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Smartphone ophthalmoscopy nears imaging quality of fundus camera in study
Based on the results of the Smartphone Ophthalmoscopy Reliability Trial, clinical utilities and everyday advantages are available with smartphone ophthalmoscopy.
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Smartphone ophthalmoscopy images may nearly equal the quality and diagnostic utility of traditional fundus camera images, according to a study.
The previously conducted Fundus Photography vs. Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study demonstrated the diagnostic usefulness of non-mydriatic fundus imaging at detecting clinically significant pathology. In contrast, the Smartphone Ophthalmoscopy Reliability Trial (SORT) examined the quality and accuracy of smartphone ophthalmoscopy in addition to determining factors that influence image quality.
“The field needs to prove that remote fundus imaging can not only be effective at screening for disease, but also lead to appropriate triaging/referrals and more prompt patient management,” lead author Murtaza K. Adam, MD, told Ocular Surgery News. “There is a paucity of research in the literature that demonstrates the clinical utility and cost-effectiveness of teleophthalmology.”
Visualization frequency and quality
The prospective, cross-sectional SORT study evaluated 94 consecutive patients who underwent smartphone ophthalmoscopy and fundus camera imaging by one experienced ophthalmology resident and two medical students who received approximately 15 minutes of training on each technique. The images were then compared with documented binocular indirect and slit lamp fundus examination findings.
In the smartphone group, the optic nerve was most frequently visualized and had the highest quality and the superior vascular arcade was least frequently visualized and had the poorest quality. In the fundus camera group, the optic nerve, superior vascular arcade and inferior vascular arcade were more frequently visualized with higher quality than the macula.
Increased age, visually significant lens opacities and pseudophakia were linked to decreased quality for fundus camera images but not for smartphone ophthalmoscopy images. Black race was associated with both poorer quality for both devices.
Student photographers vs. resident photographer
Smartphone images conducted by the ophthalmology resident were higher quality compared with both medical students, but there was no significant difference among the three photographers in fundus camera imaging quality.
After 1 month, the novice photographers were able to obtain high-quality images, but obtaining images with reliability may take more time, Adam said.
The resident had a higher detection rate of critical fundus findings, detecting 74.3% of critical findings with the smartphone and 77.1% with the fundus camera.
“The learning curve for someone who is already an ophthalmologist is not too difficult as they are already familiar with the principles of indirect ophthalmoscopy,” Adam said.
Portability, cost and access
Despite higher resolution and ease of use of fundus camera imaging, smartphone ophthalmoscopy can have advantages such as high portability, low cost and immediate access.
“In our study, we found that some smartphone images, especially in highly myopic patients, had a greater depth of field than the fundus camera,” Adam said. “The dynamic nature of capturing an image using the smartphone in video mode also allows the user to optimize the image in real time by providing feedback to the patient and adjusting the camera and light source at the same time. Furthermore, the intensity of the camera light source allowed for improved image quality through dense cataracts when compared to the fundus camera.”
Adam suggested that more research should be conducted in order to provide legislators, insurance companies and malpractice firms with information to recognize that remote ophthalmic examinations can provide a viable alternative to the status quo in certain clinical settings.
“Outside of smartphone fundus photography, advances in portable/smartphone visual acuity assessment, auto-refraction, anterior segment imaging and OCT technology are moving forward every day and will extend the impact of ophthalmologists to patients previously with little to no access to eye care, both domestic and abroad,” Adam said. – by Kristie L. Kahl
- Reference:
- Adam MK, et al. Ophthalmic Surg Lasers Imaging Retina. 2015;doi:10.3928/23258160-20150610-06.
- For more information:
- Murtaza K. Adam, MD, can be reached at Retina Service, Wills Eye Hospital, 840 Walnut St., Suite 1020, Philadelphia, PA 19107; email: murtaza.adam@gmail.com.
Disclosure: Adam reports no relevant financial disclosures.