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Melissa Sieber, Abtin Shahlaee, Murtaza K Adam, Michael Cohen, Jay L Federman; Quality and Utility of a Portable Anterior Segment and Non-mydriatic Fundus Camera Linked to a Smartphone-Based Virtual Consultation Platform. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4840.
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© ARVO (1962-2015); The Authors (2016-present)
Development and validation of high-resolution portable imaging devices with image transmission through secure networks is key to furthering the impact of teleophthalmology on patient care. This study evaluates the quality and utility of a handheld anterior segment and non-mydriatic fundus camera linked via a secure smartphone-based virtual consultation platform.
Prospective, cross-sectional study of patients subjected to bilateral anterior segment (AS) and non-mydriatic fundus photography (FP) with the Volk Pictor (Volk Optical Inc, Mentor, OH) in the Wills Eye Emergency Room (WEER). Images and ophthalmic nursing triage for each patient were transmitted to 3 masked graders via a Health Insurance Portability and Accountability Act (HIPPA) compliant smartphone-based virtual consultation platform (HippaBridge, Burlington MA). Image quality was recorded on a 5-point scale (with a grade of 1 having no diagnostic utility and a grade of 5 representing an ideal image). Pre-specified AS and fundus exam findings identified on virtual consultation were compared to standard slit lamp and binocular indirect ophthalmoscopic examination documented in the WEER. Statistical analysis was performed by constructing contingency tables and using the Pearson Chi-squared test.
Thirty-eight consecutive patients (76 eyes) with mean age 46.3 years were enrolled. AS image quality was equal to FP image quality (2.8 vs 2.8, p=0.87). Overall sensitivity rates of virtual consult images and WEER examinations to identify critical exam findings were statistically similar for anterior segment and posterior segment photos (89% versus 96%; P=0.13). Detection of all critical anterior segment findings demonstrated greater than 80% agreement with WEER documentation, aside from superficial punctate keratitis (68%) and cataract (59%). Detection rates of critical posterior segment findings ranged from 90% (optic nerve cupping) to 100% agreement (retinal vaso-occlusion and optic nerve edema). Twenty-two percent of eyes (17 of 76) imaged demonstrated a 100% detection rate of both critical AS and FP findings found on standard WEER examination.
Utilizing a high-resolution anterior segment and non-mydriatic fundus camera linked to a HIPAA-compliant smartphone-based virtual consultation platform, high sensitivity for detecting critical examination findings was achieved.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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