Panoptic ophthalmoscope

Training started with a 20-min eye anatomy and examination talk with a video overview of TDO technique. Students were asked to have one pupil dilated with tropicamide 0.5% to facilitate fundus examination. All 343 students were randomised into groups of 12–16 students using a computer-generated random number given out on arrival. Each group commenced with a different 10-min station to avoid any learning bias from the order of instruction, and rotated through six stations: (1) NMC with combined ocular coherence tomography [Topcon, 3D OCT-1 Maestro, Tokyo, Japan]; (2) coaxial traditional direct ophthalmoscope (TDO) [Welch Allyn, Macquarie Park, NSW, Australia]; (3) Panoptic Ophthalmoscope [Welch Allyn, Macquarie Park, NSW, Australia], and; smartphone fundoscopy with (4) Panoptic + iExaminer [Welch Allyn, Macquarie Park, NSW, Australia]; (5) D-eye [Padova, Italy]; and (6) a prototype smartphone adaptor each attached to an iPhone 5 or 6 [Apple Inc., Cupertino, CA, USA] (see Additional file 1 for device characteristics). An ophthalmologist and a technical assistant were present at each station providing standardised device instructions and assistance if required. Students then examined each other with each device.

At the beginning of the study, all animals (n = 24) underwent a complete ophthalmological examination. The neuroophthalmological examination consisted in the evaluation of the palpebral, corneal, pupillary (direct and indirect), and dazzle reflexes, as well as visual acuity through a maze test response. The assessment of the anterior segment was done with a portable Biomicroscope (Hawk Eye^®, Dioptrix, Toulouse, France), and the posterior segment was assessed with a PanOptic^® Ophthalmoscope (WelchAllyn, Hillrom, NY, USA). The IOP measurement was performed with a rebound tonometer (Tonolab^®, Icare, Finland). These procedures were repeated immediately after glaucoma induction, and then after 1 h, 3 h, and 1, 2, 3, 5, and 7 days in all groups, and at 14 and 21 days in cases where applied.

The experimental rats were exposed to anesthesia, and their retinas were picturized using fundoscopic examination with a Panoptic ophthalmoscope (Welch Allyn, Skaneateles Falls, USA), in which the retina was illuminated through the pupil (22 (link)).