Abstract
Smartphone-based fundus imaging (SBFI) is a low-cost approach for screening of various ophthalmic diseases and particularly suited to resource limited settings. Thus, we assessed how best to upskill alternative healthcare cadres in SBFI and whether quality of obtained images is comparable to ophthalmologists. Ophthalmic assistants and ophthalmologists received a standardized training to SBFI (Heine iC2 combined with an iPhone 6) and 10 training examinations for capturing central retinal images. Examination time, total number of images, image alignment, usable field-of-view, and image quality (sharpness/focus, reflex artifacts, contrast/illumination) were analyzed. Thirty examiners (14 ophthalmic assistants and 16 ophthalmologists) and 14 volunteer test subjects were included. Mean examination time (1st and 10th training, respectively: 2.17 ± 1.54 and 0.56 ± 0.51 min, p < .0001), usable field-of-view (92 ± 16% and 98 ± 6.0%, p = .003) and image quality in terms of sharpness/focus (p = .002) improved by the training. Examination time was significantly shorter for ophthalmologists compared to ophthalmic assistants (10th training: 0.35 ± 0.21 and 0.79 ± 0.65 min, p = .011), but there was no significant difference in usable field-of-view and image quality. This study demonstrates the high learnability of SBFI with a relatively short training and mostly comparable results across healthcare cadres. The results will aid implementing and planning further SBFI field studies.
Highlights
Smartphone-based fundus imaging (SBFI) is a low-cost approach for screening of various ophthalmic diseases and suited to resource limited settings
There was no significant difference between ophthalmologists and ophthalmic assistants at the end of the training in usable field-of-view (96.8 ± 10.0% and 97.8 ± 4.74%, Wilcoxon signed-rank p = 0.78), sharpness/focus (Wilcoxon signed-rank p = 0.053), reflex artifacts (Wilcoxon signed-rank p = 0.076), and contrast/illumination (Wilcoxon signed-rank p = 0.083)
The approximate half-hour SBFI training led to a significant improvement in examination time, usable field-of-view, and image quality
Summary
Smartphone-based fundus imaging (SBFI) is a low-cost approach for screening of various ophthalmic diseases and suited to resource limited settings. Examination time was significantly shorter for ophthalmologists compared to ophthalmic assistants (10th training: 0.35 ± 0.21 and 0.79 ± 0.65 min, p = .011), but there was no significant difference in usable field-of-view and image quality. Other studies reported inability to detect diabetic retinopathy employing SBFI by non-expert examiners[30] The reason for these observed differences is unclear, to date. To fill this gap, we compared the learning curve of ophthalmic assistants and ophthalmologists in SBFI in terms of examination time, total number of images, image alignment, usable field-of-view, and image quality for a novel SBFI device
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