June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
A Novel Telemedicine Device for Diagnosis of Corneal Abrasions and Ulcers in Resource-Poor Settings
Author Affiliations & Notes
  • Robi Maamari
    Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
    School of Medicine, University of California, Irvine, Irvine, CA
  • Somsanguan Ausayakhun
    Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
  • Todd Margolis
    Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
    F. I. Proctor Foundation, San Francisco, CA
  • Thomas Lietman
    Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
    F. I. Proctor Foundation, San Francisco, CA
  • Daniel Fletcher
    Department of Bioengineering, University of California, Berkeley, Berkeley, CA
  • Jeremy Keenan
    Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
    F. I. Proctor Foundation, San Francisco, CA
  • Footnotes
    Commercial Relationships Robi Maamari, Ocular CellScope (P); Somsanguan Ausayakhun, None; Todd Margolis, Peregrine (C), UCSF (P); Thomas Lietman, None; Daniel Fletcher, None; Jeremy Keenan, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 3584. doi:
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    • Get Citation

      Robi Maamari, Somsanguan Ausayakhun, Todd Margolis, Thomas Lietman, Daniel Fletcher, Jeremy Keenan; A Novel Telemedicine Device for Diagnosis of Corneal Abrasions and Ulcers in Resource-Poor Settings. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3584.

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

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Abstract 
 
Purpose
 

Corneal ulcers are a significant cause of corneal blindness worldwide. Normally, corneal injury is diagnosed by an ophthalmologist via slit-lamp examination. However, limited healthcare resources and personnel in developing regions may delay diagnosis and treatment, and increase the risk of vision loss. In this study, we evaluate a modified mobile phone camera for diagnosis of corneal epithelial defects.

 
Methods
 

An ophthalmologist examined 17 eyes from an inpatient ophthalmology service for corneal epithelial defects. Diagnosis was made with slit-lamp and fluorescein. Before administration of fluorescein, corneal photographs were taken for all patients with an iPhone® 4S camera coupled to a custom attachment with a +25 diopter lens and white external light-emitting diode (LED) light source (Ocular CellScope, University of California, Berkeley). A photograph was also taken after administration of fluorescein using the same phone coupled to a +25 diopter lens, 550nm/50nm emission filter, and blue LED light source. Three offsite ophthalmologists, masked to the onsite diagnosis, graded all 34 photographs. We calculated the sensitivity and specificity of both types of photography assuming the onsite ophthalmologist as the gold standard.

 
Results
 

The onsite ophthalmologist detected an epithelial defect in 6 of 17 eyes. The sensitivity of remote diagnosis of an epithelial defect was higher for the fluorescein photographs (83.3%, 100%, 66.7%) than for the white light photographs (50% for all three graders), and specificity was similar (100%, 90.9%, and 100% for fluorescein photographs and 100% for all three graders for the white light photographs). There was weak evidence that the grades of the white light photographs were different from the onsite diagnosis (P=0.08 for each grader, McNemar’s test), but no evidence of this for the fluorescein photographs (P=0.32; 0.32; 0.15).

 
Conclusions
 

The novel modified iPhone camera shows potential as a new technology for diagnosis of corneal abrasions and ulcers. This technology—especially with the fluorescein attachment—could be useful for diagnosing corneal injury in resource-poor settings. Further testing with a larger sample size is necessary to validate this telemedicine device.

 
 
Ocular CellScope with fluorescein attachment
 
Ocular CellScope with fluorescein attachment
 
 
Image of a corneal ulcer taken with the Ocular CellScope
 
Image of a corneal ulcer taken with the Ocular CellScope
 
Keywords: 550 imaging/image analysis: clinical  
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