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

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

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