ABSTRACT

To assess the utility of a universal smartphone attachment to capture images of the anterior segment of the eye, we conducted a retrospective analysis of 344 images captured using a smartphone by the patients to identify factors affecting image quality, such as lack of perspective, lack of focus, improper illumination, and resolution. Based on this analysis, a universal smartphone attachment named Grabi^TMLite and a protocol for anterior segment imaging were designed and validated in the first prospective arm of 60 patients. These images were then compared with the same eyes imaged on the gold standard slit-lamp photography. In the second prospective arm, nine patients were trained to use the Grabi^TM Lite with the imaging protocol, and the images were assessed for utility in arriving at a diagnosis. A total of 178 images were analyzed using a questionnaire by masked observers. The images were evaluated based on their quality and suitability in clinical decision-making, risk stratification for triage for referral to a tertiary eye care centre. The quality of 344 images captured by patients using only their smartphone was rated as good 24 (7%), average 209 (60.8%), and poor in 111 (32.2%). Of these, 55 (16%) images were deemed suitable for clinical decision-making, and 224 (65.6%) images were adequate for risk stratification. Lack of perspective, focus, illumination, and resolution were seen in 167 (51.2%), 284 (87.1%), 226 (69.3%), and 126 (38.7%) images, respectively. These metrics improved in the next iteration of 178 images captured by patients using Grabi Lite + imaging protocol to good 103 (57%), average 58 (32.6%), and bad 17 (19.6%) (p < .001 using chi-square test). Images deemed suitable for clinical decision-making, and risk stratification for triage also improved to 80 (45%), 158 (88.8%) (p < .001 using chi-square test), respectively. Adherence to protocol was seen in 98 (55.5%) images, of which all were suitable for risk stratification, while of these images, 66 (67.3%) were eligible for clinical decision making. In comparison with slit-lamp photography, out of 120 responses by masked observers to images captured by Grabi^TM Lite with the imaging protocol, 63 (52.85%) were suitable for clinical decision-making, and 68 (57%) were graded to be between 70 and 99% of the quality of the slit lamp photographs. The Grabi^TM lite with imaging protocol training is an effective tool to improve anterior segment imaging, potentially allowing smartphone use for teleconsultations. This device may serve as a universal solution for all smartphones with the patient as the user and is of value in the future of tele-ophthalmology.

摘要

为了评估通用智能手机附件捕捉眼前节图像的效用，我们对患者使用智能手机拍摄的 344 幅图像进行了回顾性分析，以确定影响图像质量的因素，例如缺乏透视、缺乏焦点、不适当的照明和分辨率。基于此分析，设计了名为 Grabi ^TM Lite 的通用智能手机附件和用于眼前节成像的协议，并在 60 名患者的第一个前瞻性手臂中进行了验证。然后将这些图像与在黄金标准裂隙灯摄影上成像的相同眼睛进行比较。在第二个预期组中，9 名患者接受了使用 Grabi ^TM的培训Lite 使用成像协议，并评估图像在诊断时的效用。蒙面观察者使用问卷调查共分析了 178 张图像。根据图像的质量和在临床决策中的适用性、用于转诊至三级眼科护理中心的风险分层对图像进行评估。仅使用智能手机拍摄的 344 张图像的质量被评为好 24 (7%)，平均 209 (60.8%)，差 111 (32.2%)。其中，55 幅 (16%) 图像被认为适合临床决策，224 幅 (65.6%) 图像足以进行风险分层。分别在 167 (51.2%)、284 (87.1%)、226 (69.3%) 和 126 (38.7%) 图像中看到缺乏透视、焦点、照明和分辨率。p < .001 使用卡方检验）。被认为适合临床决策的图像和分诊的风险分层也分别提高到 80 (45%) 和 158 (88.8%) (使用卡方检验p < .001)。在 98 幅 (55.5%) 图像中观察到对方案的依从性，其中所有图像都适合进行风险分层，而在这些图像中，66 幅 (67.3%) 符合临床决策的条件。与裂隙灯摄影相比，蒙面观察者对 Grabi ^TM Lite 使用成像协议拍摄的图像的 120 份回应中，63 份（52.85%）适合临床决策，68 份（57%）被评为裂隙灯照片质量的 70% 到 99% 之间。Grabi ^TM具有成像协议培训的 lite 是改善眼前节成像的有效工具，可能允许智能手机用于远程会诊。该设备可以作为以患者为用户的所有智能手机的通用解决方案，在远程眼科的未来具有价值。