Smartphone-Based, Rapid, Wide-Field Fundus Photography for Diagnosis of Pediatric Retinal Diseases

Abstract

Purpose An important, unmet clinical need is for cost-effective, reliable, easy-to-use, and portable retinal photography to evaluate preventable causes of vision loss in children. This study presents the feasibility of a novel smartphone-based retinal imaging device tailored to imaging the pediatric fundus. Methods Several modifications for children were made to our previous device, including a child-friendly 3D printed housing of animals, attention-grabbing targets, enhanced image stitching, and video-recording capabilities. Retinal photographs were obtained in children undergoing routine dilated eye examination. Experienced masked retina-specialist graders determined photograph quality and made diagnoses based on the images, which were compared to the treating clinician's diagnosis. Results Dilated fundus photographs were acquired in 43 patients with a mean age of 6.7 years. The diagnoses included retinoblastoma, Coats' disease, commotio retinae, and optic nerve hypoplasia, among others. Mean time to acquire five standard photographs totaling 90-degree field of vision was 2.3 ± 1.1 minutes. Patients rated their experience of image acquisition favorably, with a Likert score of 4.6 ± 0.8 out of 5. There was 96% agreement between image-based diagnosis and the treating clinician's diagnosis. Conclusions We report a handheld smartphone-based device with modifications tailored for wide-field fundus photography in pediatric patients that can rapidly acquire fundus photos while being well-tolerated. Translational Relevance Advances in handheld smartphone-based fundus photography devices decrease the technical barrier for image acquisition in children and may potentially increase access to ophthalmic care in communities with limited resources.

Smartphone-based imaging systems for medical applications: a critical review

“…As diagnostics are typically used for triage to treatment interventions, such applications more likely to be performed by medical personnel and in clinical settings rather than by individuals at home. Some of the primary in vivo diagnostic modalities proposed for SBI systems include white light imaging, 52 , 65 , 66 , 91 , 100 – 102 , 126 – 133 autofluorescence imaging, 17 , 65 , 66 , 71 , 100 multispectral/hyperspectral imaging, 52 , 64 , 88 endoscopy, 10 – 13 in vivo spectroscopy, 14 , 51 , 85 and in vivo microscopy. 14 – 16 , 62 , 134 For these modalities, the most frequent imaging sites are external tissues (dermis, facial, and retinal), externally accessible tissues (oral cavity, cervix, and ear), as well as some deeper tissues in the case of endoscopy (bladder, larynx, and esophagus).…”

Smartphone fundus photography: a narrative review

“…They concluded that this method has a very high sensitivity for early detection of diabetic retinopathy and sight threatening diabetic eye disease. Tapan et al utilized this idea for taking fundus photographs using smartphone in pediatric age group [ 6 ].…”

Imaging the pediatric retina

“…The emitted light of smartphones is safe as retinal irradiance from smartphones is less than that from an indirect ophthalmoscope. [ 24 25 ] The field of view varies with the dioptre strength of the handheld lens (46°, 53°, and 90° with +20D, +28D, and +40D indirect condensing lenses respectively). [ 26 ] The acquired image is inverted, like an indirect ophthalmoscope view.…”