Image quality and diagnostic accuracy of a handheld nonmydriatic fundus camera: Feasibility of a telemedical approach in screening retinal diseases

Abstract

Background: A suitable fundus camera for telemedicine screening can expand the scale of eye care service. The purpose of this study was to compare a handheld nonmydriatic digital fundus camera and a conventional mydriatic fundus camera according to the image quality of their photographs and usability of those photographs to accurately diagnose various retinal diseases. Methods: A handheld nonmydriatic fundus camera and conventional fundus camera were used to take fundus photographs of outpatients at an ophthalmic clinic before and after pupillary dilation. Image quality and diagnostic agreement of the photos were graded by two masked and experienced retinal specialists. Results: A total of 867 photographs of 393 eyes of 200 patients were collected. Approximately 80% of photos taken under nonmydriasis status using the handheld nonmydriatic fundus camera had good (55.7%) or excellent (22.7%) image quality. The overall agreement of diagnoses between the doctors was more than 90%. When the handheld nonmydriatic fundus camera was used after mydriasis, the proportion of images with good (45%) or excellent (49.7%) quality reached 94.7% and diagnostic agreement was 93.4%. Lens opacity was associated with the quality of images obtained using the handheld camera ( p = 0.041), and diagnosis disagreement for handheld camera images was associated with preexisting diabetes diagnosis ( p = 0.009). Approximately 40% of patients expressed preference for use of the handheld nonmydriatic camera. Conclusion: This study demonstrated the effectiveness of the handheld nonmydriatic fundus camera in clinical practice and its feasibility for telemedicine screening of retinal diseases.

Implementation and Evaluation of a Mobile Retinal Image Acquisition System for Screening Diabetic Retinopathy: Study Protocol

“…However, the study was conducted in 2014, and since then, smartphone technology developed significantly; therefore, we expect our results for image quality to be higher. A recent study [63] described that the fundus images acquired with a handheld fundus camera (Horus Eye-Fundus Camera; Medimaging Integrated Solution Inc., Hsinchu, Taiwan) without pupillary dilation had good (55.7%) or excellent (22.7%) image quality. The average age of the participants was 62 years old, and they had diverse retinal pathology.…”

The safety and feasibility of the screening for retinopathy of prematurity assisted by telemedicine network during COVID-19 pandemic in Wuhan, China

“…At the early stage of COVID-19 pandemic in China, especially the period of lockdown time on Wuhan, the National Healthcare Committee encouraged medical institutions to take advantage of telemedicine and standardize online medical consultation services in order to reduce cross-infection and avoid patients gathering. As we known, through telemedicine, fundus imaging could be conducted by non-ophthalmologists and then transmitted to ROP experts for screening [2,[4][5][6][7][8]. Furthermore, telemedicine system also allowed us to offer medical services when [4,6,9].…”

“…Many previous reports had demonstrated the importance and advantages of telemedicine in ophthalmology since COVID-19 outbreak [10,11]. However, most of the reports evaluated outcomes of telemedicine for adults [8,10,12], instead of children. Furthermore, little is known about the safety and feasibility of ROP screening assisted by telemedicine network for pediatric patients during COVID-19 pandemic.…”

Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care

“…Available technology only accommodated 30 to 45° images of the retina, and dilation was required to clearly assess the peripheral retina. The evolution of portable non-mydriatic cameras has improved resolution, costs, and increased accessibility, making them a reasonable option for asynchronous programs [ 26 ]. Additionally, fundus ultrawide field imaging has become more reliable [ 27 ].…”