June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Smartphone Ophthalmoscopy (D-Eye System) for Detection of Optic Nerve Pathology and Cup-to-Disc Ratio in an Outpatient Clinical Setting
Author Affiliations & Notes
  • Diane Kim Thien Dao
    Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Neepa Shah
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Madhura Tamhankar
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Paul Tapino
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Wei Pan
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Gui-Shuang Ying
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Keirnan Willett
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Brian L VanderBeek
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Alexander J Brucker
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Diane Dao, None; Neepa Shah, None; Madhura Tamhankar, None; Paul Tapino, None; Wei Pan, None; Gui-Shuang Ying, None; Keirnan Willett, None; Brian VanderBeek, None; Alexander Brucker, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4836. doi:
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      Diane Kim Thien Dao, Neepa Shah, Madhura Tamhankar, Paul Tapino, Wei Pan, Gui-Shuang Ying, Keirnan Willett, Brian L VanderBeek, Alexander J Brucker; Smartphone Ophthalmoscopy (D-Eye System) for Detection of Optic Nerve Pathology and Cup-to-Disc Ratio in an Outpatient Clinical Setting. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4836.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We performed a cross-sectional study to assess the sensitivity and specificity of the D-Eye System in detecting optic nerve pathology and determining cup:disc ratio (CDR).

Methods : Patient presenting to Scheie Eye Institute for eye exam were consented to obtain non-mydriatic and mydriatic fundus videos. Videos were graded for image quality, optic nerve pathology (presence, possible, absence), and CDR independently by a neuro-ophthalmologist and a general ophthalmologist. Each patient was examined by an ophthalmologist for optic nerve pathology (e.g. papilledema, glaucoma, pallor). Sensitivity and specificity were calculated by comparing video gradings to findings on clinical eye exam (gold standard).

Results : 97 mydriatic and 110 non-mydriatic fundus videos of 122 eyes of 61 patients were obtained. Among 74 mydriatic and 71 non-mydriatic fundus videos that were deemed gradable by both ophthalmologists, the sensitivity and specificity for mydriatic videos was (58%, 79%) for the neuro-ophthalmologist and (58%, 70%) for general ophthalmologist; for non-mydriatic videos, it was (61%, 84%) for the neuro-ophthalmologist and (46%, 58%) for general ophthalmologist (Table 1). Sensitivity was lower and specificity was higher when treating possible pathology as a negative outcome. The two graders had moderate agreement in grading mydriatic video (kappa=0.43) and non-mydriatic video (kappa=0.52).

There was moderate agreement of CDR between grading videos and clinical exam, with small mean difference (≤0.07) and moderate intraclass correlation coefficient (ICC) (Table 2). The inter-grader agreement for CDR was high with small mean difference (0.00 for mydriatic videos; 0.03 for non-mydriatic videos) and high ICC (>0.80).

Conclusions : The D-Eye system has a moderate sensitivity and specificity for detecting optic nerve pathology by ophthalmologist and good agreement with clinical determination of CDR. Smartphone cameras are an easy to use screening tool for assessing and documenting optic nerve appearance that may aid clinical exam.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Table 1: The sensitivity and specificity for detecting optic nerve pathology using the smartphone mydriatic video and non-mydriatic video

Table 1: The sensitivity and specificity for detecting optic nerve pathology using the smartphone mydriatic video and non-mydriatic video

 

Table 2 Agreement of cup:disc ratio determination using the smartphone mydriatic video or non-mydriatic video vs. eye exam determination and the inter-grader agreement from image evaluation of cup:disc ratio

Table 2 Agreement of cup:disc ratio determination using the smartphone mydriatic video or non-mydriatic video vs. eye exam determination and the inter-grader agreement from image evaluation of cup:disc ratio

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