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Rajeev Ramchandran, Vanessa Desmore, Taylor Pannell, William Fischer, Christye Sisson; Comparative Evaluation of Non-Mydriatic Camera Images by Non-Ophthalmic and Ophthalmic Photographers as part of a Primary Care Based Teleophthalmoogy Diabetic Surveillance Program. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2423.
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To compare the efficiency and effectiveness of capturing retinal images with a non-mydriatic fundus camera between an academically trained ophthalmic photographer and staff of a primary care clinic.
Four primary care clinic registered nurses and one pharmacy PhD were trained by the Biomedical Photography Communications program at the Rochester Institute of Technology (RIT) to capture retinal images using a Zeiss Visucam Non-Mydiratic Fundus Camera in a federally qualified urban health clinic in Rochester, NY as part of a teleophthalmology program to detect retinopathy in patients with diabetes. Two trainees were male and all were fluent in English. Trainees completed three individual 30 minute training sessions in English over three days and were evaluated during each session by using the camera to capture retinal images of undilated healthy normal subjects. Trainee images and those of an ophthalmic photographer who graduated from the RIT program were critiqued for focus, positioning, and working distance on a 1-4 scale using a rubric developed by the RIT program based on standard reading center criteria by a blinded professional ophthalmic photographer. A total percentage grade was given based upon overall image quality weighing the three individual criteria.
The mean overall image quality score improved from 81% to 89% over three sessions for the trainees but still below the 97% obtained by the ophthalmic photographer. Mean Scores for focus and positioning improved over the session from 2.6 and 1.8 to 3.4 and 3.6 respectively which were close to the photographer’s score of 4 for both values. All trainees had difficulty with working distance with mean scores staying at 2 over the three sessions. Variance between trainees reduced over time with standard deviation of total score, focus, positioning, and working distance decreasing from 12% to 4%, 1.14 to 0.55, 1.30 to 0.89, and 0.84 to 0.71 respectively.
New non-mydriatic cameras are user friendly and may not require rigorous training to obtain quality photographs. However, careful supervision early on and possibly periodic evaluations throughout the program are advised to ensure proper image capture, patient safety, and ability to timely identify eye disease in patients.
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