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Warachaya Phanphruk, Yingna Liu, Katharine Morley, Jacqueline Gavin, Ankoor S. Shah, David G Hunter; Validation of StrabisPIX, a mobile application for home measurement of ocular alignment. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2932.
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© ARVO (1962-2015); The Authors (2016-present)
StrabisPIX is a smartphone application developed for home strabismus screening. It allows patients and their parents to obtain images of head position and eye alignment in 9 positions of gaze and to upload these onto a secure platform for clinician review. This study evaluates the clinical utility of this application by comparing the images obtained using StrabisPIX with those obtained by orthoptists in the clinic.
In this prospective, non-masked cross-sectional study, 30 strabismus patients who were 2 years or older were recruited from a pediatric ophthalmology clinic at Boston Children’s Hospital. After consent was obtained, subjects 1) received a 5-minute standardized presentation with instructions on how to use StrabisPIX, 2) used StrabisPIX to obtain images as prompted by the application, and 3) completed a satisfaction survey. As a part of the patients’ regular clinic visit, an orthoptist obtained a separate set of images using a digital single-lens reflex camera. Two ophthalmologists and one orthoptist then evaluated all 60 sets of images and completed a standardized survey that graded 1) image quality and 2) abnormalities seen on images such as strabismus, ptosis, and/or compensatory head posture.
Most patients reported that StrabisPIX was easy to learn and use. Image quality was similar between StrabisPIX images and clinic photos in terms of focus, field of view, ocular alignment, eyelid position, and pupil anomalies. However, clinic photos had a significantly (P<0.05) higher rate of acceptability for horizontal versions (67% StrabisPIX vs. 81% clinical images), vertical versions (60% vs. 76%), and head posture (81% vs. 93%). Abnormalities were detected at a similar rate for horizontal and vertical versions, head posture, eyelid position, and pupil size. However, StrabisPIX had significantly higher detection of alignment abnormalities (89% vs. 77%). All other assessments were similar in the two groups. Interrater/intrarater agreements were moderate to high (kappa=0.44-1.00) for all parameters except pupil abnormality, which had poor to fair agreement.
Overall, StrabisPIX images had similar quality and were as useful as images obtained in the clinic in detecting abnormalities. The StrabisPIX application can provide clinicians with images documenting strabismus that may support the use of telemedicine in the future.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
StrabisPIX-guided self-imaging of ocular motility
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