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. 2019 Jun;8(1):10.7309/jmtm.8.1.1.
doi: 10.7309/jmtm.8.1.1.

Teleophthalmology through handheld mobile devices: a pilot study in rural Nepal

Karen Hong  1 , Sean Collon  2 , David Chang  3 , Sunil Thakalli  4 , John Welling  4 , Matthew Oliva  4 , Esteban Peralta  5 , Reeta Gurung  6 , Sanduk Ruit  6 , Geoffrey Tabin  1   4 , David Myung  1   7 , Suman Thapa  6
Affiliations

Teleophthalmology through handheld mobile devices: a pilot study in rural Nepal

Karen Hong et al. J Mob Technol Med. 2019 Jun.

Abstract

Background: To compare screening referral recommendations made by remotely located ophthalmic technicians with those of an ophthalmologist examining digital photos obtained by a portable ophthalmic camera system powered by an iOS handheld mobile device (iPod Touch).

Methods: Dilated screening eye exams were performed by ophthalmic technicians in four remote districts of Nepal. Anterior and posterior segment photographs captured with a Paxos Scope ophthalmic camera system attached to an iPod Touch 6th generation device were uploaded to a secure cloud database for review by an ophthalmologist in Kathmandu. The ophthalmic technicians' referral decisions based on slit-lamp exam were compared to the ophthalmologist's recommendation based on the transmitted images.

Results: Using the transmitted images, the ophthalmologist recommended referral for an additional 20% of the 346 total subjects screened who would not have been referred by the ophthalmic technician. Of those subjects, 34% were referred to the retina clinic. Conversely, among the 101 patients referred by the technician, the ophthalmologist concurred with the appropriateness of referral in more than 97% of cases but thought eight (2.8%) of those patients had variants of normal eye pathology.

Conclusion: An ophthalmologist who reviewed data and photos gathered with the mobile device teleophthalmology system identified a significant number of patients whose need for referral was not identified by the screening technician. Posterior segment pathology was most frequently found by the remote reader and not by the technician performing dilated slit lamp examinations. These results are promising for further clinical implementation of handheld mobile devices as tools for teleophthalmic screening in resource-limited settings.

Keywords: global health; ophthalmology; referral and consultation; rural population; telemedicine.

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Conflict of interest statement

Declarations Karen Hong has received a research grant from the Mary Duke Biddle Clinical Scholars Program and Dr. David Myung holds a patent for the Paxos Scope, Digisight Technologies (now Verana Health) provided the Paxos Scope technology for this study All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and have no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1:
Figure 1:
Upper: An ophthalmologist using the Paxos Scope mobile ophthalmic camera by Verana Health (San Francisco, CA, USA). Lower: The Paxos Scope components: 1-Flexible lens adaptor, 2-Anterior Adaptor, 3-Posterior Adaptor, 4-20D Lens, 5-iOS device by Apple, Inc. (Cupertino, CA, USA).
Figure 2:
Figure 2:
Anterior and posterior segment images taken with the Paxos Scope of the right eye (OD) and the left eye (OS).
Figure 3:
Figure 3:
Percentage of participants by referred subspecialty here reviewing ophthalmologist referred and ophthalmic technician decided not to refer.
Figure 4:
Figure 4:
Examples of ocular pathology as captured on anterior and posterior segment photographs with the Paxos Scope. A) Asymmetrical cupping in fundus photos of the right eye (left side) and left eye (right side) B) Pterygium located on the medial portion of the left eye of the subject C) Macular hole in the fundus photo of a right eye.
See this image and copyright information in PMC

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