Kraig Jamieson
Introduction
Being bleeped to assess an acute red eye on the ward is a familiar scenario for many junior doctors. The urgency is often heightened by anxiety – from the patient worried about their vision, from nursing staff keen for a clear plan, and from the reviewing clinician conscious of the wide differential diagnosis that accompanies ocular complaints. Yet the practical reality is that a full ophthalmic examination setup is rarely available outside clinic hours. What follows is often a compromise: a pen torch borrowed from a nurse, fluorescein tracked down from another ward, and an examination conducted under less-than-ideal conditions.
For junior doctors covering acute wards out of hours, this gap between expectation and practical reality is a common and uncomfortable one.
It was during one such on-call review that I used the ArcLight, and realised how transformative a single, portable tool could be in this setting – not only for the clinician, but for the patient and the wider multidisciplinary team.
What Is the ArcLight?
The ArcLight is a compact, low-cost, solar-powered ophthalmoscope and examination light designed to combine multiple ophthalmic examination functions into a single handheld device (1). Originally developed for use in low-resource settings, it was created to address the global challenge of limited access to ophthalmic equipment, particularly in rural or underserved areas (1,2). Its design and functionality have clear relevance to acute care environments in high-income healthcare systems.
The device incorporates a white LED for general illumination, a blue LED suitable for fluorescein examination, magnification for anterior segment assessment, and a direct ophthalmoscope function (1,3). It is lightweight, durable, and requires no charging cables or wall power, meaning it can be carried easily on call and used immediately at the bedside, in emergency departments, or on wards where access to ophthalmic equipment may be limited.
The On-Call Scenario
I was covering the medical floor as a junior registrar on a Sunday night when I overheard the team debating whether to bleep the ophthalmology registrar for a patient with a red eye. The ward staff had searched unsuccessfully for an ophthalmoscope and were preparing to escalate the call at 3 a.m. Recognising an opportunity, I offered to assess the patient using the ArcLight.
At the bedside, the ArcLight allowed a structured examination without delay. Visual acuity was assessed using near vision testing (4). Examination of the anterior segment under white light showed mild conjunctival injection with no discharge or lid margin abnormality, and fluorescein staining under blue light revealed no corneal abrasion or epithelial defect (1,3). The red reflex was symmetrical, and a basic fundoscopic assessment was unremarkable (3,5).
The working diagnosis was simple dry eye, managed conservatively with lubricating drops.
What struck me most was the broader impact of this encounter. The ophthalmology registrar was not disturbed overnight, the ward team avoided unnecessary disruption, and the patient received prompt reassurance and treatment. The availability of a portable examination tool transformed what could have been a stressful and fragmented review into a calm, efficient bedside assessment.
The ArcLight in Practice
In this scenario, the ArcLight’s value lay in its ability to consolidate multiple examination steps into a single, uninterrupted bedside assessment. Rather than pausing to locate equipment or moving the patient to another area, the examination proceeded logically and without delay. The white LED provided sufficient illumination to assess conjunctival injection, lid margins, and corneal clarity, while the integrated blue light enabled fluorescein examination without the need for additional devices (1,3).
Although fundoscopy was necessarily limited compared with a clinic-based examination, the ability to assess the red reflex and obtain a basic view of the fundus provided additional reassurance (3). In this case, these findings were sufficient to exclude serious pathology and support conservative management.
Studies evaluating the ArcLight in clinical and educational settings have demonstrated its utility for anterior segment assessment and direct ophthalmoscopy, supporting its role as a pragmatic bedside tool rather than a replacement for full ophthalmic equipment (2,4,5).
Impact on the Patient and the Wider Team
From the patient’s perspective, the examination felt thorough and transparent. Each step could be explained as it was performed, and reassurance was immediate rather than deferred. Being examined at the bedside, rather than transferred elsewhere, appeared to reduce anxiety and foster trust in the assessment process (3,5).
For nursing staff, the review was minimally disruptive. There was no need to locate additional equipment, rearrange beds, or escort the patient to another area. A clear plan was established quickly, allowing routine ward care to continue uninterrupted.
From my perspective as the reviewing clinician, the ArcLight reduced practical friction during the assessment. Rather than focusing on missing equipment, attention could remain on clinical reasoning and decision-making. For junior doctors, having the means to perform a structured and credible eye examination at the bedside can be empowering, particularly when managing potentially anxiety-provoking presentations (2,4,5).
What the ArcLight Can – and Cannot – Do
It is important to recognise that the ArcLight does not replace formal ophthalmic equipment. It cannot substitute for slit-lamp biomicroscopy, applanation tonometry, or indirect ophthalmoscopy when these are required (3). Its role is not to replace comprehensive ophthalmic assessment, but to bridge the gap between no examination and a meaningful one (1,2,3,5).
Used appropriately, the ArcLight can support safe initial assessment and triage, helping clinicians identify patients who require escalation or specialist review while avoiding unnecessary referrals when pathology is unlikely.
Educational Value for Trainees
From a training perspective, the ArcLight offers additional value. Ophthalmology is often perceived as a specialty that is difficult to engage with outside clinic settings due to reliance on specialist equipment. A portable tool lowers this barrier, encouraging more frequent and confident examination on the ward.
Educational studies comparing the ArcLight with traditional direct ophthalmoscopes suggest it is a feasible tool for teaching ophthalmoscopy to non-ophthalmology trainees, reinforcing core examination principles in everyday clinical practice (4,5).
Discussion
Although originally designed for low-resource settings, the ArcLight highlights an important truth about modern healthcare systems: equipment availability is often constrained not by cost alone, but by accessibility and logistics. Even in well-resourced hospitals, appropriate tools may be unavailable when and where they are needed most.
In the acute red eye scenario described, the ArcLight enabled timely, patient-centred care when conventional ophthalmic equipment was unavailable. Its value lay not in replacing specialist assessment, but in supporting safe, confident bedside decision-making.
Conclusion
Reflecting on this acute red eye review, it became clear that the ArcLight did more than facilitate a diagnosis. It streamlined the encounter, improved communication, and enhanced the experience for the patient, the ward team, and the reviewing clinician.
Although designed with low-resource settings in mind, the ArcLight has a clear role in acute care, on-call work, and bedside ophthalmology within well-resourced healthcare systems. Sometimes, the most effective innovations are those that quietly make good clinical practice easier to deliver.
References
- Blaikie A, Sandford-Smith J, Tuteja SY, Williams CD, O’Callaghan C. Arclight: a pocket ophthalmoscope for the 21st century. BMJ. 2016;355:i6637.
- Lowe J, Cleland CR, Mgaya E, Furahini G, Gilbert CE, Burton MJ, et al. The Arclight ophthalmoscope: a reliable low-cost alternative to the standard direct ophthalmoscope. J Ophthalmol. 2015;2015:1–7.
- Blundell R, Roberts D, Fioratou E, Abraham C, Msosa J, Chirambo T, et al. Comparative evaluation of a novel solar-powered low-cost ophthalmoscope (Arclight) by eye healthcare workers in Malawi. BMJ Innov. 2018;4:165–172.
- Moin M, Irfan A, Chaudhry A, Amjad A, Manzoor A, Siddiq L. Teaching ophthalmoscopy with direct versus Arclight ophthalmoscope in non-ophthalmology residents. Pak Postgrad Med J. 2019;30(2):69–74.
- Kousha O, Blaikie A. The Arclight and how to use it. Community Eye Health. 2019;32:50–51.