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. 2022 Dec;42(12):3933-3940.
doi: 10.1007/s10792-022-02377-4. Epub 2022 Jul 23.

Prospective evaluation of medical student accuracy conducting direct ophthalmoscopy with an unmodified iPhone X

Yusuf Ahmed  1 , Austin Pereira  2 , Amrit S Rai  2 , Victoria C Leung  2 , Aadam Ahmed  3 , Amandeep S Rai  4   5   6   7
Affiliations

Prospective evaluation of medical student accuracy conducting direct ophthalmoscopy with an unmodified iPhone X

Yusuf Ahmed et al. Int Ophthalmol. 2022 Dec.

Abstract

Purpose: To evaluate fundus examination accuracy of medical students when using an unmodified iPhone X or a direct ophthalmoscope in comparison to a staff ophthalmologist's retinal examination.

Methods: In this prospective comparative analysis, patients underwent dilated fundus examination by novice medical trainees using either an unmodified iPhone X or standard direct ophthalmoscope. The primary outcome was the mean difference and degree of agreement in cup-to-disc ratio between student examination and the staff ophthalmologist's cup-to-disc observation.

Results: A total of 18 medical students conducted 230 retinal examinations, 117 with the iPhone X and 113 with the direct ophthalmoscope. A greater proportion of students were unable to report cup-to-disc ratio using the iPhone X (81.2%) vs direct ophthalmoscope (30.1%). Student examination of cup-to-disc ratio led to a systematic bias (95% limits of agreement) of + 0.16 (-0.22 to + 0.54) and + 0.10 (-0.36 to + 0.56) with the iPhone X and direct ophthalmoscope, respectively. iPhone X and direct ophthalmoscope student observation concordance for optic disc colour (88.7 and 82.4%, respectively) and contour (68.3 and 74.2%, respectively) demonstrated low agreement with staff ophthalmologist findings. Student iPhone X observations demonstrated lower agreement with staff findings compared to direct ophthalmoscope observations for spontaneous venous pulsations (Cohen's Kappa = -0.044 vs 0.099).

Conclusion: Amongst medical trainees, optic disc visualization using an unmodified iPhone X was inferior to the direct ophthalmoscope. When able to visualize the optic nerve head, there was no significant difference in reported cup-to-disc ratio between modalities. However, both modalities demonstrated poor reliability in comparison to staff ophthalmologist findings.

Keywords: Direct ophthalmoscope; Direct ophthalmoscopy; Medical education; Medical trainees; Telemedicine; iPhone X.

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Conflict of interest statement

Dr. Amandeep S. Rai reported receiving payment/honoraria from Alcon and Bausch Health to support an educational event as well as receiving consulting fees from Alcon and Bausch Health. The other authors have no conflict of interests to disclose.

Figures

Fig. 1
Fig. 1
Bland–Altman plot for mean difference of cup-to-disc measurements between 78D slit-lamp biomicroscopy staff ophthalmologist findings and a students observations with either iPhone X or direct ophthalmoscope, b student observations with just the iPhone X, and c student observations with just the direct ophthalmoscope
See this image and copyright information in PMC

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