Evaluation of high-definition video smart glasses for real-time telemedicine strabismus consultations

Abstract

To evaluate the use of high-definition, wireless video recording Pivothead glasses in streamed strabismus examinations. A pediatric ophthalmologist wearing Pivothead glasses simultaneously performed and recorded strabismus examinations, which were completed in primary gaze, with and without correction, and at distance and near. Parameters included category of strabismus, angle measurements, and ocular motility. Another pediatric ophthalmologist, masked to clinical findings, reviewed and graded live video feed. At least 3months later, both pediatric ophthalmologists graded the stored videos. Agreement was determined by unweighted kappa for categorical variables, intraclass coefficient for continuous variables, and percent agreement. A total of 100 videos were recorded for 37 enrolled patients aged 4-16years. Agreement between streamed and in-person examinations was perfect for both horizontal and vertical (κ=1.0) deviations. Agreement for degree manifest (tropia vs intermittent tropia vs phoria) was almost perfect for all deviations (κ=0.94). Agreement was excellent for angle measurements of both horizontal (ICC=0.95) and vertical (ICC=0.91) deviations. Inferior and superior oblique agreement was 93% and 98%, respectively. Similar agreement was also observed between store-and-forward versus gold standard examinations. Real-time video feed obtained with video glasses can be read with a high degreeof reliability for detecting strabismus category, angle, and extraocular motility.