A novel smartphone ophthalmic imaging adapter: User feasibility studies in Hyderabad, India

Abstract

Aim of study: To evaluate the ability of ancillary health staff to use a novel smartphone imaging adapter system (EyeGo, now known as Paxos Scope) to capture images of sufficient quality to exclude emergent eye findings. Secondary aims were to assess user and patient experiences during image acquisition, interuser reproducibility, and subjective image quality.

Materials and methods: The system captures images using a macro lens and an indirect ophthalmoscopy lens coupled with an iPhone 5S. We conducted a prospective cohort study of 229 consecutive patients presenting to L. V. Prasad Eye Institute, Hyderabad, India. Primary outcome measure was mean photographic quality (FOTO-ED study 1-5 scale, 5 best). 210 patients and eight users completed surveys assessing comfort and ease of use. For 46 patients, two users imaged the same patient's eyes sequentially. For 182 patients, photos taken with the EyeGo system were compared to images taken by existing clinic cameras: a BX 900 slit-lamp with a Canon EOS 40D Digital Camera and an FF 450 plus Fundus Camera with VISUPAC™ Digital Imaging System. Images were graded post hoc by a reviewer blinded to diagnosis.

Results: Nine users acquired 719 useable images and 253 videos of 229 patients. Mean image quality was ≥ 4.0/5.0 (able to exclude subtle findings) for all users. 8/8 users and 189/210 patients surveyed were comfortable with the EyeGo device on a 5-point Likert scale. For 21 patients imaged with the anterior adapter by two users, a weighted κ of 0.597 (95% confidence interval: 0.389-0.806) indicated moderate reproducibility. High level of agreement between EyeGo and existing clinic cameras (92.6% anterior, 84.4% posterior) was found.

Conclusion: The novel, ophthalmic imaging system is easily learned by ancillary eye care providers, well tolerated by patients, and captures high-quality images of eye findings.

Figure 1

The EyeGo system including (a) an anterior adapter consisting of a macro lens and LED light and (b) a three-dimensional printed posterior adapter to help align a 20D lens with the phone's camera

Figure 2

An ophthalmologist is recording a movie of the posterior segment using the EyeGo three-dimensional-printed posterior adapter in conjunction with an iPhone 5. The right hand stabilizes the smartphone and captures the image while the left hand stabilizes the lens and lifts the upper eyelid

Figure 3

Examples of normal (a) anterior and (b) posterior segment images and of subtle findings including (c) detail of all sutures in corneal transplant and (d) optic nerve cupping

Figure 4

User survey response (n = 8). Five-item Likert scale reporting each user's response to three survey questions following imaging using either the anterior EyeGo imaging attachment (n = 2), posterior EyeGo imaging attachment (n = 3), or both (n = 3)

Figure 5

Patient survey responses (n = 210). Five-item Likert scale reporting each patient's response to three survey questions following EyeGo imaging with either the anterior imaging attachment (n = 72), posterior imaging attachment (n = 61), or both (n = 77)

Figure 6

Quality of imaging done using the anterior EyeGo attachment compared to number of images taken by users of various medical backgrounds. Notably, the figure includes the initial 25 images taken by each user

Figure 7

Quality of imaging done using the posterior EyeGo attachment compared to number of images taken by users of various medical backgrounds. Notably, the figure includes the initial 25 images taken by each user (23 for the retina fellow)

Figure 8

Image of corneal abscess taken with (a) anterior chamber EyeGo imaging and (b) slit lamp imaging shows similar level of detail

Figure 9

Image of posterior uveitis taken with (a) fundoscopic EyeGo imaging and (b) fundoscopic imaging shows similar level of detail