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John Edward Legarreta, Ian P Conner, Nils A Loewen, Kimberly V Miller, Jeremy Wingard; The Utility of iPhone-based Imaging for Tele-ophthalmology in a Triage Capacity for Emergency Room Consultations. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4876.
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We proposed to evaluate the effectiveness of iPhone-based imaging to aid emergency room personnel in triaging patients in possible need of ophthalmology consultation. Specifically, we evaluated external eye photography with the iPhone 4s’s native camera as well as fundus photography using a panoptic ophthalmoscope adapter for iPhone 4s.
50 consecutive patients presented to the UPMC Presbyterian Emergency Room (ER) with an ocular complaint were enrolled in the study. External and posterior segment photographs were taken with the iPhone 4s and with the panoptic adapter. Basic history and physical exam findings that could be ascertained by ER staff (vision, pupils, eye movements, tonometry) were recorded. Each patient was evaluated by a UPMC ophthalmology attending to provide the definitive diagnosis. Patients were categorized into those requiring urgent consultation (severity 1), those requiring ophthalmology consultation that could be delayed by at least 24 hours (severity 2), and those that could be managed by non-ophthalmologist physicians (severity 3). Four masked reviewers evaluated the images, histories and exam findings and assigned a triage severity level. These judgments were analyzed against the definitive triage severity. Reviewers also noted how their triage decision in each case was affected by the availability of the photographs.
Of the 50 cases, 12 were classified as severity 1 and none of the 48 reviewer triage decisions in these cases failed to bring the patient in for urgent consultation. Among cases of all severity levels, reviewers stated that their triage decision was changed in 19% of cases after evaluating the photographs. Reviewers triage decisions were either changed or confirmed in 57.5% of cases. That is, in more than half of cases, reviewers found the photographs useful for their decision-making.
The limited availability of ophthalmologists in ER and hospital settings may result in suboptimal diagnosis, treatment, and triage of eye related conditions. Patients may be transferred to tertiary care centers for ocular problems that do not in fact require urgent care by a specialist. This study shows quantitatively that a tele-ophthalmology system utilizing readily available and user-friendly technology can be utilized by off-site ophthalmologists (the reviewers) to make accurate and safe triage decisions.
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