title: Validation of tablet-based evaluation of color fundus images.
abstract: OBJECTIVE
  To compare diabetic retinopathy (DR) referral recommendations made by viewing fundus images using a tablet computer with those made using a standard desktop display.
  
  
  METHODS
  A tablet computer (iPad) and a desktop computer with a high-definition color display were compared. For each platform, 2 retinal specialists independently rated 1,200 color fundus images from patients at risk for DR using an annotation program Truthseeker. The specialists determined whether each image had referable DR and also how urgently each patient should be referred for medical examination. Graders viewed and rated the randomly presented images independently and were masked to their ratings on the alternative platform. Tablet-based and desktop display-based referral ratings were compared using cross-platform intraobserver kappa as the primary outcome measure. Additionally, interobserver kappa, sensitivity, specificity, and area under the receiver operating characteristic were determined.
  
  
  RESULTS
  A high level of cross-platform intraobserver agreement was found for the DR referral ratings between the platforms (κ = 0.778) and for the 2 graders (κ = 0.812). Interobserver agreement was similar for the 2 platforms (κ = 0.544 and κ = 0.625 for tablet and desktop, respectively). The tablet-based ratings achieved a sensitivity of 0.848, a specificity of 0.987, and an area under the receiver operating characteristic of 0.950 compared with desktop display-based ratings.
  
  
  CONCLUSIONS
  In this pilot study, tablet-based rating of color fundus images for subjects at risk for DR was consistent with desktop display-based rating. These results indicate that tablet computers can be reliably used for clinical evaluation of fundus images for DR.
authors.affiliation: Department of Biomedical Engineering, College of Public Health, University of Iowa, Iowa City, Iowa 52242, USA. mark-christopher@uiowa.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Christopher
authors.forename: Daniela C
authors.initials: DC
authors.lastname: Moga
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Russell
authors.forename: James C
authors.initials: JC
authors.lastname: Folk
authors.forename: Todd
authors.initials: T
authors.lastname: Scheetz
authors.forename: Michael D
authors.initials: MD
authors.lastname: Abràmoff
mesh_terms: D019540:Area Under Curve; D034201:Computers, Handheld / Q000592:standards*; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000295:instrumentation / Q000592:standards*; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation / Q000592:standards*; D005654:Fundus Oculi; D006801:Humans; D015588:Observer Variation; D010865:Pilot Projects; D012372:ROC Curve; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012160:Retina / Q000473:pathology*; D012680:Sensitivity and Specificity