title: Comparing smartphone camera adapters in imaging post-operative cataract patients.
abstract: Introduction The goal of this study is to compare image quality and clinical confidence for managing post-operative cataract patients based on anterior segment smartphone images obtained in real-world settings using four types of adapters: (a) macro lens (ML), (b) ML with augmented light-emitting diode (LED) illumination (ML-LED), (c) no adapter (NA) and (d) slit lamp (SL) adapter. Methods Anterior segment images were obtained from 190 eyes after cataract surgery using an eight-megapixel iPhone 6 smartphone camera with four adapters: ML, ML-LED, NA, and SL. Smartphone images were subjectively rated by ophthalmologists as acceptable or not acceptable for: (a) image quality for evaluating the anterior segment structures and (b) reader confidence in clinically managing post-operative patients based on smartphone images. Results NA, ML-LED, and SL had the highest scores for image quality with 100%, 93.7%, and 86.3% judged as acceptable, respectively. NA, SL, and ML-LED were also rated highest in clinical confidence with 100%, 98%, and 93.2% having acceptable levels, respectively. ML was judged lowest in both image quality (61.1% acceptable) and clinical confidence (37.4% acceptable). Discussion This study represents the first effort to compare different smartphone camera adapters' ability to image the anterior segment of the eye in a real-world setting. Our study shows that ML-LED, NA, and SL adapters were acceptable for visualizing anterior segment structures to physician readers in 86-100% of cases. When coupled with visual acuity, intro-ocular pressure and history, these images can result in acceptable clinical confidence in 93-100% of cases.
authors: 1 Faculty of Medicine, Khon Kaen University, Thailand.
authors: Thuss
authors: T
authors: Sanguansak
authors: 2 Department of Medicine, Massachusetts General Hospital, USA.
authors: Katharine
authors: K
authors: Morley
authors: 3 Ophthalmic Consultants of Boston, Harvard Medical School, USA.
authors: Michael
authors: M
authors: Morley
authors: 4 Department of Ophthalmology, Nong Bua Lamphu Provincial Hospital, Thailand.
authors: Suwat
authors: S
authors: Kusakul
authors: 5 USC Eye Institute, University of Southern California, USA.
authors: Ramon
authors: R
authors: Lee
authors: 6 Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, USA.
authors: Eric
authors: E
authors: Shieh
authors: 1 Faculty of Medicine, Khon Kaen University, Thailand.
authors: Yosanan
authors: Y
authors: Yospaiboon
authors: 1 Faculty of Medicine, Khon Kaen University, Thailand.
authors: Chavakij
authors: C
authors: Bhoomibunchoo
authors: 7 Department of Ophthalmology, Udon Thani Provincial Hospital, Thailand.
authors: Siriwatana
authors: S
authors: Chai-Ear
authors: 8 Ophthalmic Consultants of Boston, Tufts University, USA.
authors: Anthony
authors: A
authors: Joseph
authors: 9 Harvard Medical School, USA.
authors: Isha
authors: I
authors: Agarwal
mesh_terms: D000368:Aged; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging; D002386:Cataract / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation* / Q000592:standards; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D011184:Postoperative Period; D020377:Self Efficacy; D000068997:Smartphone
keywords: Smart phone camera; cataract surgery; smart phone adapters; telemedicine