Smartphone-based cameras effective in screening for ocular diseases in the ER: Study
Fundus photography is a fundamental tool used to diagnose and monitor posterior segment pathology. However, it is typically unavailable in many situations such as emergency departments, hospital floors, or underserved areas, where urgent ophthalmic consultations may be necessary yet difficult to obtain. Furthermore, general healthcare providers in these settings typically have not had the training needed to examine the posterior segment. This can lead to life and vision threatening diseases going undiagnosed or having a delayed diagnosis. Indirect ophthalmoscopy and handheld contact fundus cameras provide an accessible and reliable method for physicians to determine the need for and urgency of an ophthalmic consult. However, their availability and high cost limit their use in certain settings. New smartphones equipped with high-resolution cameras are increasingly being used to screen for anterior and posterior segment pathology to circumvent this problem.
Smartphone-based fundoscopy has proven its efficacy in diagnosing diabetic retinopathy, macular degeneration, and retinopathy of prematurity. However, its application in diagnosing other posterior segment pathologies, especially in the emergency care setting, has been largely limited. This method of imaging could help increase access to necessary ophthalmic intervention and reduce unnecessary cost on the healthcare system for non-urgent patient presentations.
Smartphone-based fundoscopy could provide an innovative and inexpensive option for hospitalists, primary care physicians, and emergency physicians to triage, document, and communicate with ophthalmologists in order to treat patients in a more appropriate and timely manner, thus reducing the burden of vision threatening disease. In academic centers, where residents and fellows are often the first ophthalmic provider to see the patient, providing retinal specialists with high-quality images of the posterior segment can improve patient care.
The purpose of this study by Omari et al was to assess the use of a smartphone-based fundus camera in the diagnosis of acute posterior segment pathology in the emergent setting. They compared the accuracy between residents and attendings, and include a wider breadth of posterior segment pathology, from ocular trauma to neuro-ophthalmic disease and found Smartphone-based cameras are effective in screening for ocular diseases in the ER of academic centers, where residents and fellows are often the first providers to see various types of vision and life-threatening pathology.
Images were obtained on 10 eyes with various types of posterior segment pathology. These were analyzed retrospectively by 35 reviewers (21 residents and 14 attending physicians). Accuracy of diagnosis was compared to in-office fundus photography.
The average probability of correct diagnosis was over 78%. There was no difference between resident and attending reviewers, except for one of the vitreous hemorrhage cases where residents performed better (p=0.039).
This study has demonstrated near equivalence of quality and diagnostic utility of mydriatic smartphone-based images obtained in the emergency department as compared to fundoscopic photographs. Authors were uniquely able to demonstrate that residents did just as well as attendings in grading fundus photos, if not better. This is important considering that many of these consults are placed in academic centers where residents or fellows are the first provider to see the patient and have to decide about whether attending input is needed. Furthermore, study demonstrated that this technique can be applied to diseases from multiple disciplines like neuro ophthalmology or uveitis. This is crucial as many neuro-ophthalmic or uveitic conditions can lead to potentially life-threatening pathology that may otherwise have been missed or experience a delay in treatment.
It has been postulated that photographer experience in standard fundoscopic imaging is important. Although photographers should be trained before acquiring smartphone-based imaging, the process of training appears to be more straightforward and can be generalized to even those who are not photographic technicians. In this study, all the images were obtained by one individual with minimal training, yet the images were of sufficient quality to lead to accurate diagnosis and management in most cases. This suggests that smartphone-based imaging is easy to use and more accessible than standard fundus photography. Despite the higher resolution and ease of use of traditional fundoscopic imaging, advantages of smartphone imaging include easy access, high portability, low cost, and wireless connection to secure networks for data transmission. Recent work involving funduscopic imaging with smartphones reflects increasing interest in harnessing the potential of smartphone camera technology while maximizing ease of use for both ophthalmologists and non-ophthalmologists alike.
In this study, authors found that a smartphone-based fundus camera can accurately diagnosed a variety of acute posterior segment pathologies in the emergency room in up to 78% of the cases. There was no significant difference between resident and attending reviewers, suggesting that this technology can be used in an academic setting.
Source: Omari et al; Clinical Ophthalmology 2022:16
https://doi.org/10.2147/OPTH.S364765
