eFOCUS Phase 2: Comparative Clinical Performance of Smartphone & Traditional Funduscopy

Funduscopy is performed infrequently and poorly outside of ophthalmology and neurology (1, 2). Decline in use has been ascribed to technical examination challenges and interpretation difficulty (3). We hypothesise that capturing fundus images using smartphones would minimise these challenges, thereby increasing clinical usability.

Monday, March 5th from 6:00 pm - 6:15 pm eFOCUS Phase 2: Comparative Clinical Performance of Smartphone & Traditional Funduscopy Hamish Dunn1, Samuel Marks2, Kai Teo2, Christine Kang3, Stewart Dunn4, Paul Healey2, Andrew White5 1 University of Sydney, Westmead Hospital, Sydney, Australia, 2University of Sydney, Sydney, Australia, 3Westmead Hospital, Sydney, Australia, 4University of Sydney, Pam McClean Centre, Sydney, Australia, 5University of Sydney, Westmead Institute of Medical Research, Sydney, Australia Introduction: Funduscopy is performed infrequently and poorly outside of ophthalmology and neurology (1, 2). Decline in use has been ascribed to technical examination challenges and interpretation difficulty (3). We hypothesise that capturing fundus images using smartphones would minimise these challenges, thereby increasing clinical usability. Methods: 103 second and final-year medical students participated in this randomised cross-over trial. An eLearning course in optic disc interpretation was provided. Participants were randomly allocated to one of two smartphone funduscopy adaptors (SF): the PanOptic-iExaminer (Welsch Allyn), and D-eye. A 20-minute practical training session on SF and direct ophthalmoscopy (DO) was conducted. Participants then examined 4 patients and 8 simulators with pathological and normal optic discs, with a crossover between SF and DO. Optic discs were graded independently by three masked ophthalmologists. A final survey assessed preferred technique, confidence, and ease of funduscopy. Results: Students' interpretation of abnormal or normal discs showed fair agreement between ophthalmologists and students using SP (Kappa = 0.250, p = 0.005), but insignificant agreement when students used DO (Kappa = 0.084, p = 0.353). The post-workshop questionnaire found 74% of students preferred SF over DO for clinical use (p < 0.001). Confidence in ability to view the fundus on a 1-5 Likert scale was significantly greater for SF (3.42, SD 1.02) than DO (2.60, SD 1.09) p<0.001. Ease of viewing the fundus was likewise significantly greater using SF (3.40, SD 0.91) than DO (2.43, SD 1.08) p<0.001. Conclusions: Smartphone funduscopy by medical students has somewhat better clinical sensitivity than direct ophthalmoscopy for determining disc pathology after a 20-minute tutorial and eLearning. Significantly, student-reported ease and confidence in funduscopy was greater for SF over DO, with a strong preference for smartphone use in clinical practice. This suggests that smartphone funduscopy may help overcome the technical barriers to the examination. References: 1. Roberts E, Morgan R, King D, Clerkin L. Funduscopy: a forgotten art? Postgrad Med J. 1999;75(883):282-4. 2. Bruce BB, Lamirel C, Biousse V, Ward A, Heilpern KL, Newman NJ, et al. Feasibility of nonmydriatic ocular fundus photography in the emergency department: Phase I of the FOTO-ED study. Acad Emerg Med. 2011;18(9):928-33. 3. Mackay DD GP, Bruce BB, Newman NJ, Biousse V. The demise of direct ophthalmoscopy: A modern clinical challenge. Neurol Clin Pract. 2015;5(2):150-7. Keywords: Neuroimaging, Optic neuropathy, Diagnostic Tests (ERG, VER, OCT, HRT, mfERG, etc) Eyelid & adnexal disease, Pupils Retina, High intracranial pressure/headache Financial Disclosures: The authors had no disclosures. Grant Support: None. 2018 Annual Meeting | 262