JMIR Publications

ABSTRACT

Background:

Glaucoma, a disease leading to the degeneration of retinal ganglion cells, results in changes to the optic nerve head that are often diagnosed late when visual problems arise [1]. With the prevalence of glaucoma surpassing 76 million adults worldwide and with glaucoma being the leading cause of irreversible blindness in the world, the early detection and management of glaucoma is imperative [2,3]. Digital ophthalmoscopes, such as the D-EYE, have emerged as a technology that utilizes smartphone cameras with an attachment on the lens to visualize the retina and optic nerve head without the need for dilation. The purpose of this pilot study is to examine acceptability and feasibility of a D-EYE digital ophthalmoscope to screen for glaucoma.

Objective:

To demonstrate the effect of a smartphone-based ophthalmoscope as a potential vision screening tool for optic nerve head pathology in participants enrolled in this study. Specific Aim 1: Determine the ability of the D-EYE smartphone ophthalmoscope in gathering high quality imaging to be utilized for grading the fundus into low and high risk categories for eye pathology. Specific Aim 2: Determine the difference in quality of data capture between still retinal images and 30-second retinal video recordings produced by D-EYE smartphone ophthalmoscopes.

Methods:

This observational pilot study enrolled 110 patients receiving routine eye care at the University of Florida Health (Gainesville, FL, USA) from February 2019 to February 2022 to assess the utility of the D-EYE device in capturing still images and 30-second videos of the bilateral retina and optic nerves of each participant. Study participants completed a survey to gather demographics and past medical history data with a particular focus on prior eye health history. Images were reviewed by 5 ophthalmology residents with inter-rater reliability analysis performed to assess findings.

Results:

Ophthalmology resident review indicated greater visualizability and clarity of the bilateral retina and optic nerves with 30-second videos of retinal imaging compared to still image ophthalmic capture. Furthermore, an increase in visualizability and clarity allowed for a more accurate measurement of the cup-to-disc ratio, a diagnostic marker for glaucoma. Additionally, likelihood of referral of the glaucomatous and healthy sample groups to ophthalmologists indicated a greater sensitivity of digital ophthalmoscopes in being able to detect retinal abnormalities requiring early intervention and management, supporting the technology’s use as a screening tool.

Conclusions:

Our investigation suggests that the utilization of smartphone-based digital ophthalmoscopes can be more effectively applied as a screening tool by capturing 30-second videos compared to still images alone. This novel assessment of an emerging technology in the field of ophthalmology may better equip further research as phone camera technology advances.