Abstract
Purpose: The D-EYE device, a new fundoscopic smartphone lens, has demonstrated its utility in a clinical setting to detect and document ocular pathology, but has not been tested in the pediatric population. A prospective study was performed to explore the application of D-EYE in pediatric fundus examinations. Methods: Patients ages 3 - 18 years old underwent dilated fundus examinations by masked examiners using the video function of the D-EYE, while indirect ophthalmoscopy was performed by apediatric ophthalmologist. The examiners independently analyzed the D-EYE videos for the presence or absence of abnormalities, cup-to-disc (c/d) ratios and optic nerve size and color. The D-EYE video findings were compared to indirect ophthalmoscopy findings. Results: The study included 172 eyes from 87 patients. In comparing D-EYE to indirect ophthalmoscopy for detecting fundus abnormalities, the sensitivity was 0.72, specificity was 0.97, positive predictive value (PPV) was 0.77, negative predictive value (NPV) was 0.97, positive likelihood ratio (LR) was 27.8, and negative LR was 0.29. The agreement rate between the D-EYE video graders for the c/d ratio within a value of 0.1 was 97.0%. Multiple, distinct abnormalities were discovered using the D-EYE device, including nystagmus, optic nerve hypoplasia, optic disc edema, peripapillary atrophy, disc pallor, and optic disc drusen. Conclusion: Fundoscopic imaging using the D-EYE smartphone lens reliably detects the presence of fundus abnormalities and has good reliability in assessing c/d ratios. The video capability is useful in patients with nystagmus or those who are poorly compliant with the examination and allowed for effective teaching by the pediatric ophthalmologist.
Highlights
In a world of rapidly-evolving technology and growing demand to lower healthcare expenditures, the increasing availability and utility of smartphones are transforming the field of medicine
Patients ages 3 - 18 years old underwent dilated fundus examinations by masked examiners using the video function of the D-EYE, while indirect ophthalmoscopy was performed by apediatric ophthalmologist
The video capability is useful in patients with nystagmus or those who are poorly compliant with the examination and allowed for effective teaching by the pediatric ophthalmologist
Summary
In a world of rapidly-evolving technology and growing demand to lower healthcare expenditures, the increasing availability and utility of smartphones are transforming the field of medicine. In the realm of ophthalmology, smartphones are being used more routinely to document patients’ ocular conditions. The use of smartphones to inexpensively capture fundus images to diagnose and document pathology shows great promise towards increasing accessibility of eye care both domestically and abroad [1]. Smartphones have been useful in the emergency department setting, for inpatient consultations, and during examinations under anesthesia since they provide a cheap, portable option for obtaining high-quality images of the fundus [2]. Methods that require using both a built-in smartphone camera and an external ophthalmic lens simultaneously prove difficult for many due to issues with controlling the focus and exposure during image capture, which may result in glare and poor image quality
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