as a value ranging from <NUM> (lowest quality) to <NUM> (highest quality). In another example of <FIG>, the red "X" indicates a poor quality image that fails the lowest standards for, for example, the over read service. In such a scenario, the fundus images can be recaptured using the device <NUM>. Other configurations are possible.

Once fundus images have been captures, the device <NUM> provides a reporting table <NUM> shown in <FIG>. This reporting table <NUM> provides a summary of the images for easy review by the clinician C. In this example, the reporting table <NUM> includes an entry <NUM> for each image. This entry <NUM> provides an indication of the image quality (e.g., using the color, icon, and/or scores described above) and image type (e.g. portion of the image captured). The clinician C can edit contextual information associated with the images, such as the image type. The clinician C can also select one or more of the entries <NUM> to perform such functions as discard and/or retake certain images. After review is complete, the clinician C can select a save button <NUM> to save the desired images and/or upload those images to the cloud system <NUM>. Other configurations are possible.

Claim 1:
A system for recording and viewing an image of a patient's fundus, the system comprising an apparatus (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>) for producing a fundus image, and an over read service (<NUM>), the apparatus (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>) comprising:
a processor (<NUM>) and a memory (<NUM>);
an illumination component including a light source and operatively coupled to the processor (<NUM>);
a display (<NUM>); and
a camera (<NUM>) configured to record images of a fundus, the camera including a lens (<NUM>, <NUM>, <NUM>) and operatively coupled to the processor (<NUM>),
wherein the memory (<NUM>) stores instructions that, when executed by the processor (<NUM>), cause the apparatus (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>) to:
provide a user interface on the display (<NUM>) including options for a user to select an eye position and fixation target before taking a fundus image, and options for a user to select to perform automatic capture of a fundus image or manual capture of a fundus image;
define specific images of a patient's fundus for capture on selection by a user of an eye position and fixation target;
capture the specific images of the patient's fundus either automatically or manually depending on the selection of a user on the user interface, the capturing including:
execution of an automated script for capture of the fundus image on selection of the option to perform automatic capture of a fundus image;
execution of instructions that allow a user to override the automated script for capture of the fundus image to manually capture the fundus image on selection of the option to perform manual capture of a fundus image, the instructions for manually capturing the fundus image including:
providing one or more guides to assist the user to position the apparatus relative to the eye of a patient; and
automatically triggering the capture of the fundus image when the user moves the apparatus into position;
automatically send one or more of the specific images of the patient's fundus to the over read service (<NUM>) to obtain feedback directly from one or more clinicians working as part of the over read service (<NUM>) regarding the fundus image;
receive feedback from the one or more clinicians working as part of the over read service (<NUM>) on a quality of one or more of the one or more images of the fundus; and
present a message on the display including the feedback on the quality of the fundus image from the over read service (<NUM>).