Join Me as I Learn to Use the iCam: Lesson 4. Unclear Media Caused by Misalignment

May 24, 2016

When I’m grading images, the most common image quality issue I see is unclear media resulting from misalignment caused by light hitting the edge of the pupil. When this occurs, I see a hazy ring around the outside of the image. This ring can appear white, yellow, or blue, and prevents the consultant reading the image from seeing the details of the retina on the outside edges of the image. To reduce unclear media it is important that you take the image while the white dots are clear and properly aligned.

The hazy white area marked within the red circle is unclear media as a result of misalignment.

The first step to quickly finding the alignment dots is to make sure that the camera is as centered as possible when entering the pupil. This is accomplished by keeping the circular shadow carefully centered while approaching the eye. As the base of the camera is pushed forward, use the joystick to guide the circular shadow directly over the pupil until the retinal landmarks become visible. At this point it is important to slow down and make very subtle moves with the joystick.

Continue moving the camera forward very slowly until the first alignment dot is found on screen. Please note that the dot can appear anywhere within the retinal view. Once the first dot is located, twist the blue focusing knob on the joystick to either raise or lower the alignment dot to the center of the image. At this point, slowly move the joystick to the right or left to try and locate the second dot. Once both dots are lined up with the hash marks on the side of the screen, move the camera either forward or backward so that the dots become small and sharp. Once both dots are centered in the hashmarks and are in sharp focus, snap the picture. I find it helpful to keep my thumb on the button to take the picture so that the second the dots are in place I can take the image quickly. I have struggled time and time again by waiting too long to take the picture and losing the placement of the dots.

In this photo, the white alignment dots (marked by the red arrows) are perfectly aligned within the hash marks. At this point the photo should be taken.

From time to time, I find myself having a very difficult time locating the first dot. I found that, when this happens, it is beneficial for me to pull the camera away from the patient, re-center the circular shadow, and start the process over from the beginning. In my experience, this is a quicker way to find the dots than to continue to search while you’re inside the pupil. Please let me know if you found this helpful, or if you have any additional questions about using the iCam by emailing me at

Related Articles