Design and Validation of a Low-Cost Microscope for

Diagnostics in the Developing World

B. Cline1 *, R. Luo2, and K. Kuhlmann1
1
D-Rev: Design for the Other Ninety Percent, 631 Emerson Street, Palo Alto, CA 94301
2
Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Lane 235, Stanford, CA 94305
* bcline@d-rev.org

Introduction high-dispersion holographic diffuser film were used to produce

Many infectious diseases prevalent in the developing world, 1.4 numerical aperture Köhler-equivalent illumination. For
including malaria and tuberculosis, are difficult to diagnose on epi-fluorescence imaging, a 460-nm blue LED, matched
the basis of symptoms alone but can be accurately detected with dichroic and colored glass filters, is located in the black
using microscope examination. Currently the expense, size, horizontal component to which the nosepiece and monocular
and fragility of optical microscopes impede their widespread are attached. The eyepieces and objectives are interchangeable
use in resource-limited settings. Addressing these obstacles with others that meet the DIN standard, and a binocular head
facing microscopy in the developing world is a pressing need; is now available. Components for the initial 25 prototypes
over 800,000 people, primarily children in Africa, die annually were designed by D-Rev and custom machined in California.
of malaria, and more than 1,500,000 people die annually Leaders of the project are now seeking a manufacturer for
of tuberculosis [1][2]. The aim of this study is to design and volume production.
validate a microscope for use in the developing world that Three pathologists and two microbiologists evaluated the
combines high-resolution imaging, extreme affordability, and performance of the scope in the diagnosis of six unknown slides
long-term durability. containing Wright-Giemsa stained peripheral blood smears
Methods for bright-field detection of plasmodium (malarial parasites),
An optical microscope with bright-field and Kinyoun stained sputum smears for bright-field detection of
epi-fluorescence capabilities was designed with a 10x ocular mycobacterium tuberculosis, and auramine O stained sputum
and 10x, 40x, and 100x (oil immersion) objectives (Figure 1). smears for fluorescent detection of mycobacterium tuberculosis
For bright-field imaging, light emitting diodes (LEDs) and (Figure 2).
Results
A All five pathologists and microbiologists made the correct
diagnosis on all six unknown slides used for initial validation

Figure 1: (A) Prototype of the compact, low-cost microscope with both bright-field and epi-fluorescence illumination. (B) Prototype microscope next to Nikon Eclipse E-600.

16 doi: 10.????/S???????????? www.microscopy-today.com • 2009 November

 Low-Cost Microscope for the Developing World

of the microscope (100% concordance). By eliminating the system is reduced to less than $5. The total estimated cost of
precision-aligned optical glass elements used in traditional production is under $150 for brightfield illumination and under
optical microscopes, the cost of the brightfield illumination $200 with epi-fluorescence illumination. Inexpensive stains
are available for imaging of tuberculosis and malaria under
bright-field (Ziehl-Neelsen and Giemsa respectively) and under
A fluorescence (auramine O and acridine orange, respectively).
The estimated cost per smear is $0.07 (comprised of $0.05 for
each glass slide and $0.02 for staining chemicals).
The microscope has been designed for resource-limited
settings. Operation in clinics lacking consistent access to
electricity is aided by the fact that the scope can be charged by
a small solar module as well as a wall outlet. Additionally, LED
illumination enables low-power consumption: less than 1 W for
bright-field imaging and for epi-fluorescence imaging. LEDs
also provide far greater lifetime than conventional illumination
sources. In conventional fluorescence imaging, the need for
frequent replacement of mercury or xenon arc lamps incurs a
substantial cost (estimated at $1,500 to $3,000 per year) and
requires ready availability of replacement bulbs [3]. In contrast,
the new scope’s LED illumination has a lifetime of over ten
B thousand hours, and the amortized cost of replacement is
expected to be less than $2 per year. Additionally, no alignment
of condenser elements is required in the scope’s bright-field
illumination system, an important advantage in the developing
world where there is often limited technical support for
microscopy. For portability, the microscope is compact (6” by
7” by 9”) and lightweight at 6 lbs.
Enabling fluorescence imaging provides several benefits,
especially for the diagnosis of tuberculosis. A review of
studies comparing fluorescence and bright-field screening of
tuberculosis found that use of fluorescence increased sensitivity
by an average of 10% [4]. Fluorescence imagining enables use
of lower magnification, which reduces screening times [4].
This is particularly significant for overburdened clinics in the
developing world, where technicians frequently spend less
time than recommended examining a slide before declaring it
C negative, resulting in a high rate of false negatives [5].
Conclusions
A compact, high-resolution microscope with bright-
field and epi-fluorescence capabilities can be built for less
than $200. Preliminary testing suggests that the microscope
enables accurate and inexpensive diagnosis of tuberculosis and
malaria. Field validation of the microscope, along with testing
of the diagnosis of other tropical diseases, will be conducted
in conjunction with partner organizations in the developing
world.
References
[1] WHO Fact Sheet No94. Revised January 2009.
[2] WHO Fact Sheet No104. Revised March 2007.
[3] T Hänscheid, Trans R Soc Trop Med Hyg 102 (2008) 520-521.
[4] K R Steingart, M Henry, V Ng, P C Hopewell, A Ramsay, J
Figure 2: Micrographs taken with the prototype low-cost microscope. (A)
Cunningham, R Urbanczik, M Perkins, M A Aziz, and M Pai,
Plasmodium falciparum (malarial parasites) in a peripheral blood smear. (B) Lancet Infect Dis 6 (2006) 570-581.
Mycobacterium tuberculosis in a sputum smear. (C) Trypanosoma brucei [5] A Cambanis, A Ramsay, V Wirkom, E Tata, L E Cuevas, Int
gambiense (West African sleeping sickness parasites) in a peripheral blood
smear. Scale bar = 10 μm.
J Tuberc Lung Dis 11 (2007) 40-45.

18 www.microscopy-today.com • 2009 November