title: A novel smartphone ophthalmic imaging adapter: User feasibility studies in Hyderabad, India.
abstract: OBJECTIVE
  To evaluate the ability of ancillary health staff to use a novel smartphone imaging adapter system (EyeGo, now known as Paxos Scope) to capture images of sufficient quality to exclude emergent eye findings. Secondary aims were to assess user and patient experiences during image acquisition, interuser reproducibility, and subjective image quality.
  
  
  METHODS
  The system captures images using a macro lens and an indirect ophthalmoscopy lens coupled with an iPhone 5S. We conducted a prospective cohort study of 229 consecutive patients presenting to L. V. Prasad Eye Institute, Hyderabad, India. Primary outcome measure was mean photographic quality (FOTO-ED study 1-5 scale, 5 best). 210 patients and eight users completed surveys assessing comfort and ease of use. For 46 patients, two users imaged the same patient's eyes sequentially. For 182 patients, photos taken with the EyeGo system were compared to images taken by existing clinic cameras: a BX 900 slit-lamp with a Canon EOS 40D Digital Camera and an FF 450 plus Fundus Camera with VISUPAC™ Digital Imaging System. Images were graded post hoc by a reviewer blinded to diagnosis.
  
  
  RESULTS
  Nine users acquired 719 useable images and 253 videos of 229 patients. Mean image quality was ≥ 4.0/5.0 (able to exclude subtle findings) for all users. 8/8 users and 189/210 patients surveyed were comfortable with the EyeGo device on a 5-point Likert scale. For 21 patients imaged with the anterior adapter by two users, a weighted κ of 0.597 (95% confidence interval: 0.389-0.806) indicated moderate reproducibility. High level of agreement between EyeGo and existing clinic cameras (92.6% anterior, 84.4% posterior) was found.
  
  
  CONCLUSIONS
  The novel, ophthalmic imaging system is easily learned by ancillary eye care providers, well tolerated by patients, and captures high-quality images of eye findings.
authors.forename: Cassie A
authors.initials: CA
authors.lastname: Ludwig
authors.forename: Somasheila I
authors.initials: SI
authors.lastname: Murthy
authors.forename: Rajeev R
authors.initials: RR
authors.lastname: Pappuru
authors.forename: Alexandre
authors.initials: A
authors.lastname: Jais
authors.forename: David J
authors.initials: DJ
authors.lastname: Myung
authors.affiliation: Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Chang
mesh_terms: D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation*; D004867:Equipment Design; D005128:Eye Diseases / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000295:instrumentation*; D011446:Prospective Studies; D015203:Reproducibility of Results; D000068997:Smartphone