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Lucy Xu, Felipe Conti, Robert Purgert, Rishi P Singh; Feasibility of Bedside Photography in Consult Patients. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4618.
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© ARVO (1962-2015); The Authors (2016-present)
Inpatient consultation by the bedside presents a challenge for ophthalmic image capture. The Paxos Scope (DigiSight, San Francisco, CA) is the first portable device that allows HIPAA compliant acquisition and integration of anterior and posterior ophthalmic images into the patient’s electronic medical record (EMR). We aimed to determine the feasibility of this device in a consult setting at a tertiary care hospital.
A retrospective IRB-approved study was performed. Included patients were ≥ 18 years old. Exclusion criteria were media opacity for posterior imaging, and gaze instability.An order for imaging is placed in the patient’s EMR encounter. The order sends the demographics of the patient to the Paxos app on the clinician’s smartphone. The clinician captures images using the Paxos app and portable attachments. The images are automatically uploaded to the Paxos cloud and transmitted to the patient’s EMR record in near real time using a secure connection.Patient demographics, reason for consult, and base exam were collected. The photos were graded by an ophthalmologist masked to the patient’s diagnosis and in-person clinical exam. The quality of the photos was measured using a five-point scale as described in the FOTO-ED study: 1=photo is inadequate for any diagnostic purpose, 2=unable to exclude all emergent findings, 3=only able to exclude emergent findings, 4=not ideal but still able to exclude subtle findings and 5=ideal quality. Frequency of high-quality images (grade 4 or 5) and those of no diagnostic value (grade 1) were determined. The masked grader also determined the clinical diagnosis based on the images. The frequency of agreement between diagnosis from the photos and in-person exams was calculated.
Eleven patients had images taken. Two patients were excluded due to age. Nine patients (14 eyes) were included for this study with an average age of 61 ± 18.7 years and 5 males. Nine out of 17 (53%) photos were high quality while 0 of the photos had no diagnostic value. The diagnosis by the masked grader from the photos agreed with the in-person exam in all 9 patients.
This study demonstrates that the Paxos-Scope is feasible for bedside consult ophthalmic imaging capture as half the photos were of high quality and the diagnosis from the photos agree with the in-person exam in all cases. Future use of this device can aid in triaging of emergency room consults and documentation for follow ups.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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