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

• DOI: 10.1167/tvst.8.3.29
• Publication Date: 2019-05-30T19:31:09Z
• Authors: Tapan P. Patel; Tyson N. Kim; Gina Yu; Vaidehi S. Dedania; Philip Lieu; Cynthia X. Qian; Cagri G. Besirli; Hakan Demirci; Todd Margolis; Daniel A. Fletcher; Yannis M. Paulus
• Keywords: Biomedical Engineering; 610; Bioengineering; Eye; smartphone; 618; 03 medical and health sciences; Rare Diseases; 0302 clinical medicine; Clinical Research; Opthalmology and Optometry; fundus photography; Eye Disease and Disorders of Vision; pediatric retina; wide-field; Ophthalmology and Optometry; Pediatric; screening and diagnosis; Biomedical and Clinical Sciences; Neurosciences; Ophthalmology and optometry; Articles; Health Services; 4.1 Discovery and preclinical testing of markers and technologies; 3. Good health; Detection; portable imaging; 4.2 Evaluation of markers and technologies

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.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.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.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.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.