ABSTRACT

Purpose

To determine if smartphone photography could be a useful adjunct to blindness prevalence surveys by providing an accurate diagnosis of corneal opacity.

Methods

A total of 174 patients with infectious keratitis who had undergone corneal culturing over the past 5 years were enrolled in a diagnostic accuracy study at an eye hospital in South India. Both eyes had an ophthalmologist-performed slit lamp examination, followed by anterior segment photography with a handheld digital single lens reflex (SLR) camera and a smartphone camera coupled to an external attachment that provided magnification and illumination. The diagnostic accuracy of photography was assessed relative to slit lamp examination.

Results

In total, 90 of 174 enrolled participants had a corneal opacity in the cultured eye and no opacity in the contralateral eye, and did not have a penetrating keratoplasty or missing photographs. Relative to slit lamp examination, the sensitivity of corneal opacity diagnosis was 68% (95%CI 58–77%) using the smartphone’s default settings and 59% (95%CI 49–69%) using the SLR, and the specificity was 97% (95%CI 93–100%) for the smartphone and 97% (95%CI 92–100%) for the SLR. The sensitivity of smartphone-based corneal opacity diagnosis was higher for larger scars (81% for opacities 2 mm in diameter or larger), more visually significant scars (100% for eyes with visual acuity worse than 20/400), and more recent scars (85% for eyes cultured in the past 12 months).

Conclusion

The diagnostic performance of a smartphone coupled to an external attachment, while somewhat variable, demonstrated high specificity and high sensitivity for all but the smallest opacities.

中文翻译：

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基于智能手机的眼前节成像：失明患病率调查潜在工具的比较诊断准确性研究

摘要

目的

通过提供角膜混浊的准确诊断，确定智能手机摄影是否可以成为失明患病率调查的有用辅助手段。

方法

印度南部一家眼科医院共有 174 名在过去 5 年内接受过角膜培养的感染性角膜炎患者参加了诊断准确性研究。双眼均接受了眼科医生进行的裂隙灯检查，然后使用手持式数码单镜反光 (SLR) 相机和连接到提供放大和照明的外部附件的智能手机相机进行眼前段摄影。相对于裂隙灯检查评估摄影的诊断准确性。

结果

总共 174 名登记参与者中有 90 人的培养眼出现角膜混浊，而对侧眼没有混浊，并且没有进行穿透性角膜移植术或丢失照片。相对于裂隙灯检查，使用智能手机默认设置时角膜混浊诊断的敏感性为 68% (95%CI 58–77%)，使用 SLR 时为 59% (95%CI 49–69%)，特异性为 97智能手机为 % (95%CI 93–100%)，单反相机为 97% (95%CI 92–100%)。基于智能手机的角膜混浊诊断对于较大疤痕（直径 2 毫米或更大的混浊情况为 81%）、视觉上更显着的疤痕（视力低于 20/400 的眼睛为 100%）以及最近的疤痕的敏感性较高（85% 的眼睛在过去 12 个月内进行过培养）。

结论

与外部附件相结合的智能手机的诊断性能虽然有些变化，但对除了最小的不透明度之外的所有情况都表现出高特异性和高灵敏度。