June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
A Hands-Free, Augmented-Reality, Smartphone Camera System to Document the Prevalence of Active Trachoma.
Author Affiliations & Notes
  • Fahd Naufal
    Wilmer Eye Institute, Johns Hopkins Institute, Baltimore, Maryland, United States
  • Sheila K West
    Wilmer Eye Institute, Johns Hopkins Institute, Baltimore, Maryland, United States
  • Harran Mkocha
    Kongwa Trachoma Project, Kongwa, Tanzania, United Republic of
  • Chris Bradley
    Wilmer Eye Institute, Johns Hopkins Institute, Baltimore, Maryland, United States
  • George Kabona
    Iringa Regional Referral Hospital, Iringa, Tanzania, United Republic of
  • Jeremiah Ngondi
    RTI International, North Carolina, United States
  • Robert W Massof
    Wilmer Eye Institute, Johns Hopkins Institute, Baltimore, Maryland, United States
  • Christopher J Brady
    University of Vermont, Vermont, United States
  • Footnotes
    Commercial Relationships   Fahd Naufal, None; Sheila West, None; Harran Mkocha, None; Chris Bradley, None; George Kabona, None; Jeremiah Ngondi, None; Robert Massof, None; Christopher Brady, None
  • Footnotes
    Support  Hilton Foundation and Seeing is Believing
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2623. doi:
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      Fahd Naufal, Sheila K West, Harran Mkocha, Chris Bradley, George Kabona, Jeremiah Ngondi, Robert W Massof, Christopher J Brady; A Hands-Free, Augmented-Reality, Smartphone Camera System to Document the Prevalence of Active Trachoma.. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2623.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : As the prevalence of trachoma declines in districts worldwide, standardizing graders for surveys to document elimination becomes increasingly expensive. The use of photographs to train graders may play a role. The purpose of this observational study is to develop an Image Capture and Processing System (ICAPS) that will permit hands free image acquisition of the tarsal conjunctiva. This device will allow a single person to evert the eyelid and then take, store and upload photographs to a virtual Reading Center for grading. This can potentially eliminate the need for expensive grader standardization currently used in trachoma prevalence studies.

Methods : This study was conducted as part of the Chamwino, Tanzania district survey. The ICAPS was integrated with the WHO Tropical Data system to examine 1305 children ages 1-9 years for trachomatous inflammation – follicular (TF). Three trachoma graders were trained for the survey over one day with technical training and field training components. The ICAPS comprised of Samsung’s Gear VR headset and Galaxy S8 smart phone.

Results : The ICAPS system has proved successful in being able to scan and assign bar codes to images, achieve focus on the everted eyelid, and capture images with sufficient magnification. It permits the use of augmented reality features to save and delete images and maintain a reasonable battery life. Grading of the ICAPS images compared to the field grades at the child level yielded a kappa agreement score of 0.53 but a similar proportion of children with TF (Field: 5.2%, ICAPS: 5%). The lower agreement was due to difficulties in grading follicles in the images taken in the field. This may be resolved with a newer system that can quickly take higher quality images. For 199 children, there were ungradable images for at least one eye (15%) and more ungradable images occurred in younger children ages 1-3 (18.5%) than older children ages 4-9 (4.3%). The percent of ungradable images remained consistent over the course of the study.

Conclusions : More training and ability to certify trainers is needed to reduce the percentage of ungradable images. Better understanding of the causes of disagreement in graded images and field grades is necessary before ICAPS can replace field graders. Newer phone-cameras can potentially improve image quality for more accurate follicle assessment.

This is a 2021 ARVO Annual Meeting abstract.

 

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