Quality of Mydriatic Fundus Smartphone Photography: Preliminary Results from the Smartphone Ophthalmoscopy Reliability Trial (SORT)

Abstract

Purpose: Establish quality of smartphone ophthalmoscopy (SO) fundus images obtained by inexperienced medical students and compare them to an ophthalmology resident familiar with SO.

Methods: 79 consecutive patients evaluated in the Wills Eye Emergency Department for a variety of visual and ocular complaints were enrolled into one of three study arms: medical student 1 (MS1), medical student 2 (MS2), and ophthalmology resident (OR). Acquired SO images (158 eyes) were graded for overall quality by a masked reviewer using an established quantitative fundus photo grading system. Four anatomic regions were independently evaluated for quality: optic nerve, macula, superior, and inferior vascular arcades. Observed critical fundus findings on SO fundus images were compared to emergency department dilated fundus exam documentation.

Results: OR images were significantly higher quality than MS1 and MS2 images (p<0.017, Mann-Whitney U with Bonferroni correction). Image quality trended toward improvement over time in all groups, but not significantly (all p>0.062, two-tailed Pearson’s correlation coefficient). Smartphone images detected 47% of critical fundus findings in the MS1 group, 50% in the MS2 group, and 89% in the OR group. Regional quality analysis revealed the optic nerve was most frequently visualized and highest quality (p<0.001, McNemar chi-square test), while the superior arcade was least often visualized and poorest quality with SO.

Conclusions: SO can produce high quality fundus images but is difficult to master, potentially limiting its utility for non-ophthalmologists.

Keywords: 550 imaging/image analysis: clinical • 688 retina