Journal of the Royal Society of Medicine Volume 84 February 1991

81

camera

that directly

measures

physical parameters

R Ahmed DO

S A Vernon FRCS FCOpth University Hospital, Nottingham NG7 2UH

Academic Unit of Ophthalmology,

Keywords: camera; eye; grid; measurement; ophthalmometer

Summary Accurate measurement of physical parameters is essential for the practice of modern medicine and ophthalmology in particular. A measuring device is presented that combines a single lens reflex (SLR) camera body incorporating two aligned in-camera grids with a calibrated macrozoom attachment. The device has multiple applications wherever accurate measurements are required. The ability to measure and record physical parameters in both health and disease is essential to modern medical practice. This is particularly so in ophthalmology. Despite the relative accessibility of external structures, the clinician's measuring equipment often takes the form of a clear plastic ruler with the ever present possibility of inaccuracy from parallax and perspective1. Indeed, even in the hands of expert observers, the results from the commercially produced Hertel exophthalmometer are prone to significant variation2. Various photographic methods of measurement have been described using a fixed focal length lens system3'4, and recently evaluated5. These, however, require processing of the photographs before measurements can be taken. We present a simple, relatively inexpensive multipurpose device which can measure physical parameters directly and record photographic evidence of these measurements. In essence, the device consists of a single lens reflex (SLR) camera fitted with two carefully aligned grids, linked to a calibrated macrozoom lens.

. .1 . I .. .. 1.. . I I I I m .!. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~. . ... .

Figure 2. Anterior segment photograph 1 :1 magnification where each square is 2 mm across. Vertical palpebral aperture=8.5 mm. Horizontal corneal diameter=11 mm

Optical principles and method of use The 'measuring camera' works on the principle of

measuring the size of the image of an object, rather than the size of the object itself. Modern camera lenses produce a clear wide field image even at high magnification with little peripheral distortion. In an SLR camera, the image ofthe object is focused on the viewfinder screen below the pentaprism and, when the internal mirror is raised, on the film. In the device, two carefully aligned, identical grids are placed inside the camera body, one immediately below the pentaprism, and one immediately in front of the film (Figure 1). The former is seen in the viewfinder screen having been inverted and laterally rotated by the pentaprism, and the latter is superimposed on the film. The size of the image of an object, focused in the plane of each grid, can be measured in terms of grid squares in the viewfinder screen and be recorded by taking a photograph in the normal manner (Figure 2). The macrozoom provides a clear magnified image ofthe object at a greater working distance than other

0141-0768/91/
Figure 1. Cutaway diagram to show positions ofXx2 mm grids in the camera body. G1=grid immediately below pentaprism- P. G2=grid in front of film. V=viewfinder screen. M=45 degree mirror raised during activation of camera shutter
mm

11
ka.0

020081-03/$02.00/0
1991 The Royal Society of Medicine

Figure 3. Calibration photograph of 1 magnification

mm

rule using 1 :1

82

Journal of the Royal Society of Medicine Volume 84 February 1991

^F-~ ~ ~ .-i -. .
: - i | 7i / | _ ?

In Figure 3, where one grid square equals 2 mm, there is a 1/2 mm error when measuring a 30 mm bject. On furtOher xamirtation, the central- five, -grid | 11 can be seen to be accurate. The outer five on squares either side are progressively inaccurate, an object filling the outer third of the frame having an error of 2.5%. This percentage error is constant at different ma_gnifications and probably represents spherical aberration.

low magnification such as 1 1/2 or less is used, _When the device can be hand held, which is particularly

pplications

*L-

..

....

_. .

useful in children (Figure 5). For higher magnification settings, the 'measuring camera' can be mounted on a macro rail which is in turn mounted on a table. A flit lamp table is ideal and provides a chin rest for the patient (Figure 6>. xb A o :: 'we have chosen to show the device in use as a rmuhiprpose ophthaImometer', it can cleakly be use in m'; -L-situations where Accte mements are requiid. The following list of opfhthalmic applications is by no means exhaustive: Facial assymmetry (in particular the relative positions of the orbits)
Corneal diameters

Figure 4. Macrozoom lens exended to show clibration marks

methods of magnification such as autobellows or extension tubes. This feature image permits . varied . * magnification at a standard working distance. Calibration of the grid is performed by photographing a measuring scale such as a steel ruler. The real size of each small square on the grid is 2 x 2 mm? Pr .r r:~_! P_ -A.v _. w __ _ 1: 1, a I mm :tactor of image thus at a magnincation on the grid relates to a 1 mm real object size (Figure 3). Magnification settings are provided on'the lens barrel, and fine focusing is performed by moving the device back and forth, preferably on a macrorail. Intermediate calibrations are aided by the design of the macrozoom. Movement of the lens by 1 mm in an anteroposterior direction'is performed by rotating the barrel approximately 10mm (Figure' 4).'This allows accurate placement of 'further marks on the lens barrel so that magnification factors such as 1: 1.4 are possible. Measurements can then-be taken directly from the grid visible in the viewfinder screen with photographic confirmation if necessary. Perspective error is reduced to a minimum as the depth offield is small. Any deviation ofthe object from the plane of focus results in an unacceptably blurred image in the viewfinder screen.

The- palpebral aperture (and lid excursion in ptosis assessment) Lid and conjunctival tumoura P s ( standardized ambient size ~~~~~~Pupillary the incamera light meter) lighting as assessed by(using Degree of exophthalmos (lateral orbital margin marked as a fixed point). The camera body-can be fitted to a fundus camera to produce retinal photographs with a superimposed grid. Absolate measurements offtndal lesions require individual correction for the optical properties of

Figure 5. The. 'measuring camera' in use to produce photographs similar to that shown in Figure 2

Figure 6. For 4igh magnification work the device can be used with a macrorail system fixed to a slit lamp table

Journal of the Royal Society of Medicine Volume 84 February 1991

83

the eye in question. Serial photographs with identical grid positioning may be of advantage in diabetic retinopathy or tumour size assessment. The principles of this system of measurement are protected by European Patent numbers 0 269 269 and US patent no 480 039.
References
1 Duke Elder S. A system of ophthalmology, vol 7. London: Henry Kimpton, 1962:330 2 Davenger M. Principles and sources of error in exophthalmometry. A new exophthalmometer. Acta Ophthalmol 1970;48:625-33

3 Aizawa F, Tagawa S, Ono K, et al. Photographic estimation of corneal diameter. Folia Ophthalmol Jpn 1971;22:1069-72 4 Kikkawa Y. Measurements of corneal diameter and size of palpebral aperture. Jpn J Contact Lens Soc 1979; 21:76-9 5 Robinson J, Gilmore KJ, Fielder AF. Validation of a photographic method of measuring corneal diameter. Br J Ophthalmol 1989;73:570-3

(Accepted 18 June 1990)

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